Community drug expenditure and recent cost containment measures.

The annual cost of medicines under the community drugs schemes increased from Euro 564 m in 2000 to Euro 1,961 m in 2009 before falling an estimated 8% by 2011. Escalating public health costs, fiscal stress and the unsustainability of the previous growth in expenditure has led to the increased use of pharmaceutical cost containment measures in Ireland. Collectively, these measures are estimated to have reduced public expenditure on community drugs by Euro 380 m in 2011 and involve addressing; (1) the ex-factory price of drugs including price cuts of up to 40% on off-patent and generic drugs leading to an estimated Euro 200 m saving (53%); (2) pharmacy dispensing fees and mark-ups via a new dispensing fee structure and reducing both retail and wholesale mark-ups with a Euro 100 m saving (26%); and (3) scheme coverage and patient co-payments including restricting scheme coverage for persons over 70 years and increasing the level of co-payments with savings of Euro 80 m (21%).