Reference Pricing: Explainer

Due to changes in the law, your pharmacist may offer you a generic or alternative version of your regular medicine. Groups of medicines that do the same job will be given a set price, called a reference price. This law is designed to save medicine costs for you and for the taxpayer. It's being introduced one medicine at a time. Here's how it works:

1. You go to your doctor and you need a prescription

Your doctor prescribes a medicine for you. Some groups of medicines are now on lists that show they are safe to be substituted for a generic or alternative version.

2. Your doctor sees that this medicine might be substituted for a generic or alternative version and assures you it is just as safe as your usual medicine.

  • You go to the pharmacy. The pharmacist will offer you a version of this medicine which is at or below the reference price.
  • You accept the medicine that's offered at or below the reference price. If you have a medical card, you pay the prescription charge for each item. If you have a drugs payment card, you pay up to the monthly threshold as normal.

OR

  • You would prefer to have the medicine on your prescription,even if it costs more than the reference price. You pay the difference between the reference price and the product price.
  • If you have a medical card, the HSE pays the reference price for your medicine, and you pay the difference between the reference price and the product price.You also pay the prescription charge.
  • If you have a drugs payment card, you also pay up to the monthly threshold.
  • Please note that the HSE will only count reference prices when calculating your monthly Drug Payment Scheme threshold. Using the same pharmacy makes it easier to track all your Drug Payment Scheme payments.

3. Your doctor decides for medical reasons that your medicine should not be substituted.

  • They write 'DO NOT SUBSTITUTE' beside the medicine on your prescription.
  • You go to the pharmacy. The pharmacist dispenses the medicine on your prescription. If you have a medical card, you pay the prescription charge. If you have a drugs payment card, you pay up to the monthly threshold as normal.


4. Are all medicines included?

This law is being introduced one medicine at a time. Your GP or pharmacist will tell you if your medicine is one of these, or you can check the list on www.imb.ie

5. Okay, what happens next?

The next time you take your prescription to the pharmacist, they may offer you a less expensive medicine than the one on your prescription. Groups of medicines that do the same job will have a set price, called the reference price.

6. So I have a choice?

Yes, you do. You can choose the medicine that is at, or even below, the set reference price. Or, you may want the medicine on your prescription. If you choose the more expensive version, and you have a medical card or drugs payment card, you will pay the difference between the reference price and the product price.

7. What if my doctor doesn't want my medicine to be substituted?

Then they will simply write DO NOT SUBSTITUTE on your prescription. Your pharmacist will dispense the medicine on your prescription at no extra cost.

8. Do other countries use reference pricing and generic substitution?

Yes. Most European Member States have systems of reference pricing and generic substitution. Similar systems are also in operation in Canada, Australia and the United States.

9. Who decides the reference price?

The HSE has responsibility for setting the reference price. It does this in accordance with certain criteria, in particular, securing value for money for the taxpayer. It will also have to have regard to the need to ensure that prices are not set so low as to render their sale uneconomic as this could impact on their availability on the Irish market.

10. When will the first reference price be implemented?

Under the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE may set a reference price for each group of interchangeable medicines. Once the Irish Medicines Board publishes a list of interchangeable medicines, the HSE begins the process of setting a reference price for that group in accordance with the provisions of the legislation.

11. What is the reimbursement list?

The HSE is in charge of establishing and maintaining a reimbursement list. This is a list of all the medicines or other items (e.g. dressings) that are provided by the HSE under the General Medical Services Scheme or Drug Payment Scheme. You can search the HSE's Reimbursement List and check basic prices on this website.

If you have any questions about your medicine, talk to your pharmacist or your doctor.