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Scrips for Viagra to be free in Ireland

BMJ 1999; 318 doi: (Published 12 June 1999) Cite this as: BMJ 1999;318:1578
  1. Doug Payne
  1. Dublin

    Ireland is about to become one of the few European countries where sildenafil citrate (Viagra) is free under its health service. The minister for health, Brian Cowen, followed advice from an expert panel set up to monitor the prescribing trends and safety of the drug and announced on 20 May that the drug will be available free under the general medical scheme for all patients with medical cards from 1 July.

    Other patients will be able to claim back its cost under certain circumstances. The minister, however, imposed a limit of four tablets per month per patient, to “reduce the possibility of inappropriate usage.”

    The expert group examined five options, ranging from not making the drug available at all under the general medical scheme to making it available for specified conditions only. The doctors on the panel believed, however, that this last option would be arbitrary and would not adhere to the concept of equality.

    The panel also considered whether Viagra should be available only after patient assessment by a hospital consultant, but the group believed that all medical practitioners should be able to prescribe where appropriate.

    The final option was to prescribe the drug in the same way as any other drug, but this was rejected because it ignored the impact on the financing of the medical services.

    As a result of the panel's recommendation there will be no restrictions on certain patients availing themselves of the drug, unlike in Britain, where the government has made the drug free only for those with certain specific conditions.

    Dr Cormac Macnamara of the Irish Medical Organisation said it was “a sensible, pragmatic, and humane decision that takes into account the real problem that exists.” He added that he hoped this year's budget would be adjusted to take the decision into account.

    The Department of Health estimates that it will cost IR2.3m (£1.9m; $3m) a year to supply the drug. The most commonly sold Viagra tablet currently costs about IR9.00 over the counter.

    In the United Kingdom it is only prescribed under very restrictive conditions, and in France and Germany there is no state reimbursement. The only other country in Europe-apart from Ireland as of now-where the drug is free for anyone under the country's health service, is Sweden.

    The Irish decision is not without irony. Demand for the drug in Ireland has actually been much lower than in most other countries, partly owing to the fear of possible heart problems, yet the active ingredient, sildenafil citrate, is made at a factory in Cork.

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