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CSO statistical release, , 11am

HSE Funded Pharmacy Claims

2013-2016

Pharmacy costs and claims
 2013201420152016
Pharmacy cost (‘000)€1,141,106€1,059,259€1,020,389€1,002,160
Number of pharmacy claims19,054,17118,571,49218,664,60818,990,442
Average cost per claim€60.75€57.78€55.26€53.29

Cost of pharmacy claims decrease 12% between 2013 and 2016, with the number of pharmacy claims staying static.

Figure 1 Index of Pharmacy Costs and Claims 2013-2016
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Expenditure on Health Service Executive (HSE) refunded pharmacy claims under the General Medical Scheme (GMS) amounted to just over €1 billion in 2016. This is a decrease of 12% on 2013 levels, despite the number of pharmacy claims staying relatively static over the same period (a marginal fall of only 0.3% to 18.99 million claims in 2016). The decrease in pharmacy cost was largely driven by a fall in the average cost per pharmacy claim of 12.3% - from €60.75 in 2013 to €53.29 per pharmacy claim in 2016.

These payments were paid by the Primary Care Reimbursement Service (PCRS). Please see background notes for a further description of the PCRS and GMS. Please note, care should be taken when examining trends over time in the form of expenditure and average amounts as eligibility criteria can change over time. 

Summary Points:

  • The average cost per pharmacy claim is higher for male patients than for female patients. In 2016, the overall average cost of a claim was €55.94 for male patients and €50.64 for female patients. However, the number of claims for which pharmacies are refunded is higher for female patients than for male patients. See Table 1 and 3.
  • The average cost of a pharmacy claim increases with age, and is highest in the 85 years and over age group.  The average cost of claims decreased between the years 2013-2016 for both genders and for all age groups. See Table 3.
  • The average number of pharmacy claims was higher for female patients (13.84) than for male patients (11.59) in 2016. See Table 4
  • The average number of items per pharmacy claim has stayed steady at just over 3 items per pharmacy claim (marginally decreasing from 3.1 items in 2013 to 3.06 items per claim in 2016).  The average number of items per claim increases with age and is highest in the 85 years and over age group at 4.08 number of items per claim, compared to 1.6 number of items for the youngest age group of 0-24 years. See Table 5.
  • The average cost per item has seen a decrease between 2013 and 2016. The average cost per item was €17.37 per item in 2016, compared to €19.53 in 2013. See Table 6.
Table 1 Total number of pharmacy claims, by gender, age group and Local Health Office region, 2013-2016
 2013201420152016
State    
Total19,054,17118,571,49218,664,60818,990,442
Gender of patient
Male7,696,3187,461,5237,493,9477,636,997
Female11,357,85311,109,96911,170,66111,353,445
Age Group
0 - 24 years2,273,8772,130,2212,058,0512,016,615
25 - 34 years1,539,2491,427,9091,337,6891,297,209
35 - 44 years1,857,9831,786,7751,773,2051,803,004
45 - 54 years2,068,8782,027,0352,070,0952,159,154
55 - 64 years2,555,5622,484,6512,521,5822,602,196
65 - 74 years3,636,2603,615,1953,696,9923,810,426
75 - 84 years3,567,2323,536,3633,585,4233,641,336
85 years and over1,555,1301,563,3431,621,5711,660,502
Local Health Office Region
Dublin Mid-Leinster4,747,7014,636,4324,646,9644,727,016
Dublin North East3,819,9433,740,9173,745,6893,812,861
West5,142,6385,012,7085,051,4635,140,707
South5,343,8895,181,4355,220,4925,309,858
Table 2 Pharmacy claims expenditure1, by gender, age group and Local Health Office region, 2013-2016 ('000)
 2013201420152016
State
Total1,141,1061,059,2591,020,3891,002,160
Gender of patient
Male502,294459,351436,191427,190
Female638,812599,908584,198574,970
Age Group
0 - 24 years68,80762,60958,60455,336
25 - 34 years59,06852,86747,05643,448
35 - 44 years87,17580,56575,42472,771
45 - 54 years121,863111,241105,722103,926
55 - 64 years172,142155,327147,900145,218
65 - 74 years254,053234,709226,793225,184
75 - 84 years262,573248,324242,107238,649
85 years and over115,422113,614116,780117,625
Local Health Office Region
Dublin Mid-Leinster288,770268,582257,814252,613
Dublin North East234,782218,584210,503206,391
West297,692276,465266,546262,795
South319,861295,627285,524280,359
1 Expenditure includes ingredient costs, fees and vat on pharmacy claims for GMS patients only and is exclusive of Stock costs, fees and vat.
Table 3 Average costs1 of pharmacy claims, by gender, age group and Local Health Office region, 2013-2016
 2013201420152016
State
 Average60.7557.7855.2553.29
Gender of patient
Male65.2661.5658.2155.94
Female56.2454.0052.3050.64
Age Group
0 - 24 years30.2629.3928.4827.44
25 - 34 years38.3837.0235.1833.49
35 - 44 years46.9245.0942.5440.36
45 - 54 years58.9054.8851.0748.13
55 - 64 years67.3662.5158.6555.81
65 - 74 years69.8764.9261.3559.10
75 - 84 years73.6170.2267.5365.54
85 years and over74.2272.6772.0270.84
Local Health Office Region
Dublin Mid-Leinster60.8257.9355.4853.44
Dublin North East61.4658.4356.2054.13
West57.8955.1552.7751.12
South59.8657.0654.6952.80
1Expenditure includes ingredient costs, fees and vat on pharmacy claims for GMS patients only and is exclusive of Stock costs, fees and vat.
Table 4 Average number of pharmacy claims per patient, by gender, age group and Local Health Office region, 2013-2016
 2013201420152016
State
Average17.6012.1312.4412.72
Gender of patient
Male16.4911.0111.3311.59
Female18.7013.2513.5513.84
Age Group
0 - 24 years12.105.045.045.07
25 - 34 years11.668.468.578.88
35 - 44 years11.909.739.9910.21
45 - 54 years16.9512.4212.6812.89
55 - 64 years22.2216.1216.3716.54
65 - 74 years22.8018.7018.9419.10
75 - 84 years26.1021.7121.9121.96
85 years and over43.7924.0924.3924.50
Local Health Office Region
Dublin Mid-Leinster17.6412.0512.3112.58
Dublin North East16.6011.8812.1912.53
West20.4712.4712.8313.08
South15.9612.4912.8213.05
Table 5 Average number of items per pharmacy claim, by gender, age group and Local Health Office region, 2013-2016
 2013201420152016
State    
Total3.113.103.083.07
Gender of patient    
Male3.193.173.133.11
Female3.023.023.023.02
Age Group    
0 - 24 years1.611.601.601.60
25 - 34 years1.871.851.861.88
35 - 44 years2.222.202.192.19
45 - 54 years2.782.732.692.67
55 - 64 years3.343.293.223.19
65 - 74 years3.703.643.573.53
75 - 84 years3.983.963.913.88
85 years and over4.064.074.084.08
Local Health Office Region    
Dublin Mid-Leinster3.163.153.133.13
Dublin North East3.163.143.123.11
West2.992.972.942.94
South3.083.903.073.06
Table 6 Average cost1 per item per pharmacy claim, by gender, age group and Local Health Office region, 2013-2016
 2013201420152016
State    
Average19.5318.6517.9717.37
Gender of patient    
Male20.4519.4218.6217.97
Female18.6017.8817.3216.77
Age Group    
0 - 24 years18.8018.3917.8417.12
25 - 34 years20.5019.9718.9317.82
35 - 44 years21.1420.5019.4118.40
45 - 54 years21.2020.1119.0018.05
55 - 64 years20.1419.0218.2017.47
65 - 74 years18.9117.8617.2116.72
75 - 84 years18.5017.7117.2716.89
85 years and over18.2717.8417.6617.37
Local Health Office Region    
Dublin Mid-Leinster19.2418.4117.7017.07
Dublin North East19.4618.6118.0117.38
West19.3818.5817.9217.38
South19.4218.4817.8117.24
1Expenditure includes ingredient costs, fees and vat on pharmacy claims for GMS patients only and is exclusive of Stock costs, fees and vat.

Background Notes

The data in this release is provided to the Central Statistics Office by the Primary Care Reimbursement Service (PCRS). The PCRS is the part of the Health Service Executive (HSE) that processes payments to all the GPs, pharmacists, dentists and other health professionals who provide free or reduced cost services to the public. The PCRS pays for this service on behalf of the HSE.

Under the GMS, people who are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants may be granted a medical card and receive free general medical services. All GMS claims are processed and paid by the PCRS. In most cases the GP gives a completed prescription form to an eligible person, who takes it to any Pharmacy that has an agreement with the Health Service Executive to dispense drugs, medicines and appliances on presentation of GMS prescription forms.

The figures derived in this release refer to claims that were carried out in the corresponding year. Expenditure includes ingredient costs, fees and vat on pharmacy claims for GMS patients only and is exclusive of Stock costs, fees and vat. Please note average figures were calculated from actual figures not rounded figures.

Definitions:

Medical card: With a medical card issued by the HSE, one can receive certain health services free of charge. To qualify for medical card, an individual’s weekly income must be below a certain figure. If an individual does not qualify for a medical card, they may qualify for a GP visit card.

Total expenditure includes ingredient costs, fees and vat on pharmacy claims for GMS patients only, and is exclusive of Stock costs, fees and vat.

Regions

The regions consist of the local health offices and are constructed as follows; 

Local Health Offices

Dublin Mid-Leinster

Dublin South

Dublin North East

Dublin North West

 

Dublin South East

 

Dublin North Central

 

Dublin South City

 

Dublin North City

 

Dublin South West

 

Cavan / Monaghan

 

Dublin West

 

Louth

 

Kildare / West Wicklow

 

Meath

 

Wicklow

 

 

 

Laois / Offaly 

 

 

 

Longford / Westmeath

 

 

 

 

 

 

West

Galway

South

South Lee Cork

 

Mayo

 

North Lee Cork

 

Roscommon

 

West Cork

 

Donegal

 

Kerry

 

Sligo / Leitrim

 

North Cork

 

Clare

 

Carlow / Kilkenny

 

North Tipperary / East Limerick

 

Waterford

 

Limerick

 

South Tipperary

 

 

 

Wexford

 

 

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