Expenditure on strong opioid almost tripled

State expenditure on the opioid tapentadol almost tripled – to over €3.75 million – and the number of items dispensed nearly quadrupled between 2014 and 2019, according to data released by the HSE to the Medical Independent. 

Tapentadol, known by the brand name Pa–lexia, was added to the GMS reimbursement list in July 2011. Some 24,776 items were dispensed in 2014 at a cost of €1,141,457. In 2019, 91,620 items were dispensed at a cost of €3,754,472. 

The drug is indicated for the management of severe chronic pain in adults that can be adequately managed only with opioid analgesics. It has the potential for abuse and addiction/dependence syndrome. 

The National Centre for Pharmacoeconomics (NCPE) recommendation in 2011 was that tapentadol may be considered cost-effective, but should be reserved for patients who cannot tolerate existing strong oral opioids. 

Oxycodone combination items had increased from 25,039 items dispensed in 2014, at a cost of €1,006,915, to 42,752 items in 2019 at a cost of €1,822,367. 

The data from the Primary Care Eligibility and Reimbursement Service (PCERS) was presented in 2021 to a Medical Council working group devising strategies to reduce overprescribing of potentially addictive drugs. 

The number of items dispensed for several opioids increased between 2014 and 2019, including morphine, oxycodone combinations, and codeine combinations. However, the costs of most of the drugs had been decreasing. 

The number of gabapentinoid items dispensed had also increased.  In 2019, there were 613,598 pregabalin items dispensed at a cost of €19,930,257. The PCERS presentation noted that pregabalin was reference priced in April 2020, which will provide a further decrease in expenditure. However, the number of items dispensed “may remain static”. 

In 2019 there were 131,301 gabapentin items dispensed at a cost of €2,795,368. It was reference priced in May 2020 and the number of items dispensed “may continue to increase”.