Ireland caps exenatide prescribing to 19 specialist centres

Ireland has declined to reimburse exenatide in general practice, restricting supply to specialist weight-management services. The appraisal accepted the clinical evidence and turned instead on the cost-effectiveness of an indefinite treatment duration in a population the size of the eligible one.

The carve-out removes cover for approximately 19,000 covered lives with 30 days’ notice. Employees already in treatment are offered a transition period; those in the middle of a titration are not distinguished from those at maintenance dose, which the Journal has asked about.

The structural feature of this market is that the list price and the price actually paid are different numbers, and that the second is contractually confidential in most systems. Any comparison of what a drug costs across countries that relies on published prices is comparing publications. The Journal reports both where it can and says which is which.

Sinéad Corrigan, patient advocate and former trial participant, said the duration assumption was doing all the work. "Change the assumed treatment length and the recommendation flips. That is not a criticism of the model; it is what the model is for."

The Journal has requested the anonymised authorisation dataset and will publish the analysis if it is provided. Our price series records list and net prices separately and states when a net figure is an estimate.