asked the Minister for Health if he will outline his plans for the future of the long-term illnesses scheme; and if he will make a statement on the matter.
24.
Ceisteanna—Questions. Oral Answers. - Community Drugs Schemes.
8.
asked the Minister for Health if he will specify the changes he proposes in the refund of drugs scheme for those who have to permanently purchase expensive drugs; and if he will make a statement on the matter.
25.
asked the Minister for Health if he intends to make any changes in the refund of drugs scheme to assist people on low incomes who have to pay doctor and durg bills of up to £500 a year or more, which they could have previously recouped from the VHI.
I propose to take questions Nos. 8, 24 and 25 together.
The Deputies will be aware that I undertook to review the operation of the community drugs schemes. This review has now been completed and the Government have accepted my proposals as follows:—
The present long-term illnesses scheme as currently constituted will be retained.
The introduction of a drug subsidisation scheme for persons with limited eligibility who have a regular and continuous requirement for expensive medication due to a long-term medical condition.
The scheme will be tailored to cater for those in greatest need, that is, those people who are on continuous and expensive medication.
Arrangements are being made so that the financial outlay by the individual patient on medication will be kept to the minimum. At the moment, a patient can claim a refund in respect of the amount of expenditure in excess of £28 per month. While it will not be possible to reduce this threshold at this stage, the new arrangements will ensure that that amount is the maximum which an individual will have to pay in a month.
I have already commenced discussions with the health boards, the Irish Pharmaceutical Union and other interested parties regarding the details of the scheme with a view to its earliest possible implementation.
The present drugs refund scheme will be retained in its present form for casual users.
Can the Minister tell us anything we do not know? Does he consider that it is necessary to include asthmatics in the long-term illnesses scheme, because of the terrible circumstances of people especially where families are all asthmatic and cannot afford to pay the £28? Is the Minister aware of the anomaly that exists in dispensing drugs under the long-term illnesses scheme, whereby the chemist gets the retail price plus the 50 per cent mark up which means in effect that it costs more to dispense drugs under the long-term illnesses card than it does under the medical card? Will the Minister consider that matter?
I am aware of the variation between the long term illnesses scheme and the medical card scheme as it affects the payment for the drugs. We are constantly considering that to see how it can be improved. As regards asthmatics, the first thing I would point out is that 40 per cent of the population have a totally free comprehensive medical service, including free drugs. The new scheme where individual patients will only have to pay £28 month will be available to everybody. There are many in society who have expensive treatments which are ongoing, for example, those with high blood pressure, with cancer or with skin diseases. The advantage of the new scheme announced is that all these people will benefit from having to pay only £28 a month.
Will the Minister clarify that having reviewed the community drugs support schemes he has decided that there should be no new additions to the long term illnesses list? Will he also clarify how many of the existing drug refund users he reckons will fall into this new category who will just pay the £28 up front, and how many will be deemed to be casual users? This announcement by the Minister will give the vast majority of the people concerned the old problem of having to pay a lot of money up front, wait until the health board adjudicates on whether the drugs were for use in the month in question and then perhaps discover that they will get a much lower refund than expected. Will the Minister clarify the dividing line between casual and non-casual?
Casual in this sense relates to where the patient receives drugs just once, in other words, he is not on continuous treatment. The patients who are on continuous treatment in successive months are the patients we are targeting this scheme on initially.
In relation to long term illnesses, the Minister's review turned up no new additions such as lupus or any of the other conditions for which a case has been made for inclusion in this scheme? I take it that none of those illnesses is acceptable to the Minister to qualify as a long term illness?
The scheme is targeted towards the expenses of patients. It is very important that we ensure that every patient who is paying large amounts of money for medication should benefit from whatever scheme we introduce. If I was to put one category into the long term illnesses scheme, it would be justifiable to put them all in. Unfortunately the State's resources would not stand up to that.
Would the Minister agree that the selection of illnesses included in the long term illnesses scheme is subjective in the first instance, that to include diabetes and cancer, for example, and not to include people with renal failure is very much a subjective view? Would the Minister agree that it is only fair and right that anybody who has to have ongoing medical expenses of the nature we have described should be covered under the long term illnesses card? Would the Minister also agree that the use of generic drugs and the payment of a dispensing fee on the same basis as applies in respect of medical card holders to pharmacists, would probably save the kind of money that would be required to extend the categories of illnesses covered by the long term illnesses card? Is the Minister having discussions with the pharmacists in relation to the fee payable and can he tell us when he expects this new scheme to come into operation?
The Deputy is bringing in new matter.
There are ongoing discussions with the Irish Pharmaceutical Union, the representatives of the pharmacists. I would hope to see the scheme introduced towards the middle of the year. As regards the patients who should be in the long term illness scheme, I accept what the Deputy says that there are anomalies. Ideally, we would like to be able to include everybody who is on continuous treatment, in the long term illness scheme, but in fairness to the patients, we have to work within our budget. It is important that we should ensure that every patient who is on long term treatment will benefit from the new scheme, and that is what we are doing in this scheme.
I am expressing my disappointment at the Minister's refusal to extend the long term illness scheme which was the basic request. Will there not be an enormous administration cost in the operation of the £28 per month type of scheme, and can he tell the House how he envisages that scheme will operate? Will the chemist have to fill out forms? Will the health boards have to adjudicate on the case? Who will do all the paper work that will be involved? Would it not be cheaper and more effective from the patient and the State's point of view to put people with long term illnesses, who require long term treatment on the long term illness scheme?
First, the present scheme is expensive in terms of administration because, as Deputy Bruton pointed out, patients' prescriptions, their accounts or receipts from pharmacists have to be processed by the local health board. I would envisage that there would be a reduction in the amount of administration necessary for the new scheme. I would hope it would be a computerised scheme similar to the scheme which exists at present for holders of GMS medical cards.
In relation to Deputy Stagg's disappointment that we are not extending the long term illness scheme to include everybody, what we are doing is an enormous advance in regard to the drugs refund scheme because the major problem people face was the very large outlay each month and having to wait two to three months to receive a refund. I had somebody with me recently who was waiting since Christmas to receive over £300 by way of refund. They will not have to face that sort of long delay under the new scheme. They will not even have to pay out that money in the first instance, and I believe that is an enormous advance.
I am calling Deputy Sherlock. I want to facilitate the Deputy. A final brief question as I have dealt over long on this question.
Arising from the Minister's last reply to the question raised by Deputy Stagg, he did not say how he proposes to implement the scheme. If persons do not have to pay in excess of £28 in simple language, how does the Minister propose to implement that?
That question has already been put.
I have already dealt with that question. The patient will just have to pay £28 per month. The system, for administrative purposes would, I hope, be computerised when negotiating with the pharmacists' representatives and with the general medical payments board who have a computer system, to ensure that we have an effective system in operation.
When?
Order, please. Question No. 9 please.