Written Answers. - Drugs Refund Scheme.

Michael Bell

Question:

106 Mr. Bell asked the Minister for Health and Children if his attention has been drawn to the widespread public anger at his decision to increase the threshold of the drugs refund scheme from £32 to £42 per month; if he will provide an estimation of the number of people who will be affected by this increase; if his attention has been drawn to the hardship which this additional medical expense of £10 per month will cause to many people on low incomes who do not qualify for medical cards; his justification for the increased costs for these people; and if he will give immediate consideration to reverting to the £32 figure. [1921/99]

Jimmy Deenihan

Question:

631 Mr. Deenihan asked the Minister for Health and Children the plans, if any, he has to review the changes which he introduced recently to the drugs refund scheme which will cost those affected £36 extra per quarter; and if he will make a statement on the matter. [2242/99]

I propose to take Questions Nos. 106 and 631 together.

The position is that the existing drugs cost subsidisation and drugs refund schemes will be merged into one new drug payment scheme with a threshold of £42 per month per family unit.
The primary aim of the new drug payment scheme is to bring about important improvements in the existing schemes. The new scheme will effectively merge the best elements of the two existing schemes and is designed to significantly improve the cash flow situation for families and individuals incurring ongoing expenditure on medicines.
The new family scheme will have significant advantages over the existing drugs refund scheme. Under the drugs refund scheme, families and individuals pay the full cost of their prescription medicines and may, at the end of the quarter, claim reimbursement from their health board of expenditure over £90 in that calendar quarter. Many families and individuals have very heavy expenditure on drugs and medicines in a quarter and have to wait a further six weeks from the end of that quarter before they receive a refund. This can cause considerable cash flow problems for a significant number of families and individuals. This will not happen under the new drug payment scheme. From the introduction of the new scheme, no individual or family will have to pay more than £42 per month for prescribed medicines. It means that families and individuals will, for the first time, be able to budget for the cost of medicines. Families and individuals will know that, whatever the size of their drugs bill, they will not have to pay more than £42 per month. In addition there are families where, although one member may qualify for a drug cost subsidisation scheme card, combined expenditure on medicines by other members, which can be considerable, cannot be recouped until the end of the quarter. With the new drug payment scheme, no family will have to pay more than £42 in any month for prescribed medicines. The new scheme will be of significant benefit to such families.
The fact that the drug payment scheme will operate on a monthly basis has distinct advantages over the current drugs refund scheme. Under the drugs refund scheme, a family or an individual could, for example in one month have expenditure of say £80 but no expenditure in the other two months. They would not have been entitled to a refund. Under the new scheme, they will only have to pay £42 in that month.
There are no qualifying criteria for inclusion on the new drug payment scheme. Where expenditure by a family or an individual exceeds £42 per month on prescribed medicines, the balance will be met by the State. This is in contrast to the old DCSS scheme, where patients had to be certified by their doctor as suffering from a condition requiring ongoing expenditure on medicines in excess of £32 per month.
With regard to the increase in the threshold, the position is that there has been no increase in the threshold for the existing schemes since 1991. It must also be borne in mind that the new thres hold refers to family expenditure as opposed to the existing threshold in the drug cost subsidisation scheme which relates to individual expenditure.
It is not possible to estimate the number of people that will be affected by the increased threshold in the new scheme, as the statistics in respect of claims under the drugs refund scheme refer to the number of claims and not to the number of individuals. Given the benefits of the new scheme that I have outlined above, I would point out that the new scheme is designed to be more user-friendly for individuals and families incurring expenditure on prescribed drugs and medicines in excess of £42 per month. Accordingly, it is reasonable to expect that the uptake for the new scheme will be broadly in line with the combined uptake of the drug cost subsidisation and drug refund schemes.
I would also point out that where an individual or a family is subjected to a significant level of on-going expenditure on medical expenses (general practitioner fees, prescribed drugs etc.) due to a long-term medical condition these expenses may be reckoned in determining eligibility for a medical card. In some cases a medical card may issue to a family member on a personal basis. Eligibility for a medical card is solely a matter for the chief executive officer of the relevant health board to decide.