Vol. 303 No. 12
I see we have an awful lot of people from County Kerry in the Galley with Deputy Michael Healy-Rae. They are very welcome. Guests of Deputy Brendan Griffin are also present, as are people from Cavan-Monaghan who are here as guests of the Minister, Deputy Heather Humphreys. I extend a special welcome two guests who are here from County Tipperary, namely Niall O'Brien and Mairéad McCormack. I hope they are enjoying the day.
I welcome the Minister. He has ten minutes for his contribution.
Go raibh maith agat. I welcome all our guests. As Minister for Health, I extend a particular welcome to the nurses or retired nurses who are here with us today. I have had the great pleasure of visiting University Hospital Kerry on several occasions. There has been a transformation at the hospital in recent years. It has been under intense pressure. When I went there first, I was told about consultants having to do paperwork in their cars because they could not get offices. Our nursing staff were under sustained pressure for a significant period. In recent years, it has been fantastic to see the change. We are not remotely done. We are probably only halfway done. We have a very big block of new beds coming in, which will be a game-changer. Much more capital investment is being made and many more staff are going in. I have seen first-hand the difference our healthcare workers in that hospital are making for patients. I know it is not easily achieved; it is bloody hard work. I salute our healthcare workers and thank them for everything they have done.
I am very pleased to have the opportunity to address the Seanad today on what is normally quite a technical Bill concerning amendments to health insurance legislation that nobody really pays much attention to. However, this Bill is also what we will use to legislate for the provision of free hormone replacement therapy, HRT, products. That makes it much more interesting than the annual health insurance Bill.
The Bill started its journey through the Houses as the health insurance Bill, and I received Government approval to move amendments on Committee Stage in Dáil Éireann to provide the legislative basis for these measures to introduce fully State-funded HRT relating to menopause.
Parts 1 and 2 of the Bill provide for free HRT products to women experiencing the symptoms of menopause. This means that where a woman has been prescribed HRT by her healthcare provider to alleviate the systems associated with all stages of menopause, the costs of these medications or products will be met by the State.
Part 3 provides for amendments to the health insurance legislation that are required each year to update the level of risk equalisation credits and stamp duty levies necessary to fund the credits. I approved the risk equalisation credits to apply next year and the Minister for Finance has approved the corresponding stamp duty levies.
In addition, this Bill will amend the definition of “high cost claim”. The definition of high cost claim was to have included all HSE-approved drugs, but it did not. An amendment to the definition was required to ensure the original policy intent was met.
I will now outline the specific sections of the Bill for colleagues.
Section 1 provides for the Short Title, commencement, collective citations and construction of the Bill.
Section 2 defines the Health Act 1970 as the “Act of 1970”.
Section 3 provides that the new section being introduced, section 67F of the Health Act 1970, is included for reference within section 47A of the Health Act 1970. Section 67F gives effect to the provision of free hormone replacement therapy products related to menopause to women. The existing section 47A allows the Minister for Health to issue guidance related to the concept of a person being ordinarily resident. The amendment is now required because the provision of free hormone replacement therapy products related to menopause will now be available to women who are ordinarily resident within the State.
Section 4 inserts a new section 67F into the Health Act 1970. It contains the main provisions for free menopause products to women. Within this proposed new section 67F, there are six subsections. Subsection (1) provides that the HSE will make available without charge menopause products on the HSE reimbursement list to women ordinarily resident in the State who have been prescribed menopause products by a relevant healthcare provider, that is, a registered medical practitioner, a registered nurse or a registered midwife. Subsection (2) provides that a woman shall receive the menopause product from a pharmacy that has entered into an agreement with the HSE for the dispensing of menopause products to women. Subsection (3) provides that, separate to the provisions outlined within this legislation, women with full eligibility - medical card holders - will continue to receive free menopause products under section 59(1) of the Health Act 1970. Section 59(1) provides for the provision of free drugs, medicines and medical and surgical appliances to medical card holders. Subsection (4) provides that the Minister, following consultation with the HSE, may by regulation prescribe the form and manner in which the HSE may reimburse pharmacy providers for the supply of menopause products to women, the form and manner in which the pharmacy providers may claim for the reimbursement, and the forms that would be used to make the claims and reimbursements. Subsection (5) provides that every regulation made under this section must be laid before the Oireachtas. Subsection (6) provides for the definitions.
Section 5 contains a number of consequential amendments to the Health (Pricing and Supply of Medical Goods) Act 2013. These are necessary to provide the legislative framework for the HSE’s conditional supply and reimbursement of listed menopause products, meaning hormone replacement therapy drugs, medicines and surgical and medical appliances used to alleviate the symptoms of menopause and which are on the reimbursement list as administered by the HSE. This section of the Bill allows for the introduction of a measure which will mean that where a woman has been prescribed HRT by her healthcare provider to treat her menopause symptoms at any stage in the menopause journey, the cost of those medications will be met by the State, thereby relieving some of the cost burden of menopause.
This is for any HRT medications or products prescribed for the treatment of menopause symptoms that are on the HSE’s reimbursement list. At this time, this measure does not cover the cost of consultations with healthcare providers, the costs associated with the insertion or removal of a coil, or charges that a pharmacist may be required to apply because, in many cases, the pharmacist will make their margin by either adding a percentage or charging an administrative or prescription fee. This does not cover that.
Section 6 defines the Health Insurance Act 1994 as the “Act of 1994”.
Section 7 amends the definition of high cost claim. This Bill amends the definition to include a number of HSE-published lists of drugs and all drugs that are approved under the HSE drugs approval process. It also includes immunoglobulins, a group of drugs that were approved prior to the establishment of the current HSE drugs approval process in 2013. The revised definition will apply from the date of the introduction of the high cost claim credit, which is 1 April 2022. This will ensure that the State will remain in compliance with the European Commission approval of the risk equalisation scheme.
Section 8 amends section 11C of the principal Act to provide for 1 April 2025 as the effective date for revised credits payable from the risk equalisation fund. Section 9 replaces table 2 in Schedule 4 of the principal Act. This table revises the applicable age-related health credits payable from the risk equalisation fund. The amounts are applicable on or after 1 April 2025. The amount of the credit depends on the person’s age, sex and whether they have advanced or non-advanced cover. Non-advanced contracts provide for mostly public hospital cover, while advanced contracts provide a higher level of cover and cover in private hospitals. Age-related health credits for advanced products will increase for all ages and genders. This is to meet the expected increase in claims in these segments of the market. Most of the age-related health credits will decrease for non-advanced products for all ages and genders. It is expected that there will be a reduction in claims for these sections of the market.
Section 10 amends section 125A of the Stamp Duties Consolidation Act 1999 to specify the stamp duty rates to apply in the market for 2025. The amount of stamp duty levy is calculated to align with the expected risk equalisation credits. The risk equalisation scheme is Exchequer-neutral. It is not funded by the State and the State does not derive any funds from it. When the Health Insurance Authority makes a recommendation on the amount of stamp duty levy, it must also avoid sustaining surpluses or deficits in the risk equalisation fund. The amount of stamp duty payable on a health insurance contract depends on whether a contract is advanced or non-advanced. The stamp duty payable on non-advanced health insurance contracts will decrease from 1 April 2025. It will be €94 per adult, a decrease of €11, and €31 per child, a decrease of €4. On advanced health insurance contracts, the stamp duty will increase to €469 per adult, an increase of €49, and €156 per child, an increase of €16. I commend this Bill to the House.
The Minister is welcome to the House. He is right that we deal with this health insurance Bill annually and it is great there is an amendment or addition that will benefit citizens and women. I know the Minister has worked hard on it over the last number of years and it will benefit many people. While it may be a technical Bill, it will achieve something that matters in people's lives. In that sense, it has to be welcomed and I sincerely hope it goes through the House unopposed.
The Minister is welcome. Sinn Féin will be supporting the Bill but I have a couple of queries about the HRT aspect of it. First, will GMS levies apply to HRT products? We are under the impression they will but we seek clarity on that.
The existing ones will apply.
Okay. We think a better approach might have been to align the scheme with the free contraception scheme, which is entirely free for women with the State funding the professional dispensing fee, thereby giving all patients parity of access to the medicines.
The second point concerns the Minister's statement that:
Subsection (1) provides that the HSE will make available without charge menopause products on the HSE reimbursement list to women ordinarily resident in the State[.]
The concern expressed to us by the Irish Pharmacy Union is that, given current medicine shortages, particularly of HRT products, pharmacists often have to source exempt medicinal products from other countries to meet the needs of Irish patients. These products are not on the HSE reimbursement list, so will not be available free of charge. This will be a significant issue, according to the union. For example, Estradot and Evorel HRT products are currently on the HPRA medicine shortage list. Has the Minister made provision for that issue?
Other than that, we are happy to support the Bill.
I thank both colleagues for their support. It is greatly appreciated. I will speak to the queries raised. The GMS levy will continue as is. There is a fairly modest prescription fee that applies to all GMS patients. That will still apply.
The second question is an interesting one about whether we can in the future - and why we did not now - cover all associated costs.
I am referring to, for example, GP consultations, coil insertion fees and payments to pharmacists. We examined this matter. I have allocated a large amount of money – €20 million – in new development funding for next year. We broadly had two options for spending the money in year one. The first was akin to the free contraception scheme. End to end, the State would cover GP consultations, fittings and an agreed payment to pharmacists for private patients’ prescriptions. Had we done that, we would only have been able to make it available to approximately half of the eligible women who had a prescription from a healthcare provider for menopause products. The other way to do it was to make it available to all women for now and cover the cost of medicines, patches and devices. After consultation within the Department, particularly with those involved in the women’s health action plan, and speaking informally to members of the National Women’s Council, the strong feedback I received was that it should be made available to everyone at least in the first instance, even if that meant people would have to pay GP costs. The pharmacists will have to make a margin from it as well, so there will be some administrative fee. In the next budget, I would like to see the scheme being brought in line with free contraception, wherein end-to-end cover is provided. Making it available to everyone while accepting that there would still be some associated GP charges was the way to proceed. The other reason for not running it like the free contraception scheme immediately was that it could take a considerable amount of time to reach agreement with the IPU and IMO on the charges. I was keen to make the scheme available as quickly as possible.
Pharmacists are asking a fair question about what their role will be, given that they will have to have a margin. Our position is that we recognise that they have to make a margin and that they are free to do so in whatever way they do currently. Let us say that a woman today buys HRT products that cost €60 per month and the pharmacist charges €70. That is the margin. Sometimes, the pharmacist may charge an administration fee. Pharmacists can continue doing this or they may all just move to charging administration fees. It is up to each pharmacist to decide.
When is it proposed to take Committee Stage?
Is that agreed? Agreed.
When is it proposed to take the next Stage?
Is that agreed? Agreed.
When is it proposed to take the next Stage?
Is that agreed? Agreed.
I thank Senators for their cross-party support. The free HRT scheme is an important step in the right direction and builds on a very determined agenda from this Government in terms of women's healthcare.
The free contraception scheme is going very well. We are getting very strong feedback from healthcare providers and from women who are using the scheme.
We have the free IVF scheme. We now have our first baby through the IVF scheme. An ever-increasing number of people are using the scheme. In the budget we expanded eligibility for the scheme, which is very welcome.
We have set up a national network of "see-and-treat" gynaecology clinics, which are now reducing the time women are having to wait for initial consultation and diagnostics, and, potentially, procedures, in some cases from years to weeks. In Sligo, for example, the gynae outpatient waiting list was about four years. It now takes between four to six weeks to go through all stages of consultation, diagnostics and treatment, and all on the one morning. Our healthcare workers have really done a fabulous job.
We have set up specialist endometriosis clinics, which were really urgent. Again, there is very strong feedback coming from our healthcare providers and service users.
We have set up specialist menopause clinics. We have also brought in various other measures around menopause, like awareness campaigns and taxation measures.
For the last four and a half years this Government has been prioritising women's healthcare. I want to acknowledge that right across the House there has been very broad support for it. I want to acknowledge that support from all sides of the House. It has been important. I think we still have been a way to go. I think there is more that is needed. As per the conversation we have just had, the scheme we are bringing should move as quickly as possible to being like the free contraception scheme so that all associated costs are covered. There is more we need to do on health ageing around bone health, cardiovascular health and other issues.
Next year, in Cork we will build our first public IVF or assisted human reproduction clinic. We want more around the country. We are using private providers at the moment but ultimately we want this to be inhouse and publicly provided.
There has been really important progress so I want to acknowledge the officials in the Department, healthcare workers and the HSE. The women's healthcare initiatives have really been taken on with amazing energy and determination. We are in a fundamentally different place now than we were at the start of this term. The credit for that goes to our healthcare workers. It goes to the women around Ireland who got involved in the women's health task force and the consultation exercise. It is great to be able to bring in this legislation in what may be the last week of the Oireachtas for this Government. It really is fantastic to be ending with such a positive and important piece of legislation in terms of women's healthcare so thank you.
I thank the Minister. As he said, it might be the last week. It might also be the last time he is in Seanad this term so I thank the Minister and his officials. A lot of Bills have come through the Seanad in his time as Minister for Health. He has always been very productive, and respectful, of this Chamber. We appreciate that.
When is it proposed to sit again?
Tomorrow morning at 10.30 a.m.
Is that agreed? Agreed.
