I propose to take Questions Nos. 136 and 205 together.
As the Deputy may be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government. The model of care for infertility was developed by my officials in conjunction with the HSE’s National Women & Infants Health Programme in order to ensure that infertility issues are addressed through the public health system at the lowest level of clinical intervention necessary.
This model of care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF and other advanced assisted human reproduction (AHR) treatments), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the model of care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with infertility issues at this level of intervention. The completion of Phase One of the roll-out of the model of care, envisaged before the end of 2022, will result in operational Regional Fertility Hubs in each of the six Hospital Groups across the country.
Phase Two of the roll-out will see the introduction of tertiary infertility services, including IVF, in the public health system, but will not commence until such time as infertility services at secondary level have been developed across the country, required resources have been allocated and the AHR legislation commenced.
Publication of the Bill to regulate the area of AHR is a priority for the Government, and officials in my Department and the Office of the Attorney General will continue to engage intensively over the coming weeks in order to finalise this legislation, which encompasses the regulation for the first time of a wide range of practices undertaken in this jurisdiction, including domestic altruistic surrogacy.
In addition to the support available to patients who access advanced AHR treatment, such as IVF, under the tax relief for medical expenses scheme, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. Given the costs associated with certain fertility medicines, I am aware that these schemes can have a material impact on the total cost of AHR treatment for individuals who avail of them.
The underlying aim of the policy to provide a model of funding for AHR, within the broader AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.