Dáil Éireann Debate, Tuesday - 12 July 2022
1029. Deputy Fergus O'Dowd asked the Minister for Health if the cost of the drug Ozempic will be refunded under the drugs payment scheme if it is prescribed by a doctor to prevent the development of diabetes; and if he will make a statement on the matter. [37935/22]
View answerThe Health Service Executive (HSE) has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
In line with the 2013 Health Act and the national framework agreed with industry, a company must submit an application to the HSE to have a new medicine added to the reimbursement list. Reimbursement is for licensed indications which have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority.
In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact. HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). The Minister for Health has no role in these decisions.
Ozempic® (semaglutide) is licensed with the Health Products Regulatory Authority (HPRA) in Ireland, and is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Ozempic® (semaglutide) was approved by the HSE for addition to the Reimbursement List for the treatment of Diabetes in 2018. Semaglutide has not been approved for reimbursement for any other indication to date.
Controls are in place within the HSE management systems on claiming processes to ensure that only HSE approved indications are reimbursed across a range of medicines. Controls are currently in place in relation to Ozempic® (semaglutide) to restrict reimbursement support to the HSE approved indication of Diabetes.
Persons with Diabetes are entitled to be registered under the Long Term Illness (LTI) Scheme to enable them to obtain this product free of charge. The form can be downloaded at www2.hse.ie/file-library/long-term-illness/long-term-illness-schemeapplication-form.pdf.
The HSE advise that effective of 1st August 2020, reimbursement for Ozempic® (semaglutide) is confined to those persons with full GMS and LTI eligibility. Therefore reimbursement of Ozempic® is no longer available under the Drugs Payment Scheme (DPS).
