Dáil Éireann Debate, Thursday - 13 October 2022
438. Deputy Eoin Ó Broin asked the Minister for Health if his Department has undertaken research to ascertain the costs of providing financial assistance to patients on hormone replacement therapy for menopause; if his Department intends to introduce financial assistance for these patients; and if he will make a statement on the matter. [50921/22]
View answerThe Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. In line with the Act and the national framework agreed with industry, a company must submit an application to the HSE to have a medicine added to the formal Reimbursement list. 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 Reimbursement list is the same for the General Medical Services (GMS) scheme and the Drug Payment Scheme (DPS).
The HSE advise that while HRT is used as a treatment for menopause, there are also a wide range of other HRT treatments in place across multiple clinical areas, including the replacement of cortisone in Addison’s disease, and the replacement of thyroxine in thyroid disease, etc. In addition, menopause can present differently for individual women, both in symptom severity and duration. Not all women experiencing menopause may be clinically eligible for HRT, which is prescription based. Women may also choose not to take HRT and to address their symptoms through alternative therapies and/or lifestyle changes.
The HSE do currently operate two schemes which offer financial assistance to people in receipt of prescribed HRT medication on the reimbursement list.
These HRT medications are available to medical card holders, subject to the statutory prescription charge. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card under the GMS scheme is determined by the HSE. In certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.
Under the DPS, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines, which includes some HRT medications.
In 2021, the provision of HRT under the statutory schemes cost €6.3m, comprised of €4.5m under the GMS scheme and €1.8m under the DPS. The HSE do not have access to data on the expenditure of patients receiving products privately in community pharmacies or whose expenditure for medicines falls below the threshold of the Drug Payment Scheme. This prevents the HSE from giving a robust estimation of the costs of providing HRT free to all who may need it to treat symptoms of perimenopause and menopause.
However, the HSE have estimated that the additional minimum cost to the state of providing HRT free to all who may need it clinically would likely be €4m per annum. Therefore, the total would be in excess of €10m per annum. This estimation does not take account of any associated loss of prescription charge income, any relevant future demographic changes, or how the introduction of free provision could impact on uptake.
As announced in Budget 2023, the VAT rate for non-oral forms of HRT, will be reduced to zero from 1 January 2023, thus reducing the cost of HRT for all those who need it.
Finally, individuals may also be entitled to claim tax relief on the cost of their medical expenses. This includes medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
