Dáil Éireann Debate, Tuesday - 17 October 2023
514. Deputy Carol Nolan asked the Minister for Health to address concerns that some older persons who do not hold a medical card are being asked to pay extra money at their chemist in order to get their medication put into a blister pack; if reimbursement options are available for such persons; and if he will make a statement on the matter. [44742/23]
View answerThe Irish Public Health System provides for two categories of eligibility for persons ordinarily resident in the country, i.e., full eligibility (medical cards) and limited eligibility.
In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.
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. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.
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 Drug Payment Scheme (DPS), no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
“Phased Dispensing” fees were introduced in 1996 as it was recognised that, on occasion, it was important that an individual patient, for their own safety, did not have the total month’s supply in their possession at the one time. Some years later, the Irish Pharmacy Union, which represents most community pharmacists), approached the Department of Health with a proposal to supply medicines in a “Monitored Dosage System” (MDS), advocating their use in improving compliance with medicines. This is a separate issue to “Phased Dispensing”.
There are no reimbursement arrangements under the GMS and DPS schemes for the filling of blister packs (monitored dosage system). It is entirely acceptable for a pharmacy to offer, as a quality initiative, to provide a patient’s medicines in such systems. However, it is a pharmacy arrangement with the patient and is not a state funded service.
Pharmacists cannot claim fees for this as a “Phased Dispensing” service unless (i) the GP has requested for the patient’s safety that the patient’s supply is phased (in which case it must be collected by the patient several times a month) or (ii) the patient cannot manage the full month’s supply of their medicines safely on their own in their home, in which case smaller supplies on a more frequent basis can be dispensed to the patient or their agent.
