Written Answers. - Long-Term Illness Scheme.
Noel Ahern
Ceist:
102
Mr. N. Ahern
asked the
Minister for Health and Children
if his attention has been drawn to the strong objections of many people to the increase from £32 to £42 in the drugs cost subsidisation scheme; if he will add additional illnesses to the long-term illness card scheme, such as transplant patients who must use immuno-suppressant drugs for the rest of their lives; and if he will make a statement on the matter.
[9439/99]
The long-term illness scheme entitles persons to free drugs and medicines which are prescribed in respect of a specific schedule of illnesses. The long-term illness scheme has not be extended since 1975 and there are no plans to change the scheme or to expand the number of illnesses covered by the scheme having regard to the fact that the needs of individuals with significant or ongoing medical expenses are met by a range of other schemes which provide assistance towards the cost of prescribed drugs and medicines.
Persons who suffer from an ongoing medical condition can avail of the drug cost subsidisation scheme which caters for people who do not have a medical card or long-term illness book and are certified as having a medical condition with a regular and ongoing requirement for prescribed drugs and medicines. Persons who qualify for inclusion in this scheme will not have to spend more than £32 in any month on prescribed medication.
Under the drug refund scheme which covers expenditure by the whole family, any expenditure on prescribed medication above £90 in a calendar quarter is refunded by the health board.
With effect from 1 July 1999, the existing drug cost subsidisation and drug refund schemes will be merged into one new drug payment scheme. The primary aim of this scheme is to bring about important improvements in the existing schemes by effectively merging the best elements of the two existing schemes and is designed to significantly improve the cash flow situation for families and individuals incurring ongoing expenditure on medicines.
The new family scheme will have significant advantages over the existing drug refund scheme. Under the drug refund scheme, families and individuals pay the full cost of their prescription medicines and may, at the end of the quarter, claim reimbursement from their health board of expenditure over £90 in that calendar quarter. Many families and individuals have very heavy expenditure on drugs and medicines in a quarter and have to wait a further six weeks from the end of that quarter before they receive a refund. This can cause considerable cash flow problems for a significant number of families and individuals. This will not happen under the new drug payment scheme. From the introduction of the new scheme, no individual or family will have to pay more than £42 per month for prescribed medicines. It means that families and individuals will, for the first time, be able to budget for the cost of medicines. Families and individuals will know that, whatever the size of their drugs bill, they will not have to pay more than £42 per month. In addition, there are families where, although one member may qualify for a drug cost subsidisation scheme card, combined expenditure on medicines by other members, which can be considerable, cannot be recouped until the end on the quarter. With the new drug payment scheme, no family will have to pay more than £42 in any month for prescribed medicines. The new scheme will be of significant benefit to such families.
The fact that the drug payment scheme will operate on a monthly basis has distinct advantages over the current drug refund scheme. Under the drug refund scheme, a family or an individual could, for example, in one month have expenditure of say £80 but no expenditure in the other two months. They would not have been entitled to a refund. Under the new scheme, they will only have to pay £42 in that month.
There are no qualifying criteria for inclusion on the new drug payment scheme. Where expenditure by a family or an individual exceeds £42 per month on prescribed medicines, the balance will be met by the State. This is in contrast to the old DCSS scheme, where patients had to be certified by their doctor as suffering from a condition requiring ongoing expenditure on medicines in excess of £32 per month.
With regard to the increase in the threshold from £32 to £42, the position is that there has been no increase in the threshold for the existing schemes since 1991. It must also be borne in mind that the new £42 threshold in respect of the drug payment scheme refers to family expenditure in contrast to the existing £32 threshold in the drug cost subsidisation scheme, which relates to individual expenditure.
I would point out that where an individual or a family is subjected to a significant level of ongoing expenditure on medical expenses – general practitioner fees, prescribed drugs, etc. – due to a long-term medical condition, these expenses may be reckoned in determining eligibility for a medical card. In some cases, a medical card may issue to a family member on a personal basis. Eligibility for a medical card is solely a matter for the chief executive officer of the relevant health board to decide.
