I move amendment No. 1:
In page 8, between lines 1 and 2, to insert the following:
"(c) and by the insertion of the following paragraph:
"3. In the case of any emergency hormonal contraception included on the Reimbursement List that is normally available without prescription, there shall be no requirement that a prescription be presented in order for patients to be reimbursed under the General Medicines Services Scheme ('GMS'), and the procedure for recording and documenting the service provided and for claiming reimbursement of the fee and ingredient cost shall be as for all medicines dispensed under Community Drugs Schemes.".".
This concerns an issue I highlighted on Second Stage. The amendment was moved by me through Deputy Billy Kelleher on Committee Stage. I thank the Socialist Party for tabling it for Report Stage. I admit it is not the most elegant of amendments. It is not the best in terms of wording but the reason it is so worded is to highlight the importance of the issue. I acknowledge the input and dialogue of the Minister for Health, Deputy Simon Harris, behind the scenes over recent weeks in trying to advance this issue through telephone conversations and e-mails. That is very much appreciated. It is a good way of doing business.
We know section 9 allows for emergency contraception without prescription to be reimbursed by the HSE but not for women who are on a medical card. Women with medical cards will still need to go to the doctor to get a prescription for a non-prescription drug. It is unacceptable that this type of two-tier system would continue to prevail. Throughout the debates, the Minister made many points about addressing the issue. In fairness, a lot of work has taken place in recent weeks to try to unlock this problem.
The reason I retabled the amendment is that the Irish Pharmacy Union, IPU, gave the Department a proposal to make the morning after pill available without prescription to women on medical cards in June 2015. That was more than a year and a half ago. That we are only beginning to discuss it and that there was no discussion whatsoever with the IPU since it made its proposal is why we are discussing this on Report Stage. The morning after pill became available through pharmacies without prescription in 2011, not today or yesterday. The pill is critically time-dependent. It is 95% effective if taken within the first 24 hours of unprotected sex, with its effectiveness falling dramatically the longer time goes on. We know from the National Association of General Practitioners that there is an average waiting time for a GP appointment of 34 hours. In essence, a woman with a medical card will not be able to gain access to the pill within the 24-hour window, as indicated by best practice. That is what the amendment is trying to address.
On Second Stage, certain Deputies stated one could go into a pharmacy and pay for the pill if they were that bothered about it. The fact that the morning after pill can cost between €30 and €35 is an issue. This is a huge amount of money for somebody on social welfare. In that context it does not present an opportunity for her. The flu vaccine, for example, has been available to medical card holders without prescription and pharmacists have had a system for claiming back the costs of this since 2011. Why can it not be done in this case?
The IPU has stated the administrative hurdles are not onerous. The proof of the pudding is that the required system is already operated for the flu vaccine. Emergency contraception should be freely available over the counter to all women rather than from behind the counter, as is the case at present. It can be costly for private patients. None the less, the IPU pointed out over 18 months ago that the scheme could be implemented easily and quickly from a professional perspective. There is no further training required. The procedure in place for recording and claiming the reimbursement of fees could be the same as for other medicines dispersed under the community drugs scheme.
I have two questions for the Minister of State. The IPU proposed that pharmacists receive a fee over and above the standard dispensing fee for providing the proposed service. It suggested one in line with that for the flu vaccine of about €15. I do not know whether that is a fair price but I do know that it is substantially less than the cost of a visit to a general practitioner. Can we be assured that cost and negotiations are not a reason for stalling? Have there been any discussions with the IPU? There have been discussions with the HSE and I am anxious that there be a discussion with the IPU. The Minister seemed to suggest in dialogue outside the Chamber that this proposal is deliverable in 2017. On that basis and in recognition of what I acknowledge has been a lot of work behind the scenes, I will not press the amendment.