Marcella Corcoran Kennedy (Offaly, Fine Gael) | Oireachtas source

I thank the Deputies for their contributions. I will convey Deputy Clare Daly's thanks to the Minister for Health, Deputy Simon Harris.

The purpose of section 9 is to allow the HSE to consider including over-the-counter products in the list of reimbursable items, where appropriate. This provision corrects an anomaly in the existing legislation. Under the 2013 Act, only prescription medicines can be supplied under community drug schemes. This anomaly affects a number of products that were prescription-only but are now over-the-counter, as well as some over-the-counter items that have long been available under the schemes. The 2013 Act gives a temporary reprieve in supplying over-the-counter medicines under the community drug schemes until 2018. The provisions included in the Bill will make the reprieve permanent and allow some useful medicines such as emergency contraception and nicotine replacements to remain available under the drugs payment, medical card and other schemes. However, patients will still need a doctor's prescription to obtain an approved item under the schemes, be it an over-the-counter or prescription-only item. This is an important control clinically and for the financial operation and governance of the schemes.

I wish to make a number of important points about access to emergency hormonal contraception. It is important to note that medical card holders already have access to emergency contraception which is free under the GMS scheme with a prescription. Emergency contraception is also an over-the-counter treatment; therefore, any person can enter a pharmacy and buy it without a prescription. In the 12 months to August this year, there were just under 13,000 emergency hormonal contraception prescriptions dispensed under all schemes, of which more than 12,000 were to medical card holders. Timely access is not an issue for the more than 12,000 people per year who present to their doctors and then their pharmacies for emergency contraception, rather the issue is for people who need emergency contraception but who cannot get a prescription in time, for example, at the weekend or if they are unable to obtain an urgent appointment with a GP and cannot afford to buy the product. I share the concerns raised about timely access to emergency hormonal contraception for medical card holders and accept that there should not be unnecessary barriers to women receiving this treatment.

I agree with the principle of the amendment proposed by Deputies Ruth Coppinger, Clare Daly, Mick Barry and Paul Murphy, but I do not propose to accept the amendment for the following important reasons. The Minister has already instructed officials to remove the prescription requirement for emergency hormonal contraception as a matter of urgency. Work on the development of service and clinical structures to do this is under way.

Following consultation with the Irish Pharmacy Union, IPU, last year, officials identified the challenges involved and are addressing them. Since Committee Stage they have engaged further with the HSE on the process required. Section 9 will remove the major legislative barrier to supplying over-the-counter medicines in general, including emergency contraception. Many of the IT and service processes needed were trialled in the minor ailments pilot scheme this year under which pharmacies treated patients directly for six minor conditions with over-the-counter medicines and without prescriptions.

In line with the Minister's instructions, the HSE is developing operational structures to provide an over-the-counter emergency hormonal contraception service for GMS patients professionally, safely and effectively, including clinical standards to ensure patient safety, pharmacy compliance with these standards, as with the vaccination programmes, secure claiming and verification processes. Development will continue to build on the work already done, including the IPU's professional practice guidelines for dispensing over-the-counter emergency hormonal contraception and existing structures for specific pharmacy services such as the vaccination programme.

The proposed amendment is not necessary to address any operational challenge that may arise. Furthermore, it would prescribe the supply of a single treatment in a specific manner in primary legislation. This raises potential difficulties in a number of areas, including the requirement on the HSE under the 2013 Act to provide treatment in line with patient safety and cost constraints, for example, to get the best price or refuse individual products on the basis of suitability or safety. It also raises potential difficulties in a pharmacist's use of clinical judgment, in particular, not to supply a product where it may be unsafe for a patient for clinical reasons. Supply of emergency hormonal contraception is a professional clinical service set out by the Pharmaceutical Society of Ireland which the amendment does not reflect. Further discussion will be required with the IPU on service design and Department of Health officials will pursue the matter. The IPU has previously indicated its willingness to provide this as a professional service and the Pharmaceutical Society of Ireland has issued professional practice guidelines on dispensing emergency hormonal contraception and advising patients.

It is evident that significant progress has been made to remove barriers to timely treatment for medical card holders through the use of over-the-counter products in general and, in particular, emergency contraception. I thank the Deputies for raising the issue again on Report Stage and the valuable contributions they have made in doing so. The principle behind the amendment is worthwhile and being acted on. However, the amendment is not necessary in addressing this health need and could have unintended consequences. In addition, while implementation is under way, the remaining operational challenges must be addressed before emergency hormonal contraception will be available over the counter to medical card holders. The Bill's progress was delayed by the fall of the previous Government and the delay in forming the new one. There is an upcoming discussion with the IPU on section 9 and there should be no further legal barriers. While the Deputies' amendment is well intentioned, it would not make what they want to happen happen any faster. Therefore, while I thank the Deputies for tabling it, I do not propose to accept the amendment.

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