Christopher O'Sullivan (Cork South-West, Fianna Fail)

They must have been over for the Steelers game.

To answer Deputy Toole's question at the outset, the chief pharmaceutical officer commitment will be fulfilled. I do not have a timeline on that but it is absolutely a commitment that we will follow through and fulfil.

I would like to thank the Deputies for their contributions today, especially those who spoke in support of community pharmacists and the work they do in delivering a more accessible and integrated health service in Ireland. The community pharmacy agreement marks a significant milestone in the strategic collaboration between the Department of Health, the HSE, and the IPU. It sets out a comprehensive and ongoing pathway to modernise and expand the role of community pharmacy in Ireland’s healthcare system. The agreement will support the delivery of safe, equitable, and efficient healthcare, and ensure that community pharmacists are better equipped to contribute to national health priorities through engagement, sustainable funding, and integrated service delivery.

The agreement will be implemented on a phased basis and will be supported by ongoing, regular structured engagements between the Department, HSE and the IPU. Under the agreement a strategic collaboration group will be established which will provide a structured forum for dialogue and joint consideration of strategic issues shaping the future of community pharmacy in Ireland. The agreement is comprehensive and extensive, covering a wider variety of key issues in community pharmacy. Key achievements of the agreement which the Minister for Health outlined earlier include expanded services. Community pharmacies will play a greater role in the management of common conditions, immunisation, bowel screening, and the safe return and disposal of unused medicines. There is a fee for this for all patients, but of course medical card holders can still go to their GP for free, as they do today. The introduction of this scheme means that anyone can go the pharmacy instead, for a fee. Anticipating that many private patients might go to a pharmacist instead, it may make more appointments possible at the GP, enabling a quicker free appointment for medical card holders. This agreement makes it cheaper for some but increases access for all for a prescription for a common condition. On digital integration, pharmacies will actively support national eHealth reforms, including the national e-prescription service and national electronic health record. There will be new funding, and €25 million in 2025 and €50 million in 2026 will support fee adjustments, service development, and training. On strategic collaboration, a new collaborative framework will be established to support the shaping and implementation of community pharmacy’s role in a more integrated, efficient, and patient-centred health system.

The agreement also introduces new fees and allowances for participating pharmacies, supports training and development of pharmacy teams, and a programme of work aimed at reducing the community pharmacy administrative burden. Fundamentally, this is a forward-looking agreement that will make it easier for people to access care in their communities. It reflects our shared commitment to innovation, public health, and sustainable investment. It will further support community pharmacies in diversifying their health service offerings, business models and revenue streams.

On phased dispensing, there is one important element of the agreement, changes being made to the rule set around phased dispensing, which I would like to outline to the House. This agreement does not remove phased dispensing. Phased dispensing was introduced in 1996 for patient safety reasons. The supply of medication in instalments can support patients prescribed certain high-risk medications who are at risk of medication misadventure if these medications were to be supplied on a monthly basis, as is the norm under the community drug schemes. Where a phased dispensing claim is submitted, the current requirement is that an item must be dispensed across multiple supply occasions. Community pharmacies receive additional payments in respect of phased dispensing.

Monitored dosing systems are systems that enable the individual medicine doses to be organised according to the prescribed dose schedule. These are sometimes referred to as blister packs. The State has never agreed to fund monitored dosing systems. However, a practice has built up whereby the use of monitored dosing systems is charged as if for phased dispensing. The State has never agreed to this. Phased claiming was never intended to be used to submit claims in lieu of the provision of monitored dosing systems. While monitored dosing systems may have a role for some patients there is significant uncertainty around the robustness of the evidence supporting their use. The National Centre for Pharmacoeconomics carried out an evidence assessment which indicated that the evidence was, at best, equivocal to support such a programme. Significant expenditure is therefore being incurred where it was never intended by the State. It has been agreed to introduce improved controls in this regard and to limit the use of phased dispensing to specified high-risk drugs, where a patient safety concern may exist.

Phased dispensing support is currently available under the GMS medical card scheme for the following reasons: reason 1 - at the request of a patient's physician; reason 2 - due to the inherent nature of a medicinal product, that is, product stability and shelf life; reason 3 - where a patient is commencing new drug therapy with a view to establishing patient tolerance and acceptability before continuing on a full treatment regime; and reason 4 - in exceptional circumstances where the patient is incapable of safely and effectively managing the medication regimen. Under the community pharmacy agreement, from January 2026, phased dispensing under reasons 1 and 4 will be limited to a defined set of high-risk medication classes. These are psychotropics; opioids; codeine; and pregabalin and gabapentin. The approved list of medications will be provided by the HSE in due course. For reason codes 1 and 4, by focusing phased dispensing reimbursement on the medication categories on the approved list, phased dispensing payments can be targeted to medications with the highest risk or potential for misuse. Phased dispensing fees will remain payable as per current arrangements under reason codes 2 and 3 and will not be subject to the approved list. The HSE estimates that this will free up over €20 million in funding within community pharmacy. This funding will be primarily redirected towards valued added services.

The salient point here is that appropriate phased dispensing is not being removed in this agreement. The current funding of blister packs when claimed as phased dispensing, which the State has never supported, will be suspended. This is being done in a way which puts patient safety first and allows the State to repurpose €20 million of funding to be used to implement new patient-centred services. It remains open to pharmacies to charge patients for the use of monitored dosing systems as a private service.

In the context of the overall agreement and settlement package, the State has also secured key commitments from community pharmacy in relation to reform, modernisation and the digital agenda.

The agreement will provide the basis for community pharmacy and IPU co-operation with the full ehealth agenda, including national eprescribing programme, shared care record, HSE app, electronic health recording, etc. As these programmes advance and roll out, the co-operation of community pharmacies will be crucial to the success. The Department will also progress a number of regulatory reforms over the coming months to improve efficiency and free up capacity in community pharmacy. The Department, the HSE and the Irish Pharmacy Union are committed to a process of ongoing structured engagement to support the future development of community pharmacy. The continuation of a high-level, enduring, strategic relationship is designed to support the shaping and implementation of the role of pharmacies in a more integrated, efficient and patient-centred health system.

It is recognised that ongoing collaborations, some already under way, on key operational-related matters will also continue. Furthermore, it is recognised that, from time to time and as required, specific programmes of work will be established with their own governance arrangements as appropriate. This multiyear pathway will focus on specific measurable deliverables that ensure service sustainability, expand patient care and enable community pharmacists to practice to their full scope. This landmark agreement sets a pathway forward for a strategic approach to shaping the future of community pharmacy in Ireland, all with the intent of improving healthcare service delivery and patient outcomes.

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