Olivia Mitchell (Dublin South, Fine Gael)
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The issue I raise is not of the same magnitude as the matters we have been discussing in recent days. Nevertheless, it is very important to those affected by it, for whom it is causing great hardship and distress. For almost eight months, the Health Service Executive has not been refunding moneys due to patients for certain drugs and items of medical equipment. This represents a policy change that was undertaken in a completely arbitrary fashion and without any regard to the eligibility of patients.

I am aware of two circumstances in which this change of policy is evident. The first relates to patients in need of essential life-saving equipment in their homes, such as oxygen. In the past, the cost of hiring such equipment was refunded each month in the normal manner under the drugs payment scheme. That practice ended last March and these people are now carrying the cost of the equipment. It seems the HSE simply decided one day no longer to reimburse the costs of these ill people. The reason given was that the court challenge by pharmacists to the breach of contract decision might result in the HSE having to pay more. The reality, however, is that HSE management hoped it would have to pay nothing. This was a complete red herring. The court case has nothing to do with the hiring of equipment and the latter has nothing to do with pharmacists. The HSE was using sick people as leverage in its dispute with pharmacists.

The second set of circumstances in which the HSE has failed to provide refunds is in the case of people who have experienced an out-of-hours medical emergency, whether at the weekend or late at night. In such cases, people may have been obliged to obtain medicines from a pharmacy other than the one from which they usually obtain their prescriptions. Even though they might have reached the monthly limit and were entitled to obtain those medicines free of charge, they were obliged to pay for them and have not been reimbursed. The normal practice in such cases was that one paid up-front and was reimbursed later. This is an absolute entitlement. However, the HSE decided, again arbitrarily, not to pay out in order to discredit pharmacists with their patients and so help its court case. Although it has lost that case, it still refuses to pay out. The excuse now is that it will take time to work out how much it owes. It certainly owes more than nothing, which is what those affected have received.

Will the Minister of State, Deputy Barry Andrews, relay my concerns to the Minister for Health and Children, Deputy Harney, no later than tomorrow morning and ask her to insist that the HSE reimburse this money immediately? However long it may take to work out exactly how much is owed, it should at least pay something on account. People who require life-saving equipment must have some of this money reimbursed because they cannot continue carrying the cost indefinitely. The HSE is behaving despicably in this matter, using sick people as leverage in its argument with pharmacists. It is simply not good enough. I ask the Minister of State to ensure this practice ends tomorrow.

Barry Andrews (Dún Laoghaire, Fianna Fail)
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I am replying on behalf of the Minister for Health and Children, Deputy Harney. I thank the Deputy for raising it as it provides me with an opportunity to outline to the House the current position.

In 1999, the drugs payment scheme, DPS, replaced the drugs cost subsidisation scheme, DCSS, and drugs refund scheme, DRS, whereby patients reclaimed drug expenditure from the former health boards. Anyone who does not have a medical card is eligible for the DPS. Under the scheme, no individual or family pays more than €90 per month, rising to €100 per month from 1 January 2009, for approved prescribed medicines, with the balance paid by the State. This allows families and individuals to budget for the cost of medicines. The DPS is for everyone.

Dependants for the purposes of the monthly threshold include the spouse and any children under 18 years. A dependant with a physical disability, mental handicap or illness who cannot maintain himself or herself fully, who is ordinarily resident in the family home and who does not hold a current medical card may be included in the family expenditure, regardless of age. Dependants over 18 and under 23 years of age who are in full-time education are also included. The upper age limit is in keeping with family law legislation. People over the age of 18 years who are not in full-time education and those over the age of 23 years and in full-time education, and who are not eligible for a medical card, can avail of the drugs payment scheme in their own right.

All those who are ordinarily resident in Ireland are eligible to apply for the DPS provided they do not hold a current medical card. The scheme may also be used in conjunction with a long-term illness book. Application forms for the DPS can be obtained from the local pharmacy or the local HSE health office. The number of eligible persons under the DPS at the end of 2006 was 1,525,657, or 36.03% of the population. The cost of medications under the DPS in 2006 was €285.79 million.

On occasion, payments to patients from local health offices under the DPS are made where a patient has not yet registered for the scheme or where the monthly threshold is exceeded through the use of more than one contracted pharmacy in a calendar month. These payments would be reimbursement of costs already incurred. In addition, when the scheme was established in 1999, certain exceptional items were included within its remit. These include feeding sets, oxygen and oxygen equipment, laryngectomy equipment and elastic hosiery. Oxygen equipment has been interpreted to include any breathing aid. It is my understanding that some patients rent machines to assist breathing and the cost of the rent is reimbursed as appropriate through the DPS.

Following the reduction in pharmaceutical reimbursement prices on 1 March 2008, claims made by patients to local health offices were made at the new lower reimbursement rate. A number of claims in local offices have remained unpaid pending clarification of the recent High Court case regarding wholesale mark-ups because the pharmacies in question had charged the patient at the higher price rather than the lower reimbursement price. Following the recent decision in this case, reimbursement prices, and consequently prices to patients, are being reinstated to the original level to comply with the court's judgment. Consequently, the HSE primary, community and continuing care, PCCC, directorate is now examining the issue of refund payments to patients through local health offices. As it involves direct payment to patients, it is expected that this matter will be resolved shortly. However, I will raise the Deputy's concerns directly with the Minister.