Pa Daly (Kerry, Sinn Fein)
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Chomh maith leis an Teachta McHugh, gabhaim comhghairdeas le gach duine mar gheall ar International Women’s Day.

Téann a lán daoine gach bliain, nó gach seachtain, ag iarraidh freagraí dá ngearán leighis. Faigheann siad endoscopies agus colonoscopies chun freagraí a fháil dóibh féin. Sna laethanta roimh na mion-obráidí seo, b’éigean dóibh troscadh a dhéanamh agus beagáinín leighis nó cógais a thógáil.

Many patients seeking answers for medical difficulties are sent for an endoscopy or a colonoscopy. Sometimes it could be for ulcers, flux or blockages, and sometimes pre-cancerous lesions or ulcers can be found with an endoscopy or colonoscopy. A person may have an inflamed bowel, colitis or pre-cancerous polyps. It can be very stressful for patients when they are trying to find this out. In advance of the procedure, they usually receive a prescription in the post for the preparatory medication such as Picolax or Klean-Prep. Some people say the cost of these is not huge, but nonetheless they can vary between €20 and up to €50. Different pharmacies charge different prices. It has come to my attention in recent weeks that these costs should be covered under the medical card scheme. It seems, however, they are joining an increasing list of medications prescribed or actions carried out by GPs for which patients are expected or asked to pay despite qualifying for a medical card. There was one woman in her 70s who informed our office she had asked her doctor to postpone the appointment for a few weeks because she needed to save up the money for the pre-procedure medication. Over recent years we have seen charges for blood tests becoming common. Many GP practices are now being purchased by larger medical groups, which would be run on a for-profit basis. This is likely to continue and this type of situation is likely to become more common. We need centralised GP contracts. We need to have an audit of these charges faced by medical card patients.

Moving towards the ending of the two-tier system is the aim of Sláintecare, to which the Government remains committed. I heard the Minister mentioning this this morning on the radio. Part of this plan includes augmented medical card eligibility, increased entitlement to GP care, a reduction in prescription charges, and a GP contract manifesto to support chronic disease management.

Will the Minister of State confirm there will be no price to pay by medical card patients for this type of medication and by people who must obtain blood tests?

If a person is entitled to a medical card, he or she should not have to shoulder the burden of increased charges before facing into a procedure that can only add to the stress on him or her.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy. I am taking this matter on behalf of the Minister for Health, Deputy Stephen Donnelly. The Minister and I are committed to supporting our national population-based screening programmes. The programme for Government contains a commitment in respect of expanding the age range for BowelScreen to those aged 55 to 74 years. The HSE plans to commence screening of those aged 59 years this year, in addition to the current age range of 60- to 69-year-olds. A report published by National Cancer Registry Ireland, NCRI, in September 2022 shows the positive impact of the BowelScreen programme on cancer detection in Ireland and notes that the programme is effective in detecting cancers earlier and saving lives.

With our population living longer lives than ever, many of us will undergo one of these procedures at some point. For the investigation to be most effective, the bowel must be as clean as possible. To achieve this, patients are prescribed medicines to help cleanse the area prior to the procedure. The HSE has statutory responsibility for medicine pricing and reimbursement decisions under the Health (Pricing and Supply of Medical Goods) Act 2013. The HSE's decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds on the advice of the National Centre for Pharmacoeconomics, NCPE.

In line with the 2013 Act and the national framework agreed with industry, a company must submit an application to the HSE to have a new medicine added to the formal reimbursement list. Reimbursement is for licensed indications that have been granted market authorisation by the European Medicines Agency or Health Products Regulatory Authority, HPRA. The Deputy kindly clarified his question with examples of two products, namely, Picolax and Klean-Prep. In accordance with the 2013 Act, the companies marketing these medicines must submit applications to the HSE to be added to the formal reimbursement list. As they are not on the reimbursement list, they cannot be reimbursed under the community drug schemes.

Aside from HSE reimbursement, individuals may be entitled to claim tax relief on the cost of their medical expenses. This is at the standard rate of 20% and includes medicines prescribed by a doctor. People may also be entitled to an additional needs payment from the Department of Social Protection. This payment is awarded on the basis of means-tested based on a person’s weekly income. Its purpose is to meet essential costs that a person would otherwise be unable to afford. If these products are to become eligible for reimbursement, the companies marketing them must be encouraged to engage with the pricing and reimbursement process in Ireland.

The script I have been provided with in response to the detail of the question submitted by the Deputy clearly indicates that a company must submit an application in order to be part of the list. There is a need in this regard. We have a bowel screening programme in place. It is fairly clear that a problem like this could be addressed in a timely fashion.

Pa Daly (Kerry, Sinn Fein)
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I thank the Minister of State for the clarity she provided. We all have jobs to do from here on in, the first of which will be to engage with doctors who are prescribing these medications in order to ensure that if other medications are on the list, people, particularly medical card patients, will be directed to those ones. We must also engage with the companies if there is an easy fix in the context of them getting on the list. I have come across cases where it perhaps suited companies not to be on a particular list. However, we will certainly be able to take that up with them because prescription charges are essentially a tax on ill health.

While the Minister of State made some helpful suggestions regarding the additional needs payment, there can be delays. Sometimes if people are waiting for answers, particularly if there is suspicion there may be cancer or a precancerous condition involved, it is certainly something that should be dealt with at the point of access.

We have recognised this tax on ill health in our manifesto. We feel it is easy to identify who needs a medical card and why they are entitled to one. On a more general level, we should push forward with the Sláintecare recommendations to give medical cards to members of the Defence Forces who have to leave due to medical conditions and to all cancer patients. We should grant unconditional medical cards to those with disabilities in addition to, as the Minister of State indicated, expanding these schemes.

I thank the Minister of State very much for her answer. We have a little bit more work to do. I will take the matter up with the relevant bodies.

Anne Rabbitte (Galway East, Fianna Fail)
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The Minister appreciates the importance of the issue. The procedures involved are necessary for maintaining good health and should be performed when recommended by a doctor. It is unfortunate that patients are placed in this difficult position. The Government appreciates the contributions of the pharmaceutical industry to public health in Ireland. However, the industry's engagement with the process for medicines such as these is essential to improving patient outcomes. The State and the HSE cannot compel companies to make pricing and reimbursement applications. The Minister is hopeful that with encouragement from the clinical community, progress can be made here.

April is cancer awareness month. The programme encourages men and women aged from 60 to 69 to take up the offer of screening. Screening offers the chance for early detection before symptoms develop, which often means treatment is more effective that is the case with later diagnosis. The Minister and I are committed to and ambitious about the desire to improve cancer outcomes in Ireland through early detection of disease. I look forward to the Deputy's support for events relating to bowel cancer awareness month in April, which will no doubt raise awareness of the benefits of everybody engaging in early screening processes. I thank the Deputy for raising the matter.