Marie Sherlock (Dublin Central, Labour)
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113. To ask the Minister for Health the action she has taken to ensure that community pharmacists will administer the free hormone replacement therapy, HRT, scheme from 1 June 2025; and if she will make a statement on the matter. [24511/25]

Marie Sherlock (Dublin Central, Labour)
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I put it to the Minister that 1 June is 19 days away. The majority of pharmacists I have spoken to - and have spoken to many - tell me they are not signing up to the free HRT scheme. I understand that no communication has been made to the pharmacists about the software. It is my understanding that the providers of the software have not been given any information by the Department about adding free HRT to the system. Most pharmacists are opposed and no IT system is in place. What actions has the Minister undertaken to ensure the women of this country can access free HRT from 1 June?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy for the question; it is an important one. I thank colleagues for their support on the approach taken to date. I want to be absolutely clear in relation to the intention with regard to the HRT initiative. Budget 2025 aimed to continue the good work ongoing to improve women's healthcare, and in particular to support women on their menopause journey. It was originally intended the State would pay for the HRT product - for the medicine - and pharmacies would be free to continue to charge a professional service fee to women who are not eligible either for the GMS or the drug payment scheme, DPS, while recognising there are many women who are getting this for free already. The programme for Government then re-emphasised the scope of that commitment.

I have prioritised substantial engagement with the Irish Pharmacy Union to find a pathway forward on the issue. I listened to its position - and this is important - that its members did not want to see the cost of medicine and the dispensing fee decoupled under a State-funded arrangement. Nevertheless, the Deputy will be aware that I did of course give them that option to charge the fee they are currently charging. In the spirit of compromise I offered to invest healthcare funding on dispensing fees, which was not intended from a healthcare budget perspective and not intended as Government policy in this space. I offered every participating pharmacy a €5 dispensing fee for each and every HRT product. The €5 fee is the highest fee paid under the community drug scheme to date. It is essentially a 15% to 20% increase on the existing dispensing fee for those products under the GMS and DPS at present. I made that in order that it would be an uplift for all of the women who are on the GMS or DPS. It would be a 15% to 20% uplift on the average dispensing fee paid in that case. Of course it would be €5 for all of those private patients who are paying at the moment. I made that offer to every pharmacy by writing directly to them. I also spoke at the IPU conference last Saturday.

Marie Sherlock (Dublin Central, Labour)
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I thank the Minister for the reply. At the heart of this mess are women on HRT and the women who could be on it. For non-GMS patients, the cost is €35 to €70 per month. This is a serious amount of money for many women. I am hugely passionate about this scheme but this crack of announcing first and working out the details later is simply unacceptable. There are four key issues here, the first of which is the lack of HRT. We want to give out free HRT and yet we know there are enormous stock shortages in the system. Pharmacists now are having to seek out unlicensed medicines, which are not recognised with the primary care reimbursement service, PCRS, and costing on average €15.90 while the GMS is only paying €6.47. It is either the patient or the chemist who will have to absorb that greater cost. This is going on right across the country at this point in time. The second issue is the IT system. I do not know if the Minister has looked at this but there is a key issue about adding that into the software. There has been no information to date on that. The third issue is co-operation with the sector. With the greatest of respect to the Minister, the effective use of power means sitting down and talking. Going on to Joe Duffy to issue a diktat is not how to go about it. The Department has-----

Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I will give the Deputy another chance to come back in.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The first thing is that I issued a press release in relation to this and then went on a media outlet. I must check when the Deputy last went on a media outlet and whether she regards that as an effective way of communicating either her party's position or to her constituents in any way.

It is certainly a way for the Government to communicate, as we often do. The fact that we go on a different show means what, exactly, aside from being a way of communicating directly and taking questions, having issued a press release and having engaged? There is no question of power in this regard; it is a question of delivering for women. I suggest, very carefully, that the Deputy goes back and discusses the IT system issues with whoever has briefed her regarding it. I have correspondence that says there are no IT issues, and we should watch that progress over the coming days and weeks.

I acknowledge the lack of HRT. There is an issue of medicine shortages across Europe, as we have discussed before. That is precisely why I have tried to recognise the experience and expertise of pharmacists to make sure they are recognised for what they do. I am not exactly sure what the Deputy would have me do differently. I made them two offers: one was an uplift of 20% and the other was an offer to charge anything they liked. I am not sure what the Labour Party position would have me do on behalf of the women of Ireland in order to get this effected, but perhaps the Deputy might advise me.

Marie Sherlock (Dublin Central, Labour)
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The first thing was to have written to every pharmacist in the country-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I did.

Marie Sherlock (Dublin Central, Labour)
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I wrote to pharmacies across-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I did.

Marie Sherlock (Dublin Central, Labour)
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----- my constituency. The first they heard of it was on "Liveline". The key thing is that the Department-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is just not true.

Marie Sherlock (Dublin Central, Labour)
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----- has form on this. With regard to the Covid vaccination, the first pharmacists heard of it was through the airwaves. The prescription extension scheme was introduced last September, and no homework was done on it. GPs are writing "do not repeat" scripts. There was no fee agreed with the pharmacists. The scheme is not operating as intended. On the fee itself, there is a sense out there that the diktat of €5-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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A diktat.

Marie Sherlock (Dublin Central, Labour)
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----- is the straw that is breaking the camel's back. We are all clear that pharmacists are not on the breadline.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I cannot believe this.

Marie Sherlock (Dublin Central, Labour)
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It is extremely foolish to assume that the pharmacy sector is like what it was 20 years ago. This is about recognition and respect for what pharmacists are delivering. A figure of €6.50 was agreed for the contraception scheme. I get that a negotiation has to take place - I come from a trade union background - but to my mind, no negotiation took place here.

With regard to the IT system, I have looked at the software.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Sure.

Marie Sherlock (Dublin Central, Labour)
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An additional line has to be put in. I have spoken to a number of pharmacists - not just one - and they have told me that there has been no communication with them about what will be added to the software to link them to the PCRS by 1 June.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The €5 is the top fee that is paid under the current structure. The €6.50 is the once-off fee for contraception. I gave pharmacists the option to charge above €6.50 - €7, €8, €9 or €10, whatever they wanted - and they refused that. It is a very interesting position for the Deputy to have adopted this evening. I am trying to give every option possible to deliver for the women of Ireland, but I am hearing IPU speaking notes back, which is an interesting position for the Labour Party to take. What is the cost of setting the fee at €6.50 for the rest of the schemes that we have? We can tease this through over the coming days, but I strongly suggest and hope that pharmacists will sign up. The best option for the women of Ireland is a €5 dispensing fee to be paid to pharmacists because it makes it completely free for women. I would have thought that everybody in this House on the side of the women of Ireland would be behind that and working through the other issues that are also there. I engaged strongly with the IPU at its conference and since its conference. I thanked it for its continued engagement. I hope we will find a way through on all of these issues, but I have learned a lot about the Labour Party's position this evening.