Colm Burke (Fine Gael)
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I am raising this issue because the figures relating to it were brought to my attention yesterday by the Union of Students in Ireland. As Fine Gael's spokesperson on health in the Seanad, I thought it would be appropriate to seek a response in respect of it from the relevant Department.

The Union of Students in Ireland argues that the cost of the relevant medication can vary quite substantially, from €9 to over €45. If one is a medical card holder, one cannot obtain this medication without a prescription.

My argument is that one does not have to get a doctor to diagnose that one needs a prescription. It is a considerable waste of doctors' time if someone goes to see them in order to get a prescription. I am looking at the matter in that context also. There are doctors in universities. If a person has a medical card and they must go to a doctor; the doctor has to give a prescription and his or her time is being taken up. That is a matter I have been asked to raise. I said I would do so at the earliest possible date.

Kathleen Lynch (Cork North Central, Labour)
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We have had brief discussions already on this matter, which I thank Senator Burke for raising. There are currently two emergency hormonal contraception products licensed for sale on the Irish market - Levonelle and NorLevo. Levonelle is a prescription-only product which is available to medical card holders under the GMS scheme, subject to the prescription charge – that everyone has to pay - once they have a prescription from their GP. The other levonorgestrel emergency hormonal contraception product licensed for sale on the Irish market is NorLevo. In February, 2011 the Irish Medicines Board announced its decision to allow the sale of NorLevo without prescription. This product may, therefore, be supplied from pharmacies without a prescription by or under the personal supervision of the pharmacist.

The Pharmaceutical Society of Ireland, PSI, has issued guidelines under section 18 of the Pharmacy Act 2007 to pharmacists requiring that the emergency hormonal contraceptive may only be supplied to a patient by the pharmacist personally, following a private consultation between the patient and pharmacist in order that the pharmacist can determine the appropriateness of the supply and to provide an opportunity to meet the appropriate patient counselling requirements. This consultation is required to take place in the pharmacy's patient consultation area. However, as NorLevo is an over-the-counter product it no longer complies with the applicable reimbursement criteria for the GMS scheme and the community drugs schemes, as a prescription is not normally required for its supply to a patient. Therefore, for all recipients of this product, the supply process is essentially a private transaction between the patient and the pharmacy. The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drugs schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. In that context, one of the criteria which the HSE must have regard to when deciding whether a product should be added to the list of items reimbursable under the GMS and other community drugs schemes is that the product must be such that it is ordinarily supplied to the public on foot of a prescription. Therefore, over-the-counter products are not normally covered under the GMS and other community drugs schemes. Any change in this policy approach would have wide-ranging implications.

The central point is that there is a product which can only be used in emergency contraceptive situations and it is only available on prescription. Anyone who has a medical card can avail of it. I take on board Senator Burke’s point that requiring a prescription makes it a very expensive way to make the product available.

Colm Burke (Fine Gael)
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Could the Minister of State clarify whether the product could be supplied by a pharmacist without a prescription?

Kathleen Lynch (Cork North Central, Labour)
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Yes.

Colm Burke (Fine Gael)
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Is the Minister of State saying that if someone has a medical card a prescription is not required?

Kathleen Lynch (Cork North Central, Labour)
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No.

Colm Burke (Fine Gael)
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Is a prescription required in both cases?

Kathleen Lynch (Cork North Central, Labour)
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In one case a prescription is required and in the other case the product can be bought over the counter.

Colm Burke (Fine Gael)
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Is a person entitled to get the product over the counter if they have a medical card?

Kathleen Lynch (Cork North Central, Labour)
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No. That is not what we are saying.

Colm Burke (Fine Gael)
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Is it not covered by the medical card?

Kathleen Lynch (Cork North Central, Labour)
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The drug is not available on the GMS scheme and therefore the cost cannot be reimbursed either to the pharmacist or the GP. Therefore, it is not covered by the medical card. One emergency contraceptive is covered by the GMS scheme and one does need a prescription for it. Anyone with a medical card can avail of that.

Colm Burke (Fine Gael)
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But they must have a prescription.

Kathleen Lynch (Cork North Central, Labour)
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Yes, because it is only available on prescription.

Colm Burke (Fine Gael)
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I thank the Minister of State.