Seanad debates
Thursday, 1 June 2023
Nithe i dtosach suíonna - Commencement Matters
Medicinal Products
9:30 am
Lisa Chambers (Fianna Fail)
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I welcome the Minister of State, Deputy Heydon, to the Chamber and thank him for being here to issue the Minister's response. The Minister of State will be aware that hormonal replacement therapy, HRT, has seen somewhat of a resurgence and there has been a huge increase in demand in recent years. This is in large part due to a public information campaign run by the Government on the benefits of using hormone replacement therapy when going through menopause or perimenopause but also because of the work of many individuals, organisations and public representatives in highlighting the need for better menopause care for women.
The population of Ireland is 51% women and every single one of us will at some point or other go through perimenopause and menopause. It is a very normal part of the ageing process and just presents a new chapter in life, and it should not be one that presents health difficulties. For some women, it gets to a situation where they cannot go to work, they cannot function and they cannot go about their daily life. These medicinal products are very important. They are not luxury products; they are essential to just going about your daily business, looking after your family, going to work and living your life.
As a result of the increase in demand, these products are quite expensive and they have become more difficult to get. I am aware there are shortages of a lot of medicines in the country, so it is no surprise it is impacting HRT medicines as well. One woman told me that her prescription would normally be a particular volume of medication, with a 100 g tablet, but they are no longer available and she has been told to buy the 200 g tablets and just take them every second day. It does not sound like the type of prescribing I would like to receive from my doctor or pharmacist, but needs must, and that is all that is available for her and these are essential tablets.
A big part of the reason that I wanted to raise the matter this morning is that there is a huge disparity in pricing among pharmacies. To give an example of a very commonly used product, the Oestrogel pump pack is often prescribed with oestrogen tabs.Across three pharmacies, the price ranged from €23.59 to €33.95 and €44.12. One pharmacy is nearly double the price of the other for the same product. Pharmacies are not giving the full six-month prescription. People have to come back month on month, incurring prescription charges, additional hassle and cost that should not be there. Why is there this disparity in pricing? Why are pharmacies charging wildly different prices for the exact same product? Why can a woman not fill her six-month prescription, bring it home and be done with it for six months, rather than having to traipse back into the pharmacy each month?
Women in the Republic are ordering HRT products from the North or further afield and getting them posted to them because it is easier. It should not be easier to order from the North than to pop to the local pharmacy, nor should it be cheaper. They are significant problems women have to deal with. Credit to the Government for the menopause campaign running in recent months and the advertising campaign that has happened. Alongside that, we have dispelled myths that were there for many years suggesting HRT causes cancer and is bad for you and that you need to suffer and go it alone. It could be seven to ten years of going it alone. That is how long a woman can be in need of this type of medication, maybe even longer. For some, it is shorter. It varies woman to woman.
I developed the Fianna Fáil women’s health policy last year in consultation with thousands of women across the country. A policy recommendation in that document is to make HRT products free. I would like the Minister of State to respond to that. We owe it to women at that stage to make these essential medical products free and get rid of issues with access, cost disparity and the hassle involved in accessing these products.
Martin Heydon (Kildare South, Fine Gael)
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I thank Senator Chambers for raising this important issue relating to women's health and for her ongoing work in respect of it. The Minister for Health sends his apologies that he cannot be here.
As recommended in the Women's Health Action Plan 2022-2023, launched in March 2022, the Government aims to increase the public supports available to women before, during and after the menopause. This has included the provision of improved information, awareness, and treatment for women experiencing menopause in Ireland. Achievements to date include the It's My Time initiative, established in partnership with Sport Ireland, which aims to encourage women over 40 to increase physical activity levels, which can be helpful in managing menopause symptoms, and the establishment of a GP clinical lead for women's health funded by the women's health fund. In October 2022, the Minister for Health, in partnership with the Irish College of General Practitioners, ICGP, launched a quick reference guide for menopause, which gives evidence-based information on menopause management in general practice; also in October 2022, the national menopause awareness campaign was launched to inform, educate and lift the taboo around menopause. The campaign was accompanied by a dedicated Government web page as a one-stop shop to provide trusted information for anyone affected by menopause in Ireland.
Other important initiatives include the development of six specialist menopause clinics to treat complex symptoms of menopause. Five of the six planned clinics are currently open and operational at hospital sites around Ireland. There are three clinics in Dublin, one in Galway and one in Tipperary. The sixth clinic, located in Cork, is due to open later in 2023. These clinics treat complex symptoms of menopause.
In relation to the costs for HRT medications within the public system mentioned by the Senator, the onus is on a company to apply to the HSE to have a medicine added to the reimbursement list under the community drug schemes. Many HRT products are currently reimbursable by the HSE on both the general medical services, GMS, scheme and the drug payment scheme, DPS. Medical card holders can access these reimbursable HRT products, subject to payment of the statutory prescription charge. The DPS ensures that no individual or family pays more than €80 per month towards the cost of approved prescribed medicines, which includes the reimbursement of HRT products. The DPS threshold was reduced to €80 per month on 1 March 2022 in recognition of the rising cost of living. The DPS is not means-tested and is available to anyone ordinarily resident in Ireland.
While there are no plans to make the provision of HRT products free of charge, the removal of VAT from non-oral forms of HRT medication since 1 January 2023 has also improved access to HRT treatment for women across the country.
Finally, neither the Minister for Health nor the HSE has any role in the setting of prices for medicines dispensed privately in pharmacies. These are commercial matters for the pharmacies themselves.
Lisa Chambers (Fianna Fail)
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I thank the Minister of State for his reply. I note the achievements in women’s health under this Government that have been significant and transformative. We have come from a low base. We had a lot to do and have achieved a lot in recent years. I mentioned the menopause campaign. Of course, the women’s health lead in the ICGP was significant. I worked with the Minister for Health to put that in place, and the menopause measures as well.
The problem with the DPS is, because pharmacies will not dispense the full six months, people are coming back month on month. They never pass the €80 threshold so do not really benefit from that. I acknowledge that it is there. If they could get the full six-month prescription in one go, they would benefit because they would max out at €80. Maybe it would be worth looking at allowing people draw down the full six-month prescription they get from their GP. I acknowledge the position regarding medical card holders, but that is not everybody. I am talking about universal access.
We have done much in this country for different stages. We have made contraception free for a certain number of women. That is fantastic for younger women. Now we have started to fund fertility treatment for women at a certain stage in their lives. For women at a later stage in their lives, we owe it to them to try to do something financially on a product that is essential, that you cannot do without and could be taking for a decade or more.
I ask the Minister of State to take this back to the Minister to reflect on the need - while we have addressed younger women and those in mid-life - to look at women of more mature years and to do something on that front. If work could be done on getting access to prescriptions whereby people could draw down the full six months, the DPS would then be of benefit. At the moment, it is not really applicable. I appreciate the indication towards that.
Martin Heydon (Kildare South, Fine Gael)
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The point the Senator makes about the six-month dispensing not happening is practical. That matter is not referenced in the response I have from the Minister for Health. I will bring it back to the officials and Minister to highlight it to them. It is all well and good to talk about the DPS but for those getting it monthly and not passing the €80 limit, it will not have the benefit it can have. The State wants that benefit to be there.
The response I was given clearly states that it is not the plan to have this free, but that is under the impression the DPS covers everybody of all income types and none. The DPS is universal. We need two things: for the companies to apply for the drug to be covered under the DPS, which we do not control, and for it to be dispensed in a form that would allow that to happen. I am not sure if there are clinical or medical reasons for it not being dispensed for six months. If there is a requirement to go back to the doctor to check the position in that regard, that might be a consideration. I will bring the points the Senator made back to the Department of Health and the Minister.