Ivana Bacik (Dublin Bay South, Labour)
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609. To ask the Minister for Health the position regarding persons who have paid for IVF in respect of the publicly funded scheme; his plans to ensure that such persons are compensated; and if he will make a statement on the matter. [46659/23]

Stephen Donnelly (Wicklow, Fianna Fail)
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As the Deputy may be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government.

‎The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary. ‎

This Model of Care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF (in-vitro fertilisation) and ICSI (intra-cytoplasmic sperm injection)), with patients being referred onwards through structured pathways.

Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention without the need to undergo invasive IVF or ICSI treatment. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of treatments and interventions, including: relevant blood tests, semen analysis, assessment of tubal patency, hysteroscopy, laparoscopy, fertility-related surgeries, ovulation induction and follicle tracking. All six Regional Fertility Hubs are currently operational.

Phase Two of the roll-out of the Model of Care relates to the introduction of AHR treatment, including IVF, provided through the public health system at tertiary level. In particular, the first steps have been taken towards achieving the ultimate objective of Government, which is a wholly publicly-provided fertility service.

As an interim measure, I instructed that some funding be made available to support access to advanced AHR treatment via private providers from September 2023. As well as IVF and ICSI, this allocation is also being used to provide, initially through private clinics, IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive treatment.

Referrals for AHR treatment by private providers have commenced in September 2023 after details of how the new initiative would be initially rolled out - including regarding the set of criteria which prospective patients should meet in order to access fully-funded AHR services and the specific services to be initially funded - were agreed by the Department and NWIHP and then brought to Cabinet in July 2023. The criteria were agreed following consultation with experts in the field of reproductive medicine and include limits in respect of the age of the intending birth mother, body mass index (BMI) and the number of children a couple already have. They are very much in keeping with those applied in other jurisdictions, even though in most European countries, for instance, such treatments are only partially funded and require often significant out-of-pocket payments by patients. More details on public fertility services generally, including information on the new publicly-funded AHR treatment initiative, are available from the HSE at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/

Regarding your query whether the persons who have paid for IVF will be compensated, as indicated above, referrals for publicly-funded AHR treatment for eligible patients from the Regional Fertility Hubs to approved private clinics commenced in the week beginning September 25^th2023. It is important to ensure that patients are clinically determined by a consultant in a Regional Fertility Hub for IVF, ICSI or IUI before being referred for such treatment, having undertaken at the Hub, as appropriate, extensive consultation, assessment, and the types of procedures and interventions outlined above which are available at the secondary care level. Therefore eligible patients who are referred from a Regional Fertility Hub after the “go live” date can avail of the new publicly-funded AHR treatment initiative and there will be no reimbursement for patients who have paid for treatment privately either prior to this date or after this date without having been referred by a Regional Fertility Hub.

It is important to note that a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. Given the costs associated with certain fertility medicines, I understand that these schemes can have a material impact on the total cost of AHR treatment for individuals who avail of them. In this regard, according to figures from the HSE, a total of over €40m was spent on what it termed as fertility drugs in 2022.

In addition, there is other support available in that patients who access IVF, or other advanced AHR treatment, privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.

My Department and the Government are focused, through the full implementation of the Model of Care for Fertility, on ensuring that patients receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.