David Cullinane (Waterford, Sinn Fein)
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346. To ask the Minister for Health the cost of expanding the contraception scheme to be universal in coverage. [30355/24]

Colm Burke (Cork North Central, Fine Gael)
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The free contraception scheme was launched in September 2022, for women and girls ordinarily resident in Ireland, aged 17-25. The scheme was gradually extended to women aged 17-31 inclusive and was further expanded on July 1st, 2024 to include women aged 32-35. Almost 2,400 GPs and 2,050 pharmacies in all regions of the country have signed up to provide services and products under the scheme to date; it can be accessed across the country. Following the most recent expansion, the budget for the scheme in 2024 is approximately €48m.

The scheme covers the cost of consultations, and, where appropriate, fittings, checks and removals of contraceptive devices, with GPs, family planning, student health and primary care centres. It also covers the cost of prescriptions for the wide range of contraceptive options available through the Health Service Executive (HSE) Reimbursement List. These options include long-acting reversible contraception (LARCs); injections, implants and hormonal and copper coils. It also includes emergency contraception in addition to the oral contraceptive Pill, patch and ring.

The Report of the Working Group on Access to Contraception, published in 2019, and still available on my Department's website, estimated the likely costs of a universal, fully funded State scheme for contraception. Based on uptake rates of 50% - 100%, the report estimated total costs as between €83.15 million to €156.64 million to extend the scheme to 16-44 year-olds. Adjusting these estimates to 17-55 year-olds, the costs would range from €108m to €203m.

However, real world information drawn from the "real world" operation of the scheme to date shows that original cost estimates were overestimated; typical access rates are currently slightly less than 50% for eligible age cohorts, reducing with age. Peak per capita access to the scheme seems, from data available so far, to be from ages 19-24. As women reach their late 20s and early 30s and a larger proportion take breaks from contraception to plan families, costs per additional age-cohort are reducing. Moreover, the clinical guidance on some of the long-acting reversible contraception has changed; for example, some of the hormonal coils can be left in for longer, while still retaining effectiveness. On balance, based on the current data available to us from the first 18 months of scheme operation, the most likely cost range for full extension of the FCS to 17-55 year-olds will be between €85m and €105m.

The above estimate is based on the mix of contraceptive methods currently available on the HSE Reimbursement List and is therefore subject to change. For example, any increase in LARC uptake will be associated with an increase in costs in the short-term, given relatively high up-front costs for inserting devices. This is likely to be marginal and should be offset in the longer term, given the greater cost-effectiveness of such products over their lifespans.

The costs of including women over 40 are likely to vary from younger cohorts - LARC uptake in this cohort may be higher as hormonal coils and implants are effective in treating peri-menopausal symptoms such as heavy menstrual bleeding, and may be preferred by women who have completed their families. Moreover, some forms of the contraceptive Pill are not recommended above the age of 50.

Finally, it should be noted that the introduction of new products to the Reimbursement List, ongoing incremental changes in contraceptive preferences and changing clinical guidance over time can all have different impacts on the costs of a demand-led service such as the free contraception scheme.