Robert Troy (Longford-Westmeath, Fianna Fail)
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428. To ask the Minister for Health if she will reexamine the decision to cease the phased dispensing reimbursement service for certain medications in community pharmacies (details supplied). [68566/25]

Robert Troy (Longford-Westmeath, Fianna Fail)
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429. To ask the Minister for Health if she will reexamine the decision to cease the phased dispensing reimbursement service for certain medications in community pharmacies (details supplied) which cannot be prescribed on a phased basis. [68567/25]

Pa Daly (Kerry, Sinn Fein)
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443. To ask the Minister for Health if she will explain the rationale for the planned increase to blister pack preparation charges under the new HSE–community pharmacy contract; if she will urgently review this policy in light of the disproportionate impact on older patients and those with chronic conditions; and if she will make a statement on the matter. [68616/25]

Pa Daly (Kerry, Sinn Fein)
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444. To ask the Minister for Health if she will consider introducing an exemption or subsidy for medical card holders and older patients who rely on blister packs, given the significant financial burden of the proposed price increase effective from 1 January 2026; and if she will make a statement on the matter. [68617/25]

John Connolly (Galway West, Fianna Fail)
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448. To ask the Minister for Health further to Parliamentary Question No. 1825 of 4 November 2025, the steps her Department expects pharmacies to charge for this service; the supports or alternatives available for low-income individuals who require blister packs for safe medication management but cannot afford the additional cost (details supplied); and if she will make a statement on the matter. [68663/25]

Michael Cahill (Kerry, Fianna Fail)
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510. To ask the Minister for Health if she will urgently address a matter (details supplied) and remove all charges for blister packs for the elderly; and if she will make a statement on the matter. [68890/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I propose to take Questions Nos. 428, 429, 443, 444, 448 and 510 together.

The Community Pharmacy Agreement 2025 was published on the 18th of September 2025, following the successful conclusion of negotiations with the Irish Pharmacy Union (IPU). The Agreement is supported by a €75 million new investment across 2025 and 2026.

The Agreement marks a significant milestone in the strategic collaboration between the Department of Health, the Health Service Executive (HSE), and the IPU. It sets out a comprehensive and ongoing pathway to modernise and expand the role of community pharmacy in Ireland’s healthcare system.

The Agreement is available on the Department of Health’s website at the following link: www.gov.ie/en/department-of-health/publications/community-pharmacy-agreement-2025/.

It is important to note that the Community Pharmacy Agreement 2025 does not remove phased dispensing.

Phased dispensing was introduced in 1996 for patient safety reasons. The supply of medication in instalments can support patients prescribed certain high-risk medications who are at risk of medication misadventure if these medications were to be supplied monthly, as is the norm under the community drug schemes. Where a phased dispensing claim is submitted, the current requirement is that an item must be dispensed in the pharmacy across multiple supply occasions. Community pharmacies receive additional payments in respect of phased dispensing.

Monitored Dosing Systems are systems that enable the individual medicine doses to be organised according to the prescribed dose schedule. These are sometimes referred to as blister packs. The State has never agreed to fund Monitored Dosing Systems.

However, a practice has built up whereby the use of Monitored Dosing Systems are charged as if for phased dispensing. The State has never agreed to this. Phased claiming was never intended to be used to submit claims in lieu of the provision of Monitored Dosing Systems.

Whilst Monitored Dosing Systems may have a role for some patients there is significant uncertainty around the robustness of the evidence supporting its use.

The National Centre for Pharmacoeconomics carried out an evidence assessment which indicated that the evidence was, at best, equivocal to support such a programme.

Significant expenditure is therefore being incurred where it was never intended by the State. It has been agreed to introduce improved controls in this regard and to limit the use of phased dispensing to specified high risk drugs, where a patient safety concern may exist.

Phased dispensing support is currently available for medical card holders under the General Medical Services (GMS) Scheme for the following reasons:

Reason 1 - at the request of a patient's physician.

Reason 2 - due to the inherent nature of a medicinal product i.e. product stability and shelf life.

Reason 3 - where a patient is commencing new drug therapy with a view to establishing patient tolerance and acceptability before continuing on a full treatment regime.

Reason 4 - in exceptional circumstances where the patient is incapable of safely and effectively managing the medication regimen.

Under the Community Pharmacy Agreement 2025, from January 2026, phased dispensing under reason 1 and 4 will be limited to a defined set of high-risk medication classes. These are:

• Psychotropics;
• Opioids;
• Codeine; and
• Pregabalin and gabapentin.

Jen Cummins (Dublin South Central, Social Democrats)
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430. To ask the Minister for Health her plans to cover newer and more effective MS medications that are not yet included in the reimbursement lists to make it easier for patients with MS on lower incomes to access more effective treatments. [68569/25]

Jen Cummins (Dublin South Central, Social Democrats)
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431. To ask the Minister for Health her plans to review the inclusion of all clinically proven MS medications under both the drug payment scheme and the medical card. [68570/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I propose to take Questions Nos. 430 and 431 together.

The State recognises the importance of timely access to new and innovative treatments for patients with Multiple Sclerosis (MS).

The Programme for Government contains a suite of measures on medicines which my officials will seek to progress over the lifetime of this government.

Supported by 158 million euros of funding, in the last four years, the State has delivered access to 243 new medicines. One hundred and one (101) of these were for cancer and 67 of these were for rare diseases. Budget 2026 allocated €30 million for new drugs from €217 million in additional funding for medicines.

It should be noted that once new medicines are approved the full cost of providing them as their uptake increases can reach multiples of their initial cost.

The OECD reports that Ireland has the second highest rate of state coverage of pharmaceutical expenditure in Europe.

The HSE has statutory responsibility for medicine pricing and reimbursement decisions, under the Health (Pricing and Supply of Medical Goods) Act 2013. Reimbursement is for licenced indications which have been granted marketing authorisation by the European Medicines Agency (EMA) or the Health Products Regulatory Authority (HPRA).

Once a company responsible for the commercialisation of a new medicine receives marketing authorisation, it can apply for reimbursement in the country (or countries) of its choice. The timing of company applications for new medicine reimbursement in different countries can vary for several reasons, not least the available market share in each country.

Ireland, by virtue of its size and market share, may not always be prioritised by a company in the first stages of marketing a new product.

Ireland is open for business and actively encourages all Marketing Authorisation holders of new medicines to apply for pricing and reimbursement in Ireland as soon as marketing authorisation is granted by the European Medicines Agency.

The Government has introduced a suite of new measures to enhance capacity in the HSE’s pricing and reimbursement system including 34 additional staff and a medicines application tracker to increase transparency of the process.

Access to medicines requires industry and the State to work together, through timely assessment, and reasonable pricing with fully completed HTAs (Health Technology Assessments) which will ultimately benefit patients.