Generic substitution enables pharmacists to substitute a brand medicine for a generic version, which has been designated as interchangeable by the HPRA. The HSE will reimburse notified reference price drugs for relevant interchangeable products. Where a prescriber wishes for the medicinal product to be exempt from substitution for clinical reasons, they must write in their own handwriting, or print, “Do Not Substitute” on the prescription in healthmail.
A co-payment from the patient will apply when they wish to take the branded medicinal product but “Do Not Substitute” is not written on the prescription or recorded in the case of Healthmail prescriptions. On these occasions the patient is legally liable to pay the difference between the reference price and the product price when availing of any community scheme as set out in law under Section 26 of the Health (Pricing and Supply of Medical Goods) Act 2013. This co-payment is in addition to the GMS levy and DPS payment. Reference pricing applies to all the community schemes including LTI.
For reimbursement purposes, if a patient presents with a non-GMS prescription where the prescriber has written ‘Do Not Substitute’, the pharmacy should retain a photocopy of the prescription and make it available to the HSE to validate any claim for extra costs arising.
Patients who have any issues with the above law can be directed to their local government representative.
