October saw the announcement of landmark legislation aiming to expand the role of pharmacies in Ireland. The General Scheme of the Health (Miscellaneous Provisions) Bill 2023 has already been published. This new legislation, when enacted, will enhance the Minister’s power to make regulations for the management of, and access to, medicinal products.
Speaking upon its publication, Minister for Health Stephen Donnelly TD (Wicklow, Fianna Fáil) said; “I have been clear that I want to further enhance the contribution that pharmacists make to our health services, and this will be an important step forward in that regard.” He also stated his wish to progress this legislation as a matter of priority.
In tandem with this positive development there has continued to be support across the aisles of Leinster House for community pharmacies.
Among the TDs expressing support for the pharmacy profession was Deputy Andrias Moynihan (Cork North West, Fianna Fáil), who asked Minister for Health, Stephen Donnelly TD, “if pharmacist services can be expanded to aid in alleviating some of the pressures currently experienced in GP services”.
In response to the question, Minister Donnelly said that his department recognised the “value and importance of pharmacies and pharmacists in conserving, protecting, and enhancing the health of our citizens”.
The Minister added that pharmacy services have the potential to evolve to enhance “optimal patient outcomes”.
The Minister also spoke about the establishment, in July, of an Expert Taskforce to examine the role of pharmacists in Ireland. Minister Donnelly stated that the Taskforce will carry out its work in the months ahead, and aims to deliver the first set of recommendations to the Minister as requested by the end of October 2023. Following this, the Minister said he will work with and direct officials to implement reforms.
The subject of pharmacy fees was also addressed by Minister Donnelly, this time in response to Deputy Michael Healy-Rae (Kerry, Independent).
The Minister outlined that the pharmacy fee structure, “must be reviewed every third year after 2020”, adding that his Department is currently carrying out a comprehensive review. The Minister alluded to “constructive engagement between Department officials and the Irish Pharmacy Union, that has taken place in recent months, and continues”.
As Budget 2024 was taking shape, the subject of prescription charges was raised by Deputy Richard Bruton (Dublin Bay North, Fine Gael).
Deputy Bruton asked the Minister for Health, “the prescription charges now paid by medical card holders and if the level of these thresholds is under review”.
While the Minister did not comment directly on the prospect of reviewing charges, he did outline a range of measures that the Government is taking to make healthcare more affordable and accessible.
Minister Donnelly also highlighted the reductions in the DPS threshold which occurred twice in 2022.
As winter approaches, vaccines and the vaccination programme have become topical in the Dáil once again.
In this context, Deputy Éamon Ó Cuív (Galway West, Fianna Fáil) asked the Minister for Health Stephen Donnelly TD, whether “an injection which lessens the chances of contracting shingles is covered under the GMS”.
The Minister confirmed that currently, “the HSE does not supply vaccines or provide reimbursement support for vaccines through community pharmacies under the statutory drug schemes”.
The Minister added that the “shingles vaccination is not currently provided as part of the national immunisation programme, but that it is open for a person to attain a vaccine from a GP or pharmacy, which is outside of the national immunisation programme”.
Separately, in response to a question by Aodhán Ó Ríordáin TD (Dublin Bay North, Labour), the Minister advised that HIQA are currently “carrying out a Health Technology Assessment (HTA) on the herpes zoster vaccine which protects against shingles”.
A HTA is a multidisciplinary research process that collects and summarises information about a health technology. Minister Donnelly said that, “the outcome of the HTA, once it is complete, will inform future decision making on this matter”.
General Practitioner services were also been raised in the Dáil in early October, with Sinn Féin Health Spokesperson David Cullinane TD (Waterford), asking the Minister for Health to “outline the details of the new GMS GP deal that was agreed over the summer of 2023”.
The Minister advised Deputy Cullinane that the GP Agreement 2023 is available online from both the Department of Health and HSE websites. Commenting on the provisions, the Minister highlighted some of the details including, “a new support for practice staff during maternity leave, a €2 million additional support for GP Out of Hours services and increased special items of services fees for contraception services for female GMS patients outside the Free Contraception Service”.
Several TDs have raised the topics of women’s health and contraceptive services with Minister Donnelly.
Deputy Emer Higgins (Dublin Mid West), asked for details on the progress made by his Department to promote women’s health. Providing the update on the progression of the promotion of women’s health, Minister for Health, Stephen Donnelly highlighted that in 2022, €9 million in funding was provided to enable access to free contraception for women aged between 17-25. In 2023, this scheme was extended to cover women aged 30 and under.
The Minister emphasised that this expansion adds to creating a health and social care service that offers affordable access to quality healthcare. Additionally, the Minister also stated that “€32 million was allocated to support the free contraception for women scheme, which included scheduled expansions”.
Deputy Donnchadh Ó Laoghaire (Cork South Central, Sinn Féin) asked if the Minister intends to ensure that people on lower incomes who do not have an entitlement to a medical card can be in a position to buy emergency contraception.
Minister of State with responsibility for Public Health, Well Being and the National Drugs Strategy, Hildegarde Naughton (Galway West, Fine Gael), answered by outlining the expansion of the free contraception scheme, while also highlighting that the scheme also covers the cost of consultations with GPs and family planning centres. The Minister added to the answer by anticipating that “wider access to more reliable methods of contraception, free of charge, through the free contraception scheme, may reduce the demand for emergency contraception”.
Throughout the past month there continued to be regular inquiries by politicians into the status, regulation and availability of many medications.
Concerns have been raised about the potential abuse and misuse of the drug Pregabalin, a prescription drug used to manage several long-term conditions, including epilepsy, neuropathic pain and generalised anxiety disorder.
During a parliamentary question and answer session on Medicinal Products, Aodhán Ó Ríordáin TD (Dublin Bay North, Labour), asked the Minister for Health about the measures being taken by his Department of Health to increase awareness of the dangers of Pregabalin and if the Minister will make Pregabalin a controlled substance.
Minister Donnelly highlighted that in September 2021, the Irish Medical Council had advised all doctors who were prescribing Pregabalin to follow the best practice, and to “only prescribe when required”. The Minister told Deputy O’Ríordán, that presently there are no “plans to control pregabalin under the Misuse of Drugs Act 1977”.
The protocols for the reimbursement of Cariban have continued to be scrutinised in recent weeks.
Deputy John Lahart (Dublin South West, Fianna Fáil) asked Minister Donnely if he “is considering the repeal of the requirement for a consultant’s signature to sign off on the prescribing of Cariban”. Deputy Lahart also noted some GPs feel that they should be able to prescribe Cariban without there being a financial penalty to the patient. Similar concerns were also raised by Jennifer Whitmore TD (Wicklow, Social Democrats). The Minister directed both questions to the HSE for response and added that the HSE has a “statutory responsibility for pricing and reimbursement decisions under the community schemes”.
Deputy Jennifer Murnane O’Connor (Carlow-Kilkenny, Fianna Fáil) asked about “the possibility for Saxenda and Ozempic to become part of the drugs payment scheme or medical card scheme for non-diabetic patients”.
The Minister responded to the Deputy saying, “Saxenda has been made available for reimbursement support under the community drug schemes since 1 January 2023”. Further points were made with regards to Ozempic as the Minister stated that it is only “available to those with eligibility under the General Medical Services Scheme or the Long-Term Illness Scheme”.
Brian Harrison
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