The Dáil is back in full swing following the Presidential election campaign and planning is underway for two by-elections, one in Galway West to fill the seat of the newly-elected President Catherine Connolly, and one to fill the vacancy left by former Minister for Finance, Paschal Donohoe, who announced he would be resigning as a Minister and a TD to take a new job with the World Bank.
Against this backdrop, Deputies continued to raise pharmacy related concerns, including access to the free HRT scheme, the Community Pharmacy Agreement, and the availability of phased dispensing under the Agreement.
The approach to phased dispensing under the Community Pharmacy Agreement 2025 was raised by a number of Deputies in recent weeks. This focussed specifically on the cost of blister packing services from pharmacies. Concerns were raised by TDs including Cathy Bennett (Cavan-Monaghan, Sinn Féin), Seán Fleming (Laois, Fianna Fáil), Liam Quaide (Social Democrats, Cork East), Micheal Fitzmaurice (Independent Ireland, Roscommon-Galway), and Pat ‘the Cope’ Gallagher (Fianna Fáil, Donegal).
The Minister for Health, Jennifer Carroll MacNeill, in each of her responses to the Deputies explained that, “The Community Pharmacy Agreement 2025 does not remove phased dispensing”. She clarified that Monitored Dosing Systems (blister packs) are different to phased dispensing and that a practice has built up where Monitored Dosing Systems were charged as if for phased dispensing.
Controls will be introduced that will limit the use of phased dispensing to high-risk drugs and to reduce the State expenditure being incurred through Monitored Dosing Systems.
Deputy Johnny Guirke (Meath West, Sinn Féin) raised this same issue with the Taoiseach, Micheál Martin. Outlining that the omission of funding for phased dispensing and for Monitored Dosing Systems “undermines safe medicines management for vulnerable patients, and places an additional strain on pharmacies”, he asked if the Taoiseach would reinstate reimbursement for blister packs and if he could amend the Community Pharmacy Agreement to include this reimbursement.
The Taoiseach said it was his understanding that discussions between the Department of Health and the IPU were ongoing in relation to these and other issues. He said he would raise this with the Minister for Health and will ask her to revert directly to the Deputy.
Another element of the Community Pharmacy Agreement 2025 that was raised in recent weeks was the disposal of unused medicine scheme. Deputy Johnny Mythen (Wexford, Sinn Féin) asked the Minister if the cost of the disposal of medicine is borne by the industry itself or if these costs will be passed to the State.
The Minister advised that the initiative will commence in 2026 following a procurement process, but that it is intended that people can “return unused and out-of-date medicines to their local pharmacies at no cost to them”.
In the Dáil, the free Hormone Replacement Therapy (HRT) scheme continued to be raised by Deputies. As he did last month, Deputy Aindrias Moynihan (Cork North-West, Fianna Fáil) raised the exclusion of Veozah, the HRT drug, which is not available under the free HRT scheme. The Taoiseach, Micheál Martin, explained that “the HSE is currently considering the application for Veozah.”
Deputy Pádraig Rice (Cork South Central, Social Democrats) raised the issue of the cost of HRT treatment and if transgender women were excluded from the scheme. Similarly, Deputy Ruth Coppinger (Dublin West, PBP-Solidarity) raised HRT treatment twice in the past number of weeks and asked if transgender men and women were excluded from availing of the scheme.
Deputy Coppinger asked the Minister, “the reason a distinction was made between women who have their ovaries removed and those born without them in the case of transgender women to get access to the free HRT scheme”.
The Minister outlined that the free HRT scheme is intended to support women who have been prescribed HRT to alleviate the symptoms associated with all stages of menopause, and that “the diagnosis of any medical condition and the prescribing of treatment for said condition is a matter for a patient and healthcare provider to discuss”.
The Minister for Health advised, in response to both queries, that the current provision of the free HRT scheme limits eligibility to those prescribed HRT by a healthcare provider to alleviate the symptoms associated with all stages of menopause.
In a related query, both Deputy Ruth Coppinger and Deputy Barry Ward (Dún Laoghaire, Fine Gael) asked about the systems in place to identify if an individual is eligible or ineligible for the free HRT scheme. The Minister advised that this is done through Healthmail and is managed by eHealth Ireland and supported by the Irish College of General Practitioners and the IPU.
Deputy Pádraig Rice also asked the Minister if men prescribed HRT for low testosterone levels would be able to avail of the free HRT scheme. The Minister for Health shared that “there are no plans to expand the eligibility of the Free HRT Arrangement at this point”.
More generally, Deputy Martin Daly (Roscommon-Galway, Fianna Fáil) asked the Minister for the number of people that have availed of the free HRT scheme since its introduction. The Minister redirected the Deputy to the HSE who would respond directly to the Deputy with the information.
The shortage of salbutamol nebuliser solution in community pharmacies was raised by Deputy Micheál Carrigy (Longford-Westmeath, Fine Gael), who asked the Minister for Health, if she will “ensure that vulnerable patients who rely on nebulised salbutamol for COPD or asthma relief are prioritised for access where clinically available”.
The Minister provided an overview of the current shortage, which is due to “an unexpected increase in demand globally and manufacturing delays”. She advised that that if the shortages result in a significant public health impact, the HSE can issue clinical guidance to healthcare professionals.
Deputy Paul McAuliffe (Dublin North-West) raised the issue of a shortage of Estradot and asked the Minister if she could share when it will be available again for prescription for patients of the menopause hub.
The Minister advised that the manufacturer of this drug notified the HPRA that this shortage was “due to a manufacturing delay impacting multiple countries”. She shared that despite efforts to improve supply, the company are unable to advise of an exact date for resolution of the shortage.
Leader of the Social Democrats, Deputy Holly Cairns (Cork South-West, Social Democrats) asked the Minister for Health about her Department’s work to improve access to EpiPens in local communities.
The Minister advised that community pharmacies, which she describes as “the most accessible and trusted healthcare providers in Ireland”, are authorised to administer emergency medicines. Under the Community Pharmacy Agreement 2025, a recurring allowance of €525 will be available to community pharmacists in order to train and ready pharmacists to respond to administer emergency medicines safely.
Seeking information on the progress that has been made on the digitalisation of healthcare services, Deputy Erin McGreehan (Louth, Fianna Fáil) asked the Minister for an update on the Digital for Care: A Digital Health Framework for Ireland 2024-2030 Framework. The Minister for Health provided a comprehensive response to the Deputy, outlining the goal of the Framework to “set a roadmap to digitally transform health services and improve access for patients”.
The Minister shared an update on a number of pieces of work involved in the Framework, including the success of the HSE Health app, the phased rollout of the National Shared Care Record (NSCR) technology platform, which is set to begin in Q4 2025, and the National Electronic Health Record (EHR) system, which the HSE has developed a preliminary business case for.
The final item the Minister mentioned in her response is the delivery of a National Electronic Prescribing (NEP) service, which the HSE published a tender for in May and is currently shortlisting vendors for. This would see the implementation of a fully integrated e-prescription service, enabling the secure and efficient transmission of electronic prescriptions and dispensations for patients.
The Minister shared the importance of this service by saying, “digital versions of medications information is a foundational component of a digital health record and importantly, a key starting point for national health services on a journey to deliver wider electronic health records for all”.
Deputy John Paul O’Shea (Cork North-West, Fine Gael) asked the Minister if she would share the discussions between her, her Department and the HSE regarding the cancellation of the tender that would see the introduction of enhanced influenza vaccines for those over 65.
The Minister provided a comprehensive overview of the considerations her Department and the HSE made, and shared that ultimately the decision was made that the current enhanced vaccines available for older people “met the criteria set out in the Health Technology Assessment for net monetary benefit compared to standard flu vaccine”.
This issue was also raised by Deputy Colm Burke (Cork North Central, Fine Gael), who shared the success of the vaccine programme in Scotland which saw “a 62 per cent reduction of people in the age group 75 to 79 being admitted to ICU.”
Responding to him, Deputy Leader of Fianna Fáil, Minister Jack Chambers responded to say that the National Immunisation Office (NIO), “is continuously ambitious in terms of broad vaccination”, and that he would raise the issue with the Minister and the NIO, with specific reference to the Deputy’s specific question relating to the learnings from Scotland.
A number of Deputies asked the Minister for Health if she had plans to introduce a free shingles vaccine for older people, including Deputy Naoise Ó Muirí (Dublin Bay North, Fine Gael), Deputy Ciarán Ahern (Dublin South-West, Labour Party), Deputy Marie Sherlock (Dublin Central, Labour Party), Deputy Seán Crowe (Dublin South-West, Sinn Féin), and Deputy Erin McGreehan (Louth, Fianna Fáil).
The concerns were summarised by Deputy Naoise Ó Muirí who asked the Minister the reason the shingles vaccine is not currently subsidised, “despite its proven effectiveness in preventing shingles, particularly among older adults” and asked if her Department is considering a scheme to make the vaccine more affordable.
The Minister shared that the Health Information and Quality Authority (HIQA), which carried out an assessment on the vaccine, found that a free shingles vaccine programme would have “substantial budget impact” and that “its protective effect diminishes over time”. She said that on this basis, it was found not to be a cost effective vaccine programme, but would be if the cost of the vaccine reduced by 80 per cent.
Brian Harrison
Managing Director, MKC Communications
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