31 March 2026

Dear IPU Member,

As previously advised, representatives of the Pharmacy Contractors Committee (PCC) have been engaging with the Department of Health (DoH) and the HSE regarding phased dispensing arrangements. Following these discussions, a negotiated proposal has been agreed upon by the PCC and ratified by the Executive Committee.

Under the CPA25 changes to the phased dispensing model were agreed. These were paused with agreement in January and were to be implemented in April. After a period of engagement a new agreement was made between the PCC and state stakeholders.

The new agreement replaces the previous phased dispensing model, in place prior to CPA 2025, with a GMS Medicines Optimisation Service, with an increased focus on medicines optimisation support for patients. Under this model, pharmacists will determine the most appropriate optimisation supports, where clinically indicated, for certain cohorts of medical card patients.

The new arrangements will be implemented from 1 June. Until then, current phased dispensing arrangements remain in place.

To allow members to communicate with their teams and patients the following are the main areas of the agreement:

1. New Medicines Optimisation Fee
A new medicine optimisation fee of €0.35 per GMS item will be introduced, across all GMS items, resulting in revised GMS dispensing fees as follows:
• €4.10 fee + €0.35 optimisation fee→ €4.45
• €4.50 + €0.35 optimisation fee → €4.85
• €5.60 + €0.35 optimisation fee → €5.95

The new fees will be applied across all GMS dispensing (does not apply to LTI or DPS fees) and support pharmacists in delivering clinically appropriate medicines optimisation interventions for an agreed cohort of patients (as listed in section 3 below).

2. Enhanced Medicines Optimisation Patient Support Fee
GMS patients requiring a higher level of support (e.g. dispensing more frequently than weekly) will qualify for a monthly medicines optimisation patient care fee of €32.50, where:
• The patient is prescribed a medicine from a specified class; AND
• The prescription directs the medicines to be supplied at intervals of less than one week
The new fee arrangements are intended to cover:
• GMS patients requiring medicines optimisation for clinical or safety reasons (as outlined in section 3 below); and
• All GMS patients who were receiving phased dispensing or MDS free of charge as of August 2025.
These patient groups must not be charged for these services.

3. Patient Groups who may benefit from Medicines Optimisation Support
The new fees will support the provision of optimisation supports (as outlined in section 4) to people in the cohorts below where deemed clinically appropriate:
• Patients who are on high-risk medicines and are at risk of misuse or abuse of these medicines.
• Patients with physical impairments affecting use of standard packaging (who do not have carer support).
• Patients diagnosed with cognitive impairment or dementia who have carer support (including home care).
• Patients with an intellectual disability.
• Patients unable to manage medications due to social inclusion factors (e.g. homelessness or marginalisation).

4. Types of Medicines Optimisation Supports
There are many different optimisation supports available which can help patients to use their medicines safely and effectively:
• Reasonable adjustments to support the person to use original packs of medicines may include:
– reminder charts.
– winged bottle caps / easy open lids.
– large print labels, braille and talking labels.
– alarms (such as notifications on mobile phones).
– tablet splitters.
• Patient counselling to support understanding, identify techniques for self-management and monitoring and support adherence.
• Dosette boxes.
• ‘Know, Check, Ask for Safer Medicines Use’ supports.
• Instalment dispensing.
• Monitored dosage systems (MDS) or blister packs.
The agreement details that, in line with the available evidence and international practice, MDS should continue to be a last resort due to the known risks associated with them and having regard to the fact that they may impact patient autonomy and empowerment. Engagement with prescribers is also planned to emphasise the lack of evidence for MDS and the risks of removing medicines from their original packaging.

5. Private Fee Arrangements
GMS patients who do not require medicines optimisation support for clinical or patient safety reasons (as outlined in section 3), but who wish to avail of optimisation supports, may be offered this as a private service where appropriate.
MDS for GMS patients living in residential care settings will not be provided free of charge under this agreement.

6. Member Briefing Webinar
To support members, a webinar will be held as soon as all the details are finalised. We will notify you of the time and date as soon as possible. In the interim, if you have any questions, please submit them to info@ipu.ie. These will inform the webinar discussion.

I appreciate there will be questions in relation to this and a more detailed document with full details will follow.

Thank you for your attention to this important update and for your continued engagement.

Regards,

Tom Murray
IPU President