I move: That Dáil Éireann: notes that: — in September, the Government accepted and published the new Community Pharmacy Agreement 2025, which was negotiated by the Department of Health; — the Community Pharmacy Agreement 2025 explicitly excluded reimbursement for monitored dosage systems (MDS), which had previously been reimbursed through the phased dispensing reimbursement mechanism, a practice which was widely known, accepted, and unchallenged by the Government; — MDS, such as blister packs, are an essential and basic tool for improving medication management and safety, and can be the difference between taking medicines safely and risking missed doses, double dosing, or dangerous confusion; and — the Community Pharmacy Agreement 2025 could have included reimbursement for MDS where they are requested by a person's general practitioner or other appropriately qualified treating clinician; further notes that: — blister packs without subsidisation can cost an individual in the range of €20 to €50 a month, even more in some cases where a person has particularly complex needs; — blister packs are an essential component in medication management, which allow for greater involvement of a person's carer or personal assistant in ensuring a person receives the right medicine in the right dosage at the right time, particularly where a person has cognitive or mobility issues or a physical or intellectual disability, which is otherwise not permitted; and — many people, in particular older people, people with disabilities, and people with multiple conditions, had come to rely on this service being provided free of charge and cannot afford the additional cost which the Government has now imposed on them, which can accumulate to several weeks' worth of income a year; considers that the inclusion of MDS in reimbursement arrangements with pharmacies is a small step towards universal healthcare which the Government should take; and condemns: — the Government's decision to withdraw blister pack supports from vulnerable people at the most expensive time of year for households and in the midst of a cost-of-living crisis; and — the failure of Government and the Minister for Health to ensure coverage of MDS in the new Community Pharmacy Agreement 2025 on the basis of need; and calls on the Government to: — urgently avert the new fees for MDS, which are due to take effect from 1st January, 2026 by temporarily permitting reimbursement as was the case to date; and — immediately engage with the Irish Pharmacy Union, to include a reimbursement mechanism for MDS in the Community Pharmacy Agreement 2025, which delivers coverage on the basis of need, not ability to pay for all people who need them on the basis of a clinical recommendation. It came as a shock to many patients when they received letters from pharmacists or were told orally by pharmacists that the blister packs that were previously funded and paid for, as they saw it, were now going to be subject to a charge from 1 January 2026 onwards. It is important to point out that these are very vulnerable patients. The vast majority of them are older people, over the age of 65. They are people with dementia, disabilities and a range of health needs, but they are the most vulnerable patients. The vast majority of people will not need blister packs, but for those who do, they are a necessity and they are important for a number of purposes. They help patients manage medicines, and they are also a very important aid and tool for carers and family members. I know from my own siblings and others who look after people that they have to make sure that the blister pack is out, the patient uses the appropriate medication and everybody benefits from it. It is really good for patients and there was an awful shock, when patients received notification formally or informally that this was going to come to an end and they will have to have to pay for it. Sometimes we lose sight of the fact that €20, €40 or €50 a month is a huge amount for some people. We cannot ever live in a bubble here in Leinster House. We have to understand that this type of charge is a loss for a person who is on a very low income, a disability payment or a low-paid pension. For those people to be hit with this additional charge really did come as a shock to them and their families and to carers. However, it was not a shock to me that this was going to happen because I raised it directly with the Minister. I also issued a press statement at the time when the new community pharmacy agreement was put in place. I recognised this as a glaring omission and I warned that this would become an issue and unfortunately, it did. I understood the importance of them for patients and families and I certainly knew that when the time came and people realised that what they were getting previously free of charge and covered was going to be to be subject to a charge, would go down very badly and rightly so. It has been described as cruel by many people who have texted into radio programmes over the past week as well. The Minister issued a statement on Friday of last week saying that she would put on hold the new community pharmacy agreement for a couple of months. The reason she gave for putting it on hold was rightly, that there is a lot of additional work for pharmacists. They are administering the flu vaccine and the Covid vaccine, which I got myself in a pharmacy last week. There is obviously additional work in managing diseases and the flu circulating in the community and other issues that pharmacists are dealing with. That was the reason the Minister gave. Nowhere in the press statement did she say she would look at this. In fact, she described blister packs as being private fees. In a response she gave in the Seanad, she doubled down as well on that.

Sentiment score: 0.02

I do not understand this approach. It may not have been the Minister who gave the speech in the Seanad but certainly it was a Minister who essentially doubled down. Nowhere did the reply say there would be any agreement. In fact, what it said was that this is a private matter between patients and pharmacists. I understand that this was funded indirectly; I said so at the time. It seems that this was funded through the phased dispensing scheme and that pharmacists were essentially offsetting the cost of blister packs through phased dispensing. Whatever about the rights and wrongs of that at this point in time, many of these people who were previously getting it funded now have to pay and they simply cannot afford to do so. We are being constructive in tabling this motion to ask the Minister to engage and to look at putting in place a scheme whereby this can be funded. There are different ways this can be done. She could allow GPs, for example, to determine whether, through the same funding pot as phased dispensing, we provide for blister packs as well. Obviously, funding into the pot could be increased. There are a lot of options open to the Minister. However, the option of saying "No" will not win over the support of those people who are now, as they see it, being left high and dry. I know the Minister is not opposing the motion but I appeal to her to listen not just to me but to all those people who have reacted very angrily. They do not really care who is right or who is wrong as to how these were funded in the past. The only thing that matters for them and their families is that they are now facing an additional cost, and that is very unfair on those patients.

Sentiment score: 0.00

I will clear a number of things up for the Minister, who is not here, because she seems to think we do not understand how this works or what issues are at play here. We have never said that every patient has had blister packs paid for. That was never the case. We also understand, and I acknowledged this at the time the community pharmacy agreement was being reached, that phased dispensing was being used by some pharmacists to offset the cost of blister packs. Whatever about the rights and wrongs of that, which is what I said to the Minister in my opening remarks, what is undeniable is vulnerable patients are now being told they will have to pay. Whatever about the indirect or unorthodox way it was paid for in the past, that does not really matter to those patients right now. That is where the Government and the Minister are tone deaf. I have no problem with transparency when it comes to the Minister, the Government or pharmacists. I have no problem with what the Minister called "targeted probity processes" being put in place to examine what pharmacists were or were not doing. That is a matter for the Government, the regulator and pharmacists, but what was missing entirely from the Minister's opening speech was any empathy for people who are now left high and dry. That was what was missing - that human empathy where very vulnerable patients are now being told they are going to have to pay. What I am saying, and I do not understand why this would be in any way a mystery to the Government or seen in any way as radical, is the State should pay for those vulnerable patients. We all signed up to the spirit and logic of Sláintecare, where we want a transition to a single-tier health service that is free at the point of delivery. I hope that is where we are going. We have had a couple of examples over the past number of weeks and months, where I have had to seriously ask myself whether this Government is committed to that. It is not unreasonable to ask a Government, in circumstances where vulnerable patients are now being left high and dry, to do its job. As was said, the Government knew when it negotiated this agreement and, as it saw it, tightened up on the rules in relation to phased dispensing, that this was going to happen. I knew it was going to happen. I warned the Government, it did not listen and now we have very upset, vulnerable patients who have been left high and dry. It is simply not good enough. It is not good enough, by the way, that the Government will say it is not opposing the motion but will then not do anything about it. It has to go and negotiate with pharmacists and put in place a long-term solution for those people it has abandoned.

Sentiment score: -0.07