Sign in. It’s quick, free and it’s up to you.
An account is an optional way to support the work we do. Find out more.
PHARMACISTS HAVE TOLD The Journal that they will not be able to sign up to the scheme making Hormone Replacement Therapy (HRT) products free for women in June because it is not sustainable for them.
Yesterday, Minister for Health Jennifer Carroll MacNeill announced that the scheme, which was supposed to be in place since January, will now commence from 1 June.
The medicine-based treatment, which is used to relieve symptoms of menopause, perimenopause and postmenopause, is already free for holders of medical cards, but otherwise can cost in the region of €30 to €70 a month.
Some women previously told The Journal they had to ration their HRT patches due to the cost, with one woman saying she delayed taking HRT until January because she thought the free scheme would be in place by then.
Women who have a prescription for HRT from their doctor will be able to access it for free from June, though they will still have to pay the cost of their GP visit.
In a change from what was initially announced, the Health Minister said that the Government will now pay pharmacists a €5 dispensing fee per HRT product, along with a €1,000 one-off grant.
But pharmacists have said that they will not be able to sign up to the voluntary, State-funded scheme because they can’t afford to at the dispensing fee being proposed.
Carroll MacNeill told RTÉ’s Liveline programme yesterday that having met with the IPU, they “just couldn’t agree on the price” as she had to “find money” to cover the dispensing fee, adding that she “couldn’t go as far as the Irish Pharmacy Union wanted me to go”.
“I really do want to progress it now. I think women have waited long enough and they’re entitled to get this medication,” she said.
Speaking on RTÉ’s Morning Ireland programme this morning, Irish Pharmacy Union president Tom Murray said they had put “multiple proposals to the Minister and to the Department about a breakeven point where we would be able to make this supply.”
Murray said that based on figures by external economic advisors, this breakeven point is €6.46 per product. He said the IPU has asked for a €6.50 fee to be provided in order to implement the scheme.
“As it currently stands, we will be asking [customers] for payment. We’re six weeks out. We’re happy to work with the Minister and continue consultation to resolve this,” he said.
According to the IPU, the average dispensing fee per item last year was €4.51. Under the current reimbursement schemes for pharmacies, the Government pays pharmacists 91.8% of the cost of the medicine.
Kathy Maher, a pharmacist in Duleek, Co Meath, told The Journal that yesterday’s announcement is “very disappointing”.
She said that while the move to cover a dispensing fee is welcome, the €5 proposed is “not viable” and is “the same fee that was introduced 17 years ago”, during the 2008 recession.
“What’s really striking for me as a pharmacist is the Department Health acknowledged in 2022 when we set the fee for free contraception, the fee that the Department said at that point is €6.50,” Maher said.
I can’t see how a menopause patient is worth less to the Department than a contraceptive patient. That’s how it feels.
“It’s asking pharmacies to move from private funding to state funding at a substantial loss in a much more clinically complex conversation.”
The free contraception scheme, which was launched in 2022 and has been expanded to include women aged 17 to 35, covers the €6.50 dispensing cost for contraceptive prescriptions by pharmacists.
Maher, who is also the chair of the IPU’s Pharmacy Contractors Committee, said she has “done nothing” but take calls from both independent and larger pharmacies this morning.
“The message I’m hearing loud and clear from every pharmacist that I’ve spoken to this morning is that there will be very few pharmacists signing up to this.
“We want this to work for the women of Ireland, but it needs to work at a rate that is sustainable, fair and workable for pharmacies. Pharmacies are ready to deliver, but we can’t do it at a financial loss.”
Maher said the IPU also proposed that women could get their receipts from the pharmacy, which could be backdated to 1 January, and then submit them to the HSE’s reimbursement service.
She said that this “could be implemented today”. However, the Department said “they didn’t have the resources to do that, so they haven’t done that”.
As it stands, there is still no IT system in place where pharmacists could seek reimbursement of product for the free HRT scheme. It took nine months to set up a system when the free contraception scheme was introduced.
Maher is doubtful that a system will be up and running by 1 June. “It’s very, very complex to get something up and running in six weeks when you have no sign in from the sector that you’re asking to deliver. I really don’t know how this is going to happen.”
Victoria Jones, who runs a pharmacy in Coolock in Dublin, told The Journal that she will not be able to sign up to the scheme as it stands because it is “completely unworkable”.
“I want to, but I would have to let my staff go, and I can’t do that. I can’t keep my doors open if I do this,” Jones said.
She said that the cost of running a business “is becoming so much more that we just can’t do another loss-making scheme”.
“I’m a professional. I have to pay very high insurances, which are going up all the time. My staff expenses are going up all the time. There’s sick pay, there’s pensions, there’s electricity.”
Due to the Government currently paying pharmacists 91.8% of the cost of medicine, Jones said she is “at a loss of 8% before I even hand the product over to the person”.
If I pay €10 for that product, the government are only reimbursing me on the same scheme at minus eight percent. So it’s not really a fiver. What do you get for a fiver? You don’t even get a roll in the shop.
Jones said she doesn’t know a single pharmacist that has signed up to the scheme “because they know they can’t, and they don’t want to have to close their doors”.
She said she thinks the Health Minister has tried to “bully pharmacists through the media” by failing to go with the dispensing fee proposed by the IPU.
“It’s just such a badly thought out plan that I think the Minister’s ego is what’s driving this, because she wants to be seen to get a win for the women of Ireland,” she said.
“Are the GPs going to give free HRT prescription consultations? No, they’re not. The Minister wouldn’t dare rattle that cage.”
Jones said that patient care, safety and counselling is “the most important bit of pharmacy”.
“We can’t put a price on that, but we just have to be able to keep the lights on,” she added.
“I spend so much of my unpaid free time outside of my working hours, doing free information for women and trying to give women the best information and resources for themselves. I think it’s so important that we do get there, but we just can’t do it this way.”
If pharmacists do not sign up for the scheme with the €5 dispensing fee, there is an alternative offer to continue to charge the dispensing fees that they are charging with a €3,000 one-off grant.
Sheena Mitchell, who has run her own pharmacy in Dublin since 2008, told The Journal that she will not be accepting either offer.
“It’s not feasible for me to sign up to the €5 offer, because it’s just not financially viable. The other offer has a detrimental impact on women’s health equity, so I’m not going to do that either,” Mitchell said.
The Government recognised when implementing the free contraception scheme “that we need a fee of €6.50 to sustain a scheme”, she said, adding that the HRT dispensing fee should also be brought up to this level.
I just can’t absorb any more loss. We need to actually be able to pay our staff so that we can continue to provide a safe level of service to our patients. It’s straightforward.
“I would urge the Minister to go back to the union and have meaningful conversations and actually address the issues at hand with transparency and with integrity.”
The Department of Health has been contacted for comment.
To embed this post, copy the code below on your site
have your say