I propose to take Questions Nos. 2072 and 2142 together.
Monitored Dosage Systems (MDS), known as “blister packs” or compliance aids, are systems that enable the individual medicine doses for any medication to be organised according to the prescribed dose schedule. These are ordinarily provided once a month and packaged to indicate when medication should be taken.
The State has never agreed to fund blister packs and there has never been a fee associated with blister packs/monitored dosage systems under the Pharmacy contract; this includes under the long-term illness scheme and the other community drug schemes. This has always been the case and has been repeated in several HSE circulars to pharmacists.
The community pharmacy contract has supported phased dispensing since 1996 for patient safety reasons and will continue to do so. Phased dispensing requires the patient to present to the pharmacy on multiple occasions in the month (e.g., each week) when it would be unsafe for the patient to receive the totality of their medication in one supply occasion, or if the shelf life of the medicine requires it. Community pharmacies receive additional fees for this service – which has only ever been in place for medical card holders.
The changes agreed under the Community Pharmacy Agreement – now paused until later in quarter 1 2026 – will introduce improved controls to align phased dispensing to specified high risk drugs, where a patient safety concern may exist. This will ensure that patients on high-risk medicines, such as anti-psychotics or opioids, are appropriately targeted with support.
Psychotropic medications represent a class of medication that are high risk, have a high dependency potential, and carry a significant risk of misuse. They are often prescribed in the management of conditions where cognitive or functional impairments justify closer monitoring through phased supply.
The State has not imposed a new charge on MDS, also known as “blister packs”. This remains a private service provided by pharmacies. It is also understood that different approaches are taken by community pharmacies in respect of funding the use of MDS for medical card holders:
• Some have been blister packing their patient’s medicines for free,
• Some have been charging the patient privately for providing that service, and,
• Some have submitted claims for phased dispensing to the HSE when in reality they were using MDS. The State has never agreed to this last practice, and it is inappropriate claiming to do so.
It remains open to pharmacies to charge patients or not for the use of MDS as a private service, as many currently do. It is important where a pharmacy charges a fee for any professional service, that they provide updated information to patients in line with the new Pricing Transparency Guidelines, which came into effect on 1 December 2025.
In addition, community pharmacies can, and do, use a variety of means to assist their patients including:
• counselling,
• reminder charts,
• the “Know Check Ask system” with the HSE, and,
• tools like picture or large-print labels and alarms.
All of these are aimed at improving understanding and adherence to medication. This remains a key part of the service and support that pharmacies provide to patients. There is no change in that regard.
The HSE Health App ‘My medicines list’ provides a secure place for patients to record a list of their medicines, which can be useful for pharmacy or hospital visits. It also allows people to see a list of their medicines received through the Drugs Payment Scheme or Medical Card Scheme. Keeping a list can help patients know their medicines. It can also help when patients are discussing their medicines with a healthcare professional.
These measures can assist older people, people with disabilities, and people with multiple conditions, to ensure that they manage their medicines safely. Patients should talk to their pharmacist directly about the best way to manage their medicines.
