Wednesday, 11 Feb 2026

Medical Cards

Questions (323)

Pat Buckley

Question:

323. Deputy Pat Buckley asked the Minister for Health to review and consider the provision of full medical cards for persons living with spinal injuries; and if she will make a statement on the matter. [10666/26]

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Written answers

Minister for Health

Medical card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold. This is the amount of money that an individual can earn per week and still qualify for a card. It is specific to the individual’s own financial circumstances.

People under 70 are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after deduction of tax, PRSI and Universal Social Charge. Certain expenses are also taken into account. Detailed guidelines are available at: www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/. People aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, those aged over 70 can also be assessed under the general means tested scheme where there are particularly high medical costs. Details are available at: www2.hse.ie/services/schemes-allowances/medical-cards/other-types-of-medical-card/over-70s/.

The issue of granting medical cards on the basis of illness or a disability was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.

However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card - in particular, to take full account of difficult circumstances in the case of applicants who may be in excess of the income guidelines. In such circumstances, the HSE may exercise discretion and grant a medical card, for example:

• Discretionary medical cards issued to patients with significant medical expenses but who do not satisfy the means test.

• Emergency medical cards are issued to patients that are terminally ill, or are seriously ill, and in urgent need of medical care that they cannot afford.

I can assure the Deputy that, in order to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.

Pharmacy Services

Questions (324, 328)

Ken O'Flynn

Question:

324. Deputy Ken O'Flynn asked the Minister for Health whether her Department recognises that, for some people with disabilities and people receiving home-care supports, pharmacist-prepared monitored dosage systems, including blister packs, are clinically required to ensure safe medication administration and compliance; whether any national clinical guidance, policy circular, or Department-approved criteria exist to determine when such supports are clinically indicated; and if she will make a statement on the matter. [10668/26]

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Ken O'Flynn

Question:

328. Deputy Ken O'Flynn asked the Minister for Health what interim safeguards or guidance have been issued by her Department to ensure that patients with disabilities or complex medication needs do not experience disruption to medication compliance supports during the current pause in changes to phased dispensing arrangements; and whether clinicians or pharmacists have discretion to continue such supports where clinically indicated. [10672/26]

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Written answers

Minister for Health

I propose to take Questions Nos. 324 and 328 together.

My Department recognises that for certain patients, using monitored dosage systems or “blister packs” can be helpful, and they rely heavily on these products. For clarity, the cost of blister-packing medications has never been covered by the State. My Department officials are currently examining the issue of the appropriateness, or otherwise, of blister packs in certain circumstances, as a matter of priority. Engagement between the Department of Health, the HSE Primary Care Reimbursement Service, the Irish Pharmacy Union and the Pharmaceutical Society of Ireland on this matter is ongoing.

It remains open to pharmacies to charge patients, or not, for the use of blister packs as a private service, as many currently do, and has always been the case. 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 1st December 2025.

The current pause on the planned changes to ‘phased dispensing’ rules will facilitate community pharmacists to talk with their patients in an individualised manner, about the circumstances specific to that patient.

Pharmacy Services

Questions (325)

Ken O'Flynn

Question:

325. Deputy Ken O'Flynn asked the Minister for Health whether her Department has undertaken, or commissioned, any patient safety or risk assessment regarding the withdrawal or non-funding of pharmacist-prepared blister packs for people with disabilities or cognitive impairment who rely on such supports in a home-care setting; the findings of any such assessment; and if none has been undertaken, when such an assessment will be completed. [10669/26]

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Written answers

Minister for Health

I would like to take this opportunity to reiterate that there has been no withdrawal of funding of blister packs as they are not, and have never been funded by the State.

It remains open to pharmacies to charge patients, or not, for the use of blister packs as a private service, as has always been the case.

Pharmacy Services

Questions (326)

Ken O'Flynn

Question:

326. Deputy Ken O'Flynn asked the Minister for Health whether her Department has carried out a disability impact assessment, equality impact assessment, or human rights analysis in respect of the non-funding of monitored dosage systems, including blister packs, under the long-term Illness scheme; and if she will confirm whether the implications for people with disabilities living independently or with home-care supports were formally considered. [10670/26]

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Written answers

Minister for Health

The Long-Term Illness (LTI) Scheme covers the cost of medicines and medical and surgical appliances for the treatment of certain specific long-term conditions. The State does not fund, and has never funded monitored dosage systems (blister packs) under the LTI scheme.

However, the State has supported phased dispensing for medical card holders since 1996 for patient safety reasons and will continue to do so. Community pharmacies receive additional fees for this service. Phased dispensing means that the patient must attend the pharmacy multiple times per month (for example, weekly, twice weekly, or in some cases every day) to receive smaller quantities of their medication.

Recently, as part of the Community Pharmacy Agreement 2025, changes were introduced to improve controls for phased dispensing. This will ensure that patients on high-risk medicines, such as anti-psychotics or opioids, are appropriately targeted with support.

I wish to thank the Deputy for the opportunity to reiterate that phased dispensing and monitored dosage systems are not the same thing.

The State has never funded blister packs. Therefore, there has been no removal or withdrawing of funding by the State. It remains a private service, and community pharmacies may decide to charge patients for providing this service.

Pharmacy Services

Questions (327)

Ken O'Flynn

Question:

327. Deputy Ken O'Flynn asked the Minister for Health when her Department first became aware that monitored dosage systems, including blister packs, were being provided to patients in practice while pharmacies claimed phased dispensing fees; the policy, governance, or compliance actions that were taken by her Department at that time; and if she will outline the Department’s oversight responsibilities in respect of ensuring patient safety during any subsequent policy or fee changes. [10671/26]

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Written answers

Minister for Health

The Deputy will be aware that there have been concerns regarding inappropriate claiming of phased fees over the last number of years, which my Department officials have been engaging with the HSE on. While speaking in the Dáil in December of 2025, I referenced two instances of litigation in this area and on both occasions the State won.

In 2017, the HSE issued comprehensive guidance to pharmacists (in Circular 13/2017) regarding claiming for phased dispensing. To strengthen governance and oversight, a prior approval process for phased dispensing claims was introduced at this time.

The changes in phased dispensing fees, negotiated as part of the Community Pharmacy Agreement (CPA) in September 2025, have highlighted the use of blister packs by patients. I would like to reaffirm that no policy or fee changes have happened in relation to blister packs. The State has never funded blister packs. It remains a private service for which pharmacists may charge a professional fee.

Responsibility for pharmacy reimbursement under the community drug schemes, and related probity measures lies with the HSE Primary Care Reimbursement Service (PCRS), alongside the specific regulatory remit of the pharmacy Regulator, the Pharmaceutical Society of Ireland (PSI). As part of ongoing probity and fiduciary obligations, the HSE reviews, analyses and rigorously assesses claims received by all pharmacies. The HSE continues to invest significant data analytics capacity and other resources to improve and enhance its controls on an ongoing basis.

It is important to acknowledge that the majority of pharmacies comply with expected levels of claiming behaviour. However, where the HSE does identify pharmacies who fail to meet the standard of claiming behaviour expected, including those related to invalid claiming of phased dispensing fees, these matters are investigated thoroughly. The HSE has progressed a significant number of data analytic exercises, investigations (including pharmacy inspections) and reviews by the HSE Probity Governance Group in recent years.

Where appropriate, the HSE refers matters of concern to the PSI in relation to professional issues and, where appropriate, to An Garda Síochána in compliance with the legal obligation to report information in relation to possible fraud.

My Department Officials continue to engage with both the HSE PCRS and the PSI on matters relating to phased dispensing. I understand the HSE are currently working on a robust probity plan and I look forward to receiving this shortly.

Question No. 328 answered with Question No. 324.

Pharmacy Services

Questions (329)

Ken O'Flynn

Question:

329. Deputy Ken O'Flynn asked the Minister for Health the mechanism that exist, or are being considered, whereby a clinician, pharmacist, or multidisciplinary care team may formally certify that monitored dosage systems, including blister packs, are clinically necessary for an individual patient; and whether such certification would permit continued provision without cost to the patient under existing schemes. [10673/26]

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Written answers

Written answers

Minister for Health (Deputy Jennifer Carroll MacNeill)

My Department engages with the Department of Housing, Local Government and Heritage and the LDA in relevant work including in the context of the Housing for All subgroup on State Lands, "Delivering Homes, Building Communities" 2025-2031: An Action Plan on Housing Supply & Targeting Homelessness, and the LDA Report on Relevant Public Land.

Queries in relation to the LDA, Housing For All, and the 2025-2031 Action Plan should be directed in the first instance to the Department of Housing, Local Government and Housing.

My Department and the HSE will continue to work collaboratively with all key stakeholders in relation to its surplus assets as part of an all-of-Government approach to increasing housing stock.

State Properties

Questions (335)

Ken O'Flynn

Question:

335. Deputy Ken O'Flynn asked the Minister for Health to identify the principal legal, financial, or administrative barriers preventing the timely reuse or disposal of vacant residential properties owned by the Health Service Executive; the steps being taken to address these barriers; and if she will make a statement on the matter. [10681/26]

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Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.