Dáil Éireann Debate, Thursday - 18 December 2025
648. Deputy Paul Lawless asked the Minister for Health if she will reconsider the decision to remove State funding for monitored dosing blister packs from January 2026, given the essential role these packs play in medication safety for older persons, those with disabilities, and patients on complex prescriptions; and the engagement which has taken place with the Irish Pharmacy Union to prevent hardship for vulnerable patients. [73405/25]
Amharc ar fhreagra649. Deputy Paul Lawless asked the Minister for Health whether any portion of the €50 million allocated under the Community Pharmacy Agreement can be ring-fenced to maintain funding for blister packs; and if she will provide details of any cost-benefit analysis undertaken before deciding to discontinue this service, which pharmacists have described as critical for adherence and reducing hospital admissions; and if she will make a statement on the matter. [73406/25]
Amharc ar fhreagra650. Deputy Paul Lawless asked the Minister for Health if she will engage with pharmacists to develop an alternative funding mechanism for monitored dosing systems, in view of warnings from patient advocacy groups and charities that the removal of State support will lead to medication errors, increased hospitalisations, and additional costs to the health service; and if she will make a statement on the matter. [73407/25]
Amharc ar fhreagraI propose to take Questions Nos. 648 to 650, inclusive, 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 this and there has never been a fee associated with monitored dosage systems under the Pharmacy contract. This has always been the case and has been repeated in several HSE circulars to pharmacists.
I recognise that for certain patients, or their carers, the use of blister packs to simplify adherence with their dosage schedule can be helpful and they rely heavily on the provision of these products.
However, it is important to recognise that phased dispensing and blister packing are not the same thing. The State funds phased dispensing for medical card holders. It does not, however, fund MDS (blister packs).
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.
The new Community Pharmacy Agreement 2025, which was negotiated by the Department of Health, the Health Service Executive, and the Irish Pharmacy Union, was published in September 2025. The Agreement is supported by a €75 million new investment across 2025 and 2026.
The Agreement reiterated the long-standing position of the State that MDS (“blister packs”), were not reimbursable under the General Medical Services (GMS) Scheme, or any other State scheme.
In addition, funding released by implementation of improved controls around the phased dispensing of high-risk medicines are committed for reinvestment back into community pharmacy and patient services. Phased dispensing is available – under certain criteria – to those with medical card eligibility and this will remain the case.
Under the landmark Agreement, a new Strategic Collaboration Group will be established in early 2026 to provide a structured forum for joint consideration of strategic issues shaping the future of community pharmacy in Ireland. A key pillar of this is a dedicated fund allocated to progressing opportunities to improve or expand community pharmacy services in relation to medicines optimisation. This new structured collaborative process will help to design and deliver evidence-informed high impact medicines optimisation services to patients and support future opportunities for service investment.
