In March 2026, an agreement was reached between my Department, the Irish Pharmacy Union, and the HSE, regarding a significant reform of phased dispensing arrangements alongside the introduction of a new medicine optimisation support service (MOSS). This MOSS is available free of charge for specified vulnerable patient groups who are also medical card holders, where the pharmacist deems it clinically appropriate.
Details of the changes can be found in the Department’s Press Release on 31 March 2026 -Reforms announced to phased dispensing and enhanced medicine supports under the Community Pharmacy Agreement (CPA) https://www.gov.ie/en/department-of-health/press-releases/reforms-announced-to-phased-dispensing-and-enhanced-medicine-supports-under-the-community-pharmacy-agreement-cpa/.
Further information and frequently asked questions can also be found here: Medicine Optimisation Support Service https://www.gov.ie/en/department-of-health/services/medicine-optimisation-support-service/
From 1 June 2026, medical card holders in the following vulnerable patient groups may be supported to receive a range of tailored supports, free-of-charge, where the pharmacist deems it clinically appropriate:
• Patients with physical impairment affecting the ability to use conventional packaging (who do not have carers that could support them to use original packs)
• Patients diagnosed with cognitive impairment or dementia who have carers to support them (including home care) by prompting them to take their medications at the appropriate intervals
• Patients with an intellectual disability. For the purposes of the Medicine Optimisation Support Service, the following definition applies: Intellectual Disability is characterised by lifelong limitations in cognitive and adaptive functioning and experiences of social and environmental restrictions which create barriers to effective participation in daily life.
• Patients who, for social inclusion reasons, including homeless or marginalised people, are unable to appropriately manage their medication.
• Patients who are on high-risk medicines and are at risk of misuse and/or abuse of those medicines.
Importantly, all patients who were receiving phased dispensing or blister packs free-of-charge prior to the Community Pharmacy Agreement (in August 2025) can continue to do so.
These vulnerable patient groups will be supported, where clinically appropriate, with a range of tailored MOSS supports including:
• Adjustments to facilitate use of original packaging. These include, for example:
• Reminder charts,
• Administration charts,
• Winged bottle caps / easy open lids,
• Labelling adjustments,
• Alarms (such as notifications on mobile phones),
• Tablet splitters.
• Dosette boxes.
• Instalment dispensing; and
• Blister packs where clinically necessary.
Importantly, blister packs will remain a last resort in line with the international evidence, due to associated risks including reduced patient autonomy and potential safety concerns.
The reforms ensure that resources are targeted towards those who genuinely need them and recognise community pharmacists as vital partners in patient safety and medicines optimisation. Empowering the pharmacist to engage with these patients, in such an individualised manner, will ensure that these patients are supported to manage their medicines in an individualised way.
It is important to note that not all medicines are suitable for blister packs. Pharmacists will consider relevant medicine-specific factors to assess if all the patient’s individual medicines are suitable for supply in a blister pack.
Where clinically required, and deemed appropriate, blister packs will be provided free of-charge to eligible medical card patients, in identified cohorts (including those diagnosed with dementia or cognitive impairment).
On 18 May 2026, guidance was issued to all community pharmacists on this matter via HSE Pharmacy Circular 016/26 Medicines Optimisation Support Service Fee https://about.hse.ie/hcp-publications/hcp-pharmacy-circular-01626-medicines-optimisation-support-service-fee/.
