If you are ordinarily resident, you are entitled to either free or subsidised approved prescribed drugs and medicines and certain medical and surgical aids and appliances.
Certain people and certain products are not liable for the prescription charge:
If you are not covered by the medical card or any of the schemes listed above, you can register for the Drugs Payment Scheme which limits the monthly cost of prescription medicines.
In general, approved prescribed drugs and medicines are provided by the retail pharmacy (chemist's shop). The official term is now community pharmacy but it may also be described as the retail pharmacy or just the pharmacy. Virtually all pharmacies have agreements with the HSE to provide services under the Primary Care Reimbursement Services scheme.
Agreements were made in 1996 with pharmacists whereby they undertook to review patients' medical therapy and screen for any problems such as drug therapy problems, drug allergies, clinical abuse or misuse.
GPs may provide drugs and medicines directly to patients if the GP has only one practice centre and it is three miles or more from the nearest retail pharmacist. Doctors who dispense drugs and medicines under these arrangements are sometimes called dispensing doctors.
Hospitals and other specialist institutions may also provide drugs, medicines and aids and appliances directly.
The rules about when drugs and medicines are free or subsidised are the same regardless of who provides them.
Regulations were introduced under the Irish Medicines Board Act 2006 which allow nurses the authority to prescribe medicines. Previously, only doctors had authority to prescribe.
Individual nurse prescribers must be employed by a health service provider and may only prescribe the drugs relevant to the setting in which they are employed. There are specific restrictions on certain controlled drugs.
Your entitlement to free or subsidised prescribed drugs and medicines is to those products that are approved by the Health Service Executive (HSE) for the purposes of these schemes. The HSE Primary Care Reimbursement Service provides a list of medicines or aids provided under the medical card or Drugs Payment Scheme.
There is a system in place for the approval and control of drugs. The Health Products Regulatory Authority (HPRA) is the authority with responsibility for licensing medicines and testing them for safety, quality and efficacy. Drugs must be approved by the HPRA before they can be sold at all. HPRA approval does not necessarily mean that the drugs and medicines will be approved for the free and subsidised schemes. There are other factors involved in the approval process, including costs.
Certain items that can be bought over the counter are excluded from the schemes. Examples of such products are some painkillers, such as Panadol, Disprin, Solpadeine and Nurofen, vitamin supplements and products for the treatment of baldness.
The Health (Pricing and Supply of Medical Goods) Act 2013 allows pharmacists to substitute different versions of some prescribed medicines – often less expensive generic versions of brand name medicines. The medicines must be included in a list of interchangeable drugs published by the HPRA. The HPRA has published an information leaflet about generic medicines (pdf).
The HSE sets one price that it will pay for each group of interchangeable medicines. This is known as the reference price. The phased introduction of reference pricing began from 1 November 2013.
If you have a medical card, the HSE will pay the reference price for any interchangeable medicine. If you choose to buy a more expensive version of the medicine, you must pay the difference between the reference price and the retail price.
If you are on the Drugs Payment Scheme the HSE will use the reference price to calculate your monthly drugs costs. If you choose a more expensive version of a medicine that is covered you must pay the extra cost.
If you need a particular brand of medicine for medical reasons your doctor can write 'Do not Substitute' on the prescription and you will not have to pay extra if it costs more than the reference price.
If you have a question relating to this topic you can contact the Citizens Information Phone Service on 0761 07 4000 (Monday to Friday, 9am to 8pm) or you can visit your local Citizens Information Centre.