Prescribed drugs and medicines
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.
Under the Long Term Illness Scheme, people suffering from certain conditions can get free drugs, medicines and medical and surgical appliances for the treatment of that condition.
The Health Amendment Act Card provides drugs and medicines for people who have contracted Hepatitis C directly or indirectly through the administration of blood products or transfusions.
Drugs Payment Scheme
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.
Prescribed drugs and medicines are eligible for tax relief on medical expenses.
In general, approved prescribed drugs and medicines are provided by the retail pharmacy (chemist's shop). Virtually all pharmacies have agreements with the Health Service Executive (HSE) to provide services under the Primary Care Reimbursement Services scheme.
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.
Approved drugs and medicines
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.
Free or subsidised schemes
The HSE Primary Care Reimbursement Service provides a list of medicines or aids provided under the medical card or Drugs Payment Scheme. These products are approved for the schemes by the HSE.
Medical card holders who are prescribed items that are not on this list can apply to have them covered under a discretionary hardship scheme. If you have a medical card and an item on your prescription is not covered by it, your pharmacist can apply on your behalf to the Local Health Office to have the item covered by the hardship scheme. If the hardship scheme does not cover the medicine and you have to pay for it, you may want to check with your doctor to see if there is an alternative. You can get more information about the scheme from your pharmacist.
Certain items that can be bought over the counter are excluded from the free or subsidised schemes. Examples of such products are vitamin supplements, products for the treatment of baldness, and some painkillers, such as Panadol, Disprin, Solpadeine and Nurofen.
Generic drugs and reference pricing
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.
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. If you have a medical card, you pay the prescription charge. If you have a Drugs Payment Scheme Card, you pay up to the monthly threshold as normal.
Prescribing by nurses
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.