I welcome the Minister of State, Deputy Murnane O'Connor, and thank her time and for coming to the House.

I thank an tAire Stáit for coming in to talk about this. This is a decision I find deeply troubling, not just as a Senator but also as a pharmacy technician. I worked for more than ten years in pharmacy preparing these blister packs. I know exactly all the standard operating procedures that go on behind the scenes in preparing a blister pack. I also understand exactly the people who get the blister packs and rely on them. What I cannot get my head around is that the guidelines changed in 2017. I was working in pharmacy in 2017. I printed out the letter we got from the HSE in 2017. There was a list of four criteria that a patient needed to meet to get a medicine blister-packed. It is already nearly impossible for someone to qualify for a blister pack. The criteria are, first, at the request of a patient's physician; second, due to the inherent nature of a medicinal product, that is, product stability and shelf life; third, where a patient is commencing new drug therapy with a view to establishing patient tolerance and acceptability before continuing on a full treatment regimen; and, fourth, in exceptional circumstances, where the patient is incapable of safely and effectively managing the medication regimen.

These four criteria have to be met to get pre-approval from the HSE before a patient can get their medication blister-packed. This small group of people are already in a very vulnerable position. We know they have been identified as needing to have the medication blister-packed as they would otherwise not manage their medication. This is where the service is being taken away. I genuinely cannot understand how the Government believes it is acceptable to introduce a charge for this service. I was thinking last night about all the different people I packed for. I was looking at the list of medications now covered and asking myself what a blind person will do now or what will a person with dementia or an intellectual disability do.

I also have a 14-year-old daughter who takes medication and we need to have it blister-packed because of the GP stamp. This will now not be covered. She is 14 and I am a working mother. I am not there all the time. It is my only way of knowing if she took her medication safely. We can see here there are green pills. I am not going to go into what they are but one is a 20 mg tablet and one is a 10 mg tablet. I know from studying for two years to be a pharmacy technician the tiny difference in size between the two.

These are complex medications and it is not fair to introduce this. Whether it is €20, €30 or €50 of a charge people cannot afford it at the minute. I have been inundated with calls from pharmacists and technicians I used to work with. I have also had a number of calls from diabetes nurses from the diabetes clinics because none of the diabetes medications are covered. What are they going to do now for compliance? People are not going to be able to afford the medications so they are just going to have to go without.

What has baffled me even more is the list of medications that are on it. Where someone is on an antidepressant, an SSRI, for their mental health, that may be covered, but if they are on a heart or cholesterol medication, that is not covered. People are going to have some medication packed and some not. If you talk to any health professional, we know the danger that comes with that and the hoarding of medication in presses. Blister packs have changed so much of that. Any ambulance or emergency worker will tell you that when they go into a house, they will pick up the pack and they can see straight away the name, the date of birth and the medication. More importantly, they can also see if the person has taken the medication that day. It is one of these decisions that is going to cause avoidable admissions to our hospitals, and for families and carers this is a nightmare.

I will have to pay to get my daughter's medication blister-packed, but what does someone who cannot afford it do?

I thank the Senator for raising this matter and for giving me the opportunity, on behalf of the Minister, Deputy Carroll MacNeill, to clarify the position on the phased dispensing and monitored dosage system, which is also known as blister packs.

I wish to clarify that phased dispensing and monitored dosage systems and blister packing are not the same thing. While the State has supported phased dispensing under the community pharmacy contract since 1996, it has never supported monitored dosage systems. The State supports phased dispensing for patient safety reasons and will continue to do so. Community pharmacies receive additional fees for this service. The supply of medication in instalments can support patients using certain high-risk medications who are at risk of accidents if these medications were to be supplied on a monthly basis, as is the norm under the community drug schemes.

The community pharmacy agreement does not remove phased dispensing. These medicines will continue to be supported by phased dispensing and fees will continue to be paid. On the other hand, monitored dosing systems, which are sometimes referred to as blister packs, are systems that allow the individual doses to be organised according to the prescribed dose schedule. As noted earlier, the State has never agreed to fund monitored dosing systems and there has never been a fee associated with them under the pharmacy contract. However, a practice has built up in some pharmacies where the use of monitored dosing systems is being charged as if for phased dispensing. The State has never agreed to this inappropriate claiming. Significant expenditure was being incurred by the State that was never intended and for a purpose outside of the contracted arrangements, with limited evidence of effectiveness. The introduction of improved controls around phased dispensing is being done in a way which puts patient safety first and allows the State to repurpose funding to be used to implement new patient-centred services. It remains open to pharmacies to charge patients or not for the use of monitored dosing systems as a private service, as many currently do.

Phased dispensing supports have only ever been in place for medical card holders. Claims for blister packing are not reimbursable by the State and this has not changed. The rules for phased dispensing have been set down in several HSE pharmacy circulars, and any claims put through for blister packing under the phased dispensing arrangements have been inappropriate claims. Charges for blister packing currently vary between pharmacies and this is a matter for them as private businesses. Some pharmacies do not charge for this service. Community pharmacies use different methods to assist their patients, including counselling, reminder charts, the Know Check Ask system with the HSE and tools like pictures or large-print labels and alarms.

These are used in particular for older people, people with disabilities and people with multiple conditions to ensure that they manage their medicines safely.

In the context of the negotiation of the community pharmacy agreement 2025, the first such contractual negotiation with the sector in 30 years, the State used the opportunity to negotiate and agree improved controls to further reduce inappropriate claiming for monitored dosage systems as phased dispensing. However, the Minister for Health last week agreed to pause the changes in the phased dispensing control mechanisms until the end of quarter 1 of 2026. The Minister has been working on this for the past few months.

The phased dispensing fees are being changed, whether a pharmacy chooses to put them in a blister pack for the patient's convenience or compliance and whether the State ever agreed to pay for it or not. It paid for phased dispensing and pharmacies' blister pack medication. Some charge and others do not. The changes to the phased dispensing fees are where the pharmacies will lose out. They will no longer be able to pack medication for that because the list of medications now covered under phased dispensing is the issue. Phased dispensing is the only fees the pharmacy gets. That is where the problem will come in. I do not understand how this list was chosen. There is a certain group of medications here. This definitely did not come from any pharmacists or healthcare professionals because there are more complex medications like those for diabetes or those for someone who may be blind. How did was the decision reached that these are the only drugs covered for phased dispensing now? They are normally what end up in a blister pack. They need to get them phased and it needs to be on a weekly basis. The pharmacy discusses with the patient whether it is putting them into a blister pack and whether it is charging or not. The fees are the issue. There will no longer be reimbursement of the fees.

We do need to clarify this. As the Minister said, it will be quarter 1 of 2026. She has said the community pharmacy agreement 2025 does not remove the phased dispensing. We will check what is on that list. The rule changes around phased dispensing were introduced to deal with a situation where significant expenditure was being incurred by the State. It was not intended for purposes outside the contracted arrangements, with limited evidence of effectiveness.

In her statement of 12 December, the Minister noted the community pharmacy sector is under particular pressure at that moment, with an earlier than expected start to the flu season, as we are all aware of now, delivering vaccinations and preparing to establish the new common conditions service, which is really good and I am sure the Senator agrees with that.

The Minister has agreed that the IPU needed to engage further with its membership to clarify the situation and that the community pharmacists need to do further work with their patients, especially their most vulnerable patients, to clarify the supports available to them and determine the best way of safely complying with their medicine-dosage regime.

It is important we clarify the information. I assure the Senator the Minister will come back to her on this.

I thank the Minister of State and the Senator. I appreciate the Minister of State taking time from her busy schedule. It is always great to see her here in the Seanad.