This matter kind of explains itself. I thank the Minister of State for being here. The ask is that Mounjaro be included in the long-term illness scheme through the medical card. I was contacted by a constituent in my home county, Mayo, whose husband has unfortunately been sick since 2010 and is a cancer survivor. His health is declining and the cancer treatment has caused a number of severe side effects. He is unable to work and his wife is his full-time carer. They have two teenage children. There are a lot of pressures on the family. He requires a lot of medication each day. Thankfully, many are covered by the medical card scheme under the long-term illness plan. However, he has type 2 diabetes and suffer from severe side effects taking Ozempic. As a result, he has been forced to take Mounjaro injections instead but they are not covered by the plan. The family was able to manage this previously by crossing the Border and buying it in Northern Ireland. That was their workaround because it is more expensive here than it is up North. It is costing them €600 in the Republic versus about £400 in the North. The rules have changed, however, which means that they can no longer buy Mounjaro in Northern Ireland and have to buy it in the Republic. This is costing them about €600 per prescription and is putting huge financial pressure and a burden on this couple and their family.

While, as I already mentioned, it is welcome that certain elements are included in the long-term illness scheme through the medical card, it is a loophole. Can it be included? If there are reasons the computer says "No", is it possible for it to be included in instances where there are side-effects from the patient taking Ozempic? I would welcome the Minister of State's consideration of it, in the interest of helping a family in need.

Before the Minister of State commences her reply, I welcome guests of the Minister, Deputy Calleary. They are very welcome to the Seanad. I am probably pronouncing it wrong. They are from Behy ICA. May they enjoy their day. It is a great place to visit.

I also welcome the ladies to the House. I spoke to them earlier.

I thank Senator Duffy for highlighting this important issue. I am answering on behalf of the Minister for Health, Deputy Carroll MacNeill.

The State is aware of the importance of access to new medicines for patients and acutely aware of the plight of patients diagnosed with diabetes. There has been significant investment in new medicines in recent years. In 2023, nearly €1 in every €8 of public money spent on health was spent on medicines. This level of investment is unprecedented in supporting patients to access available new innovative medicines. Budgets 2021 to 2025 included dedicated funding for new medicines of €158 million. Budget 2026 allocated an additional €30 million of funding to new drugs. From 2021 to March 2026, this has enabled the HSE to approve reimbursements for 263 new or existing medicines.

The long-term illness, LTI, scheme was established under the Health Act 1970 and regulations were made in 1971, 1973 and 1975, prescribing 16 conditions to be covered by the scheme. Under the LTI scheme, patients receive drugs, medicines and medical and surgical appliances directly related to treatment of illnesses free of charge. Under the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for decisions on pricing and reimbursement of the cost of medicines. The Act provides for a rigorous process for the assessment of new medicines for reimbursement. This ensures the right medicines are chosen and approval is at a sustainable price. That is important.

For a drug to be reimbursed under the community drug scheme, a company must first submit an application to the HSE. Mounjaro is a medication licensed by the European Medicines Agency, EMA, for use alongside diet and physical activity in adults with inadequately controlled type 2 diabetes, on its own when metformin is not suitable, or in combination with other diabetes treatments. It is also authorised for weight management in adults with obesity or those who are overweight and have related health conditions.

A pricing and reimbursement application for Mounjaro was first submitted by the applicant in January 2024 for the treatment of adults with inadequately controlled type 2 diabetes as monotherapy where metformin is not suitable, or in combination with other diabetes treatments. A second application was submitted in July 2024 for chronic weight management in adults with obesity or those who are overweight and have at least one overweight-related condition. Following the conclusion of a rapid review by the National Centre for Pharmacoeconomics, NCPE, for both indications, two health technology assessments, HTAs, were commissioned by the HSE. A HTA is a detailed evaluation of medical technologies, including medicines, to determine their effectiveness, safety, cost efficiency and broader impact on health and the budget of the service. The HTA takes time to evaluate and involves gathering and analysing complex clinical and economic data, consulting stakeholders and aligning with regulatory standards to ensure decisions are evidence based and transparent.

I thank the Senator; I have nearly concluded. As I mentioned, I am taking this Commencement matter on behalf of the Minister.

Following the submission of both health technology assessments by the applicant, the HTA report on each indication was submitted by the NCPE to the HSE in December 2025 and February 2026. This has been looked at. The corporate pharmaceutical unit in the HSE, which is the point of contact between the HSE and the pharmaceutical industry, has advised that commercial engagements are ongoing and, due to the commercially confidential nature of these engagements, it is not in a position to comment further at this time. As the Senator can see, there is work going on.

I acknowledge the members of the Behy Irish Countrywomen's Association, ICA, as they head out the door, and wish them well on the rest of their visit and trip. I know Margaret is celebrating her birthday today. They might wish her a happy birthday; I know she is here.

I thank the Minister of State for her reply. I understand there is work under way. I know she has taken the point based on my contribution anyway, but I want to reiterate that we need to do whatever can be done to support the inclusion of Mounjaro. It can have a transformational positive impact on the lives of those who benefit from it, especially those who are suffering from long-term illness, recovering from cancer, and who are experiencing side effects from Ozempic. I understand there are commercial sensitivities in relation to these discussions but I hope an outcome will be reached sooner rather than later. I hope the decision will be to make it eligible so that people can benefit from it. The Minister of State can take it from the House and from me that we would like to see Mounjaro supported and included in the scheme for the betterment of people who need it most.

I thank the Senator for highlighting the case for the family. As he said, €600 per month is a lot of money. I will definitely go back to the Minister, Deputy Jennifer Carroll MacNeill, on this; I assure the Senator of that. I thank him again.

The State has made significant investment into the medicines pricing and reimbursement system since 2024, including funding to recruit an additional 34 staff across the pricing and reimbursement system, which includes an 80% uplift in the number of staff in the NCPE. We also have a pricing and reimbursement medicine tracker now. I am sure the Senator is aware of this. It was launched to provide transparency to patients and industry alike, in addition to two new framework agreements with Medicines for Ireland and the Irish Pharmaceutical Healthcare Association, IPHA, on the supply and pricing of medicines. That has been successfully concluded following extensive engagement and negotiations with our pharmaceutical sector. These agreements will enable faster access to new, innovative medicines for patients. The Senator is right. This is something that needs to be looked at and he can be assured I will definitely speak to the Minister, Deputy Jennifer Carroll MacNeill, on his behalf. I thank him again for raising this matter.