Gabhaim buíochas leis an Aire Stáit agus guím breithlá sona di. Tá ceann de na rátaí asma is airde ar domhan againn in Éirinn. Is é an galar scamhóige ainsealach is coitianta in Éirinn í. Is féidir an cuid is mó de na básanna a bhaineann le hasma a chosc trí chúram agus bainistíocht níos fearr. There are currently 450,000 people living with asthma here. One in ten of those are children. Some 86,048 patients with asthma were enrolled with the chronic disease management programme, CDMP, as of 2023 and in the same year, 81 people died from the disease.

We have a terrible record here in Ireland in managing the condition. We have the second highest mortality rate among the EU 27, with women twice as likely to die from the disease. It is a story of work days missed, school days missed, over 4,000 inpatient hospital admissions and avoidable hospital admissions. If the Minister of State wants to consider it in economic terms because sometimes that is what the civil servants understand best, asthma cost Irish society over €1.2 billion in 2022. It does not have to be this way.

Asthma care has evolved significantly over recent years but such enhanced care requires investment. It requires investment in severe asthma care, establishing and maintaining a severe asthma registry, employing qualified advanced nurse practitioners, improving access to diagnosis, addressing environmental issues affecting asthma sufferers, such as damp homes and urban air pollution, and investing in something potentially transformative for young people, that is, maintenance and reliever therapy, MART, inhalers.

What are MART inhalers? MART is an inhaled corticosteroid, ICS, formoterol maintenance and reliever therapy combination inhaler and is considered the gold standard for people with asthma aged 12 and over and for children aged six to 11 whose asthma remains uncontrolled. MART uses a single ICS formoterol combination inhaler for both daily maintenance and symptom relief. This approach ensures that anti-inflammatory treatment is delivered whenever symptoms occur, while also simplifying treatment regimens. Clinical evidence consistently demonstrates that MART reduces the frequency and severity of asthma attacks, improves overall asthma control and is more effective than the short-acting beta-agonist, SABA, or blue inhaler with which we are all familiar.

Adherence to preventative treatment in Ireland remains low and cost is most certainly a factor. Many patients continue to rely on reliever inhalers to manage symptoms rather than addressing the underlying inflammation that drives asthma. Children and young people, in particular, are over-reliant on the blue inhaler and this is leading to poor management of the condition. The Asthma Society of Ireland estimates that rolling out free MART inhalers to 12- to 17-year-olds would represent a cost of €12.1 million. The Minister of State can imagine what that outlay would do for hospital admissions from asthma attacks and what it would do to reassure patients and parents and give young people with asthma a better quality of life by being able to participate fully in sports and other activities.

This age cohort is a critical one for asthma care in the population more generally, as management shifts from parent to patient and where sticking to a treatment path often declines. Being young is about being young, and often the routine is abandoned. This is borne out through research conducted by the Irish Council of General Practitioners. Many young people rely on the blue inhaler in the pocket to manage symptoms, yet poor asthma control can have a long-term impact on lung development, reduce lung function, remodel airways, and increase the risk of repository infections and weight problems.

The Asthma Society of Ireland is calling on the Government to provide funding as part of budget 2027 for free access to inhaled corticosteroid, ICS, formoterol inhalers, which are prescribed as maintenance and reliever therapy, MART, with a proposed phased introduction beginning with young people aged 12 to 17. This will be an important first step towards improving access to an evidence-based treatment and addressing significant inequalities that can arise from the cost of asthma medication.

Therefore, I ask that the Minister of State give consideration to whether funding for MART could be included in budget 2027 and whether she will commit to introducing subsidised access to the MART inhaler for young people aged 12 to 17 as the first phase of a wider approach. I also ask what assessment the Department has done of the potential benefits of increased access to MART, including the potential to reduce asthma-exacerbated emergency department attendances, hospitalisation, and over-reliance on short-acting reliever inhalers. The Asthma Society has made this a key ask in its pre-budget submission for 2027. Budget 2027 provides an opportunity for the Government to take a meaningful step towards improving asthma outcomes in Ireland.

I would welcome the Minister of State's response.

I thank Senator Noonan for the opportunity to address the Seanad on this issue. He has made a very compelling case. I am taking this Commencement matter on behalf of the Minister for Health, Jennifer Carroll MacNeill.

The State acknowledges the importance of access to new and innovative medicines for patients and is acutely aware of the challenges that patients diagnosed with asthma face. By way of background, MART inhalers are combination medicines that combine a steroid with formoterol, a long-acting bronchodilator medicine. This has an important benefit for patients in the form of a reduced need to carry separate maintenance and reliever inhalers.

Affordable access to medicines is a priority for the Government. There are a range of health supports available for patients with asthma under the general medical services, GMS, scheme and the drugs payment scheme, DPS, that reduce the cost of asthma medicines, including MART combination inhalers.

The HSE has statutory responsibility for medicine pricing and reimbursement decisions under the Health (Pricing and Supply of Medical Goods) Act 2013. The HSE has added a number of MART inhalers to the reimbursement list for eligible patients in Ireland, recognising the value offered by these medicines and supporting patient access. Medicines on the reimbursement list for medical card holders are available free from a pharmacist on payment of the statutory prescription charge, while under the drugs payment scheme, no individual or family pays more than €80 each month towards the cost of approved prescribed medicines.

In addition, individuals may also be able to claim tax relief on their medicinal expenditure at the standard rate of 20%, further increasing affordability. Eligibility for the drug payment scheme and medical card is determined in the context of the broader eligibility framework rather than by individual condition. There has been a significant shift in the quality and delivery of asthma care in recent years, with more patients being provided with care in the community and at an earlier stage.

The HSE’s chronic disease management programme provides free, twice-yearly reviews with a GP and practice nurse for medical card or GP visit card holders diagnosed with asthma. This includes personalised care plans to manage daily medications and address symptom management and flare-ups. Research into the chronic disease management programme has shown that over 90% of patients with chronic diseases such as asthma are now successfully managing their conditions in community settings.

The State continues to invest in making asthma medicines affordable for patients with: over €100 million in expenditure per annum within the community; new and innovative treatments continuously being added to the reimbursement list, and a suite of measures in the new framework agreements on the supply and pricing of medicines to strengthen affordability and availability across the coming years.

The Senator made a very important point about subsidised access. The health budget this year is €27 billion, €4 billion of which will be spent on drugs. A massive amount of the budget is being spent on drugs, and that is only going in one direction. Consideration of any future changes to the eligibility for medicines will be made in the context of current healthcare priorities and the budget available. The Minister and other Ministers of State are currently in negotiations in relation to the budget. However, I will certainly bring the points Senator Noonan has made very clearly to the Minister. I do not think there is a family in Ireland that is not familiar with the blue inhaler. For young people, it can be a most distressing time for them, especially when they get a diagnosis.

I thank the Senator Noonan for raising this matter.

I thank the Minister of State for her answer. I take on board the points she made as well as how there are supports in place. I reiterate the point that making this universally available for 12-to-17-year-olds could be transformative in terms of asthma care. It is an age cohort where their care for themselves maybe falls down a little bit, so having the MART inhaler available could be a really significant transformation. I understand the pressures that Department is under in terms of the drugs budget.

I want to thank the Asthma Society of Ireland for its engagement with me on this. We had a fantastic World Lung Day event last week. It was really interesting to see the range of work going on in terms of lung diseases in Ireland. Separately, the Asthma Society faces significant challenges in terms of the support for national organisations funding, as they were unsuccessful this year. I ask that the Minister of State engage with Minister of State, Deputy Buttimer, in relation to that. The society is a vital organisation. Back in the day, my mother used to fund-raise for it at church gate collections. There is a different funding model now, but it is a vital organisation and cog in the wheel in terms of asthma care. I ask the Minister of State to engage with her counterpart.

I have noted the Senator's comments. I also want to acknowledge the work that the Asthma Society of Ireland does. It is very supportive of families, especially families dealing with young children that are trying to grapple with the situation when they find out their child may be asthmatic.

As the House knows, affordable access to medicines remains a priority for the Government. Ireland is among the highest spenders on health across the EU and has the third highest rate of state coverage of pharmaceutical expenditure in Europe. Supported by €158 million of funding in budgets 2021 to 2025, the State delivered access to 250 new medicines. Budget 2026 allocated an additional €217 million for investment in medicines, including €30 million in funding for new medicines. This has, as of September, delivered access to 40 new medicines in the current year, which is most welcome. The year 1 cost of a new drug comes from the allocation for new medicines, but it should be noted that once these medicines are approved for reimbursement, the full cost of providing them can reach multiples of this initial cost as their uptake increases.

I assure the House that the Minister for Health appreciates the importance of ensuring that patients with asthma have access to the latest treatments. Senator Noonan specifically mentioned young people aged 12 to 17. The Minister has received a pre-budget submission from the Asthma Society of Ireland, which is under consideration in the context of preparations for budget 2027. The Minister and the wider Government remain committed to improving care for patients living with asthma, including severe asthma. I will certainly bring back the points that Senator Noonan raised because they are very important to a huge amount of people who live with asthma.