“The devil is always in the detail”
Recently, the announcement by Minister for Health Stephen Donnelly regarding the new Free Hormone Replacement Therapy (HRT) Scheme was met with widespread applause among women in Ireland.
The promise to provide free HRT to help manage the symptoms of menopause was seen as a progressive step forward.
However, as Sheena Mitchell, a pharmacist and healthcare advocate, explained in a recent piece, the reality is far from the government’s claims of a fully free scheme.
In a recent article, Mitchell highlighted that unlike the Free Contraception Scheme, which covers the full cost of consultations, medications, and dispensing fees, the Free HRT Scheme does not provide the same level of support.
“The devil is always in the detail and unfortunately, unlike the Free Contraception Scheme introduced by the same Health Minister in 2022 and expanded recently to women aged up to 35-years, the Free HRT Scheme is not actually Free,” she said.
“To explain, with the Free Contraception Scheme, the fees for a doctor consultation, the pharmacist dispensing the medication, and the contraception products themselves are all covered by the government.
“What is more, all of the medication or medical devices prescribed for contraception are readily available in pharmacies to be dispensed.
“In contrast, the Free HRT Scheme will only cover the medication or medical devices that are licenced by the Government of Ireland.”
While the medication itself may be covered for licensed products, any unlicenced alternatives, often required due to supply shortages, will still have to be paid for by the patient.
“So, when a prescribed product like an oestrogen patch is not available to pharmacists to procure because it is in short supply, an alternative patch licenced in Europe is sourced by your pharmacist and agreed with your prescribing doctor.
“This means that the HRT product the patient receives will be unlicenced and the cost will be borne by the patient and not be reimbursed by the State. Most women are on two to three different HRT products every month and so this cost can really add up.”
“The Free HRT Scheme will only cover the medication or medical devices that are licensed by the Government of Ireland”
In addition, the scheme does not cover the consultation fees that are essential for HRT treatment.
Sheena Mitchell points out that many women will face consultation fees ranging from €60 to €250 for initial and follow-up appointments, as many GPs are reluctant to provide menopause treatment.
This means that while the medication may be free in some cases, the associated costs to get the prescription are not.
“The final costs then in the HRT medication process are the dispensary fee from the pharmacist and the prescription tax by the State.
“Neither of which are covered under the Free HRT Scheme but are fully covered under the Free Contraception Scheme.”
Sheena went on to say: “The Minister for Health has written into law that there will be Free HRT for women.
“However, unlike the contraceptive scheme, he is unwilling to pay a doctor to assess a woman’s suitability for HRT, unwilling to pay a pharmacist to dispense the medication, and unwilling to pay the pharmaceutical suppliers for a sufficient quantity of the hormone replacement therapy drugs to meet demand.”
The pharmacy professional has estimated that the average woman could end up paying anywhere from €18 to €1,224 annually for HRT medication, depending on factors like availability, age, and the stage of menopause.
Mitchell further criticised the scheme’s rollout, explaining that there is still no clear infrastructure or eligibility criteria in place, and no engagement from the government with the necessary healthcare services to make it truly accessible to women.
Ultimately, while the Free HRT Scheme was initially seen as a victory for women’s health, Sheena Mitchell’s perspective reveals a stark reality opposing this.
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