The Irish Pharmacy Union and the Department of Health are at loggerheads about which is at fault for a delay in implementing a national plan to make Hormone Replacement Therapy (HRT) free to all women, according to correspondence seen by Prime Time.
In November, Minister for Health Stephen Donnelly said legislation had been passed to allow the introduction of the measure in January 2025. However, the scheme is not yet operational, and no date has been provided for implementation.
Hormone replacement therapy is a medicine-based treatment used to relieve symptoms of menopause and perimenopause.
The IPU says “significant implementation gaps” remain which make it impossible for pharmacies to begin providing the HRT scheme.
“A lack of guidance and a refusal by the Department of Health and the HSE to engage with the IPU on members’ concerns is the reason for the failure to introduce this scheme to date,” it said in a statement.
It added that it has not been given a list of medication that will be covered, that there has been no guidance issued by the Department, and a tested IT system is not in place.
The Department of Health has said it is engaging with the pharmacy union, including meeting twice before Christmas. The goal is to introduce the free scheme “as soon as possible” it said in a statement.
Meanwhile, a briefing note prepared by the Department of Health for senior politicians and seen by Prime Time shows health officials believe that pharmacists’ reluctance to reveal the amount they charge to dispense medication is contributing to the delayed rollout.
“There is huge disquiet among pharmacists about the fact they will be required to disclose that they charge a professional service fee,” the note said.
“Patients are generally not aware that this is the case. This lack of transparency is deeply concerning,” it added.
Under current plans, when operational, the scheme will mean HRT medication will be free but the cost of the GP visit will not be covered.
Patients will also still have to pay a pharmacy dispensing fee, which the Department briefing note says can be as much as €10 per item.
The IPU has written to the department to propose an integrated women’s health plan that would combine the free HRT scheme with the free contraception scheme. This would create “one streamlined service, eliminating unnecessary hurdles while ensuring consistency and equity in women’s hormonal health care”, the IPU letter said.
Separately, the National Women’s Council is also calling for the replication of the contraception scheme, where GP visits and pharmacy fees are covered.
“We do understand there can be constraints, but it’s disappointing to see a scheme that already works in one instance for a younger age category of women that can’t be replicated for women in mid to older life,” Doireann Crosson, National Women’s Council Health Coordinator, said.
While also welcoming the ambition of the HRT initiative, Dr Caoimhe Hartley, Clinical Lead at the Rotunda Complex Menopause Clinic, said the current impasse was creating “a layer of complication” for women.
“We don’t know at this point exactly what this HRT scheme is going to look like, we don’t know what date it’s going to be brought in, we don’t know exactly what products will be covered and whether it will cover dispensing fees or not.”
Members of the opposition have also criticised the delay.
Sinn Féin said it represented “gross incompetence” and the plans had been a “cynical announcement” made by the Government before the election.
The party’s health spokesperson, David Cullinane, said the Department is “blaming pharmacists for a scheme that they should have negotiated and they should have put in place.”
The Social Democrats called for an end to what it described as “needless bickering” between the department and the IPU.
“It is completely unacceptable that the rollout of free hormone replacement therapy for women has been delayed by a farcical blame game between the Department of Health and pharmacists,” TD Sinéad Gibney said.
Dr Hartley said the lack of clarity was adding to the problems caused by current shortages of HRT.
The supply of HRT products has been constrained globally for a variety of reasons including increased patient awareness and demand that has outstripped manufacturing capacity.
The drug company behind a widely prescribed HRT patch in Ireland has said supplies will be constrained for at least another year.
Sandoz, which manufactures Estradot, told Prime Time the patches are produced by a third-party partner in the US.
“Due to capacity constraints at their manufacturing site we will have limited global supply which will include Ireland.”
“The supply of Estradot will continue to be constrained throughout 2025,” it said.
While issues with patches look set to continue there is better news for those who use gel-based HRT products.
Besins Healthcare, the company behind a popular gel form of estrogen, Oestrogel told the Prime Time it has increased production and the supply of its HRT products into Ireland has been “plentiful and continuous.”
Another major drug company, Novo Nordisk meanwhile said it was working closely with Irish authorities to “ensure patients have access to the medication they need.”
It said it was taking steps to increase the manufacturing of its products to address the high demand.
Louise Byrne and Lucinda Glynn’s report on the HRT scheme is broadcast on the Thursday 9 January edition of Prime Time.
