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PHARMACISTS ARE STILL none the wiser as to how and when the government’s plan to roll out free Hormone Replacement Therapy (HRT) products for women experiencing symptoms of menopause will begin.
The outgoing health minister Stephen Donnelly announced that €20 million was being made available from January as part of Budget 2025 for the provision of state-funded HRT products, which would make them free for all women who have a prescription from their doctor.
The medicine-based treatment, which is used to relieve symptoms of menopause, perimenopause and postmenopause, is already free for holders of medical cards, but otherwise can cost in the region of €30 to €70 a month.
Under the new scheme, the products would be free of charge, but women who have a prescription from their doctor would still have to pay for their GP visit and the dispensing fee to the pharmacist.
However, there has been a delay in rolling out the measure which means women currently still have to pay for HRT products as pharmacies say they have not received details on how the scheme is supposed to work.
Pharmacists say the impasse is because they don’t think that the scheme should be described as ‘free HRT’ when women will still have to pay the dispensing fee, as well as for a GP appointment to get their prescription.
The Health Minister says that the scheme “has been available to be implemented since January” and should be rolled out now, despite this.
When the January deadline passed, the Irish Pharmacy Union (IPU) told The Journal that it had written to the Department of Health four times and held two formal meetings “seeking clarity on how the scheme is proposed to operate”, but had not received clarity on it.
Earlier this month, Health Minister Jennifer Carroll MacNeill said she had met with the IPU on 11 February and had “a good discussion” with them about the rollout of the scheme.
The Fine Gael TD said there had been a perception the medication would be “free entirely” and that the Government would cover the dispensing fee, but this is not the case.
“It was an effort to begin to do something, but there wasn’t agreement with the pharmacists that they would dispense it, and so it wasn’t implemented, even though it has been available to be implemented since the beginning of January,” the Minister said.
Dr Caoimhe Hartley established the Menopause Health clinic in Dalkey in 2021. She is also the clinical lead of the Complex Menopause Service at the Rotunda Hospital.
She told The Journal that the fact that a free HRT scheme is even being discussed is “brilliant”. However, she said there is “a lot of confusion” amongst her patients over the status of the scheme as it stands, which has led to “frustration”.
“We still have patients who are coming in, and we’ll talk to them about a prescription, and we’ll give them a prescription, and then they’ll ask us, ‘I presume this is free?’. They will have heard about the free HRT scheme, but they’re not aware of the fact that it hasn’t actually come into action yet.
“Five or six years ago, it wouldn’t have been on anybody’s radar to talk about having any sort of HRT scheme. The clinic that I run in The Rotunda, that’s a public clinic. That would not have existed five or six years ago. Something has definitely shifted, which is really positive.”
A spokesperson for the Department of Health told The Journal that it has engaged “extensively” with the IPU in relation to the rollout of the scheme, and that it remains “actively engaged on the matter with the goal to introduce this measure as soon as possible”.
Sheena Mitchell, a third-generation pharmacist, has run her own pharmacy in Dublin since 2008. She also hosts her own healthcare podcast.
Speaking to The Journal, she said pharmacists flagged that there were problems with the scheme from the time it was first announced.
“The biggest problem initially was in the naming of the scheme because it was inaccurate,” she said. “Calling it free HRT is misleading to the patient, and it’s us that are patient-facing.”
Mitchell said the name of the scheme had “caused a lot of confusion” for some patients, who thought that it would be the same as the free contraception scheme, which covers the cost of both GP visits and dispensing fees.
“It’s not free for the patient to receive the HRT. Patients have to pay for their GP consultation, then they have to go into the pharmacy and pay the dispensing fee. There’s a whole myriad of ways where the costs actually do significantly rack up for the patient.”
Consultations with GPs can cost between €50 and €70, while pharmacy dispensing fees can vary depending on the relevant reimbursement scheme.
She also said there was “zero consultation” with the community pharmacy sector before the measure was announced, adding that they have yet to receive a list of medications that would be included under the scheme.
“A policy was made without an implementation plan, so the stakeholders weren’t engaged. We heard about the scheme at the same time as the media, and ergo, there is no structure in place to facilitate the scheme.”
As a community pharmacist, I can tell you now that I haven’t received a single notification in the form of email, letter or phone call from either the HSE, the Department of Health, or the Minister in relation to the scheme since it was announced in the media.
Mitchell said the scheme is “a real missed opportunity to get equality among women of all different age groups when it comes to hormonal care.”
“For me, it’s not about the women who are already buying HRT. It’s about those women who aren’t accessing HRT now because of cost considerations,” she said.
Around 80% of women will experience one or more symptoms of menopause. Hot flashes, night sweats, low mood, brain fog, sleep disturbances, joint pain and urinary tract infections are just some of the symptoms associated with menopause.
“This reflected an opportunity for those women to be brought into the healthcare system and to have their issues addressed, but unfortunately, they still can’t afford to go to the doctor, and they still won’t be able to pay the pharmacy fee,” Mitchell said.
“The barriers exist, and it doesn’t represent equity or equality… It’s a further break in trust with our health service.”
Dr Hartley said that HRT is “the most effective treatment when it comes to managing a lot of the symptoms of menopause”.
For the 20% of women who get really severe symptoms of menopause, she said HRT can be “completely life changing for them and give them back their quality of life that they may have lost”.
“That’s the issue. When we have women on HRT, and it has changed their life, not being able to access it, either because of the financial barrier or because the thing that they were taking isn’t available anymore in the pharmacies, is really difficult and really detrimental to their quality of life and even their health.”
Kathy Maher, a pharmacist in Duleek, Co Meath and chair of the IPU’s Pharmacy Contractors Committee, told The Journal that the IPU was “fully supportive” of the Government’s commitment to the scheme when it was announced last October.
“We saw the difference that the contraception scheme made to women’s health, and we can see what a difference a free HRT initiative would make,” Maher said.
However, from the outset, she did not expect that the scheme would be up and running by the “ambitious” January deadline.
At the minute, there still isn’t any IT system in place for us to seek reimbursement of product. We’re not sure yet if there needs to be further legislation. There’s still no clarity in terms of the product that will be applicable.
According to Maher, the lack of an IT system is the most limiting step in implementing the scheme. When the free contraception scheme was announced, it took nine months to get a system in place, she said.
“From a public point of view, it’s hard to believe that there are actually 22 different medicine schemes by which pharmacies operate, and each one of them have different reimbursement rules of how we interact with the State and claim product payment. How the IT system would work for HRT hasn’t been made clear yet.”
HRT products are currently dispensed under two schemes. The General Medical Services Scheme (GMS) applies to those with medical or GP visit cards. However, if the product is not licensed in Ireland, there is no guarantee that it will be reimbursable for pharmacists.
The Drug Payment Scheme (DPS) sees the patient pay a maximum of €80 per month for medicines. The pharmacist receives the reimbursement price for the drug and the dispensing fee under the DPS.
If a patient is not spending more than €80 per month in their household, they are not eligible for the DPS as they do not meet the threshold. In this case, they pay privately.
In the Programme for Government, the coalition states that it will “streamline community pharmacy reimbursement procedures” and “review the pharmacy fee structure”.
Earlier this month, the Health Minister said the scheme has been “available to be implemented since the beginning of January”.
But Sheena Mitchell said that as there has been no communication in relation to an IT system, pharmacists have “no way” to administer the scheme.
“It just seems quite ridiculous that they’ve rolled out a scheme where they’re going to have to make another additional reimbursement platform, and that hasn’t been developed yet. Community pharmacists have certainly had no correspondence about it.”
Along with the delay in the rollout of the scheme, pharmacists have also been grappling with supply issues surrounding HRT products over the last three years.
While estrogen gel and progesterone are currently not affected, HRT patches have been “incredibly difficult to source for probably the last nine or 10 months”, Kathy Maher said.
The supply of products has been a bigger difficulty, and I would say at times, has been at crisis level.
“What can happen is one product might go into short supply, everyone has to switch to another, and then the demand on that product is extreme, and then we have to switch back.”
The Health Products Regulatory Authority (HPRA) told The Journal that there has been “intermittent supply” of some HRT products over recent years both in Ireland and abroad “due to a significant increase in demand and manufacturing issues which are limiting the ability to meet this increased demand”.
Dr Hartley said the shortages is currently “a much bigger issue than the cost” for her patients.
“We’re giving patients a prescription and we don’t know what’s available at any given time, and we also don’t know what’s available in one part of the country versus another.”
Maher said that healthcare professionals have worked hard in recent years to break down the stigma surrounding hormonal health and menopause care and symptoms, which she said can be “really debilitating” for women.
“The reassurance and the validation that they get from being heard is really important. But when there’s no continuity of product to treat, or perhaps for some women, HRT is not suitable or appropriate, they still have to manage their symptoms.”
When pharmacists do have to source unlicensed medicine due to supply issues, the State will not cover the cost in some cases as the product is not licensed in Ireland, Mitchell said, adding that dispensing fees can vary from pharmacist to pharmacist.
“For some women, it could be €8 a week on three items. That’s €24 a month, and that might be the choice between that and sports club for their child, or a new pair of shoes,” she said.
“Unfortunately, a lot of women can’t actually afford that and they will put themselves far down the priority list.”
The IPU has called for an increase in the fee to €6.50 per item of medicine dispensed under the community drug schemes.
“Now, on average, we get something like €4.34. We are so far behind and it’s just impossible to make ends meet,” Mitchell said.
Myself and my husband are husband-wife operators and there are months where I don’t take a wage so that I can pay my staff. That’s the reality.
Maher said that as the manufacturers of medicines not licensed in Ireland don’t have an agreement for the cost of the medicine with the State, those medicines can fluctuate in price.
“We just need to make sure that pharmacies are reimbursed at the price that they pay.”
She said the IPU is ”looking forward to ongoing collaboration with the Minister and her officials within the Department to get a proposal that will work for women”.
While she said that no deadline has yet been set for its implementation, she is “hopeful” that everyone is “focused and working in a collaborative fashion in the weeks to come”.
Dr Hartley said that offering clarity on when the scheme will come into effect needs to be prioritised.
“We have to start giving people some certainty about what’s happening, because the confusion around all of this is, together with the shortages that we talked about, immensely frustrating for women. Not knowing.”
In a statement to The Journal, a spokesperson for the Department of Health said both it and the HSE have engaged “extensively” with the IPU in relation to “the practical rollout of this measure, which was intended to commence in January”.
“Last month the Minister met with the IPU to discuss ambitions for expanding and reforming community pharmacy and on progressing the HRT initiative. The IPU committed to coming back to the Minister regarding the introduction of the HRT scheme, they have done so, and we remain actively engaged on the matter with the goal to introduce this measure as soon as possible,” the spokesperson said.
They said the free HRT scheme “represents another step to widen access to and reduce costs associated with menopause related treatments and services and follows on from all the other developments that have taken place over several years”.
“Reimbursement support for this new measure will be available to participating pharmacies from the date of commencement,” the spokesperson said.
Words fail me. Horrific excuse for a person to do that to a new born baby. Give the child up for adoption, not attempt to kill it. Crazy!!
There are no words. So sick.
Dublin Lad- ironic comment given your strong advocacy of Abortion on demand during the year? Not having a go. Just making a point.
Making a stupid point…
Kevin what’s your point? That you don’t know the difference between abortion and murder?
Same result
Not really, one results in no baby being born, the other results in a dead baby (or in this case critically injured).
Andrea- stunning evocative and thoughtful riposte, there. I’m in awe of your debating prowess.
Gearoid- actually the result is ultimately and incontrovertibly exactly the same; one less person walking & talking around the place.
Oh no, Kevin is unimpressed by me. That’s my Christmas ruined! Are you impressed by my sarcasm at least? Please say you are!!
Nobby nomates
Nobby nomates – must be a bootlicker of FG, probably dreams of enda kenny wiping his nose on his jacket!
Andrea- I don’t know what you mean. I was very complimentary about you, was I not?
Joe.. Same result.. So true..
It not the same result. There’s a dead person after a murder. There’s not after an abortion. An abortion does not mean there is one less person walking the earth, it means there is the same amount of people. Unless you count a fetus as a person in which case we’re wasting our time.
There’s a Huge difference between an abortion and THROWING a child out a window!!!! This woman was obviously not in her right mind , hope that poor baby is ok.
So it’s only a person when it pops out? And your inference that any other viewpoint makes the person unworthy of any ‘real’ debate is really crass. Sorry but I think you need to do some research….
Haha, I never said or implied any of that stuff. My views are a bit more complicated then “it’s only a person when it pops out” and it’s nothing to do with anyone’s views being unworthy, I’m just not bothered with conversation that will just go around in circles so don’t worry, no need for you to get up there on your high horse. I’ve researched the subject of abortion extensively, I’m pro-choice and my conscience is clear. I’m happy to discuss it with anyone but I’m well used to how it goes when it comes down to the “abortion =murder” point of view and I know from experience that that argument is a fat waste of time for everyone involved.
I hope the baby makes it thru
Tragic, on all sides…
Not going to say more than I hope the baby makes a full recovery until more facts are know about this case. It all seems very bizarre .
She fuked the baby out the window. She is mentally not right in the head. Hope the baby recovers.
If it was the father that threw the newborn out the window, we’d be looking at a very different comments section right now. There’d be no shortage of blame and ridicule.
I have never heard of a man becoming pregnant through rape or incest, having to conceal or deny a pregnancy, being denied or unable to afford an abortion, nor be forced to raise the child of his rapist. Men can generally abandon or deny their offspring with impunity, and are less likely to face adverse or dangerous consequences for becoming pregnant, being sexually active or becoming a parent.
Now it’s early and unfair to comment on this case, and there there is no reason why a tiny and vulnerable person should ever be made to suffer, but in our society we generally take into account the personal situations, mental stability and social contexts of those who have transgressed society’s rules.
Harming a baby is indefensible, but there are certainly differing sets of mitigating factors at play for a woman and a man in these situations. To pretend otherwise is to be deliberately disingenuous.
My point highlights a double standard ever present in public consciousness and media consciousness.
When a man kills a child it is both reported and considered an evil act and in itself indefensible. When a woman does it, or attempts it, the automatic assumption is mental illness.
In actuality, it’s normally mental illness at play in both cases and for both genders.
Likewise there have been very high profile cases in Ireland whereby fathers have taken children away from violent partners and they have been portrayed as kidnappers by both media and wider society. All they did, was protect their children as best they could.
So, you see, excuses (often valid) are made for one gender, and not for another. You have in fact, made those very same parallels in your post.
Well said, Conor.
Red Rooster, men doesn’t go through the hormonal changes during nine months of pregnancy, together with the added stress of disapproving parents, and then giving birth with no medical or emotional support. This is not about men, only in the implication that the father of this particular child wasn’t around to support the mother of his baby!
*Men don’t*, before the grammar Nazis start! ;)
I made no such inference. You did.
“men doesn’t go through the hormonal changes during nine months of pregnancy” Not so. Men do go through changes. Major changes. It’s all out there for you to research if you so wish. Chemical, emotional, and neurological changes.
However, I made a simple observation in my initial post. That observation stands, despite Conor’s post and yours.
You’re quite right, redrooster: men do go through hormonal changes. They’re not as strong as the hormonal changes the mother goes through, and at the end of the day the woman is left holding the baby, literally. It’s not all that long ago that women and girls were giving birth in secret here in Ireland. A little compassion wouldn’t go amiss maybe. And as some of the other comments have said we don’t know the full circumstances of what happened.
I agree it’s not long ago women were giving birth in secret. Nor is it long ago that a woman gave birth and the newborn was whisked away by nuns straight after birth never to be seen again. We live in a country with a horrid history – a history within living memory.
Now, roles have reversed. And we treat men in the same ways through our lack of laws – unmarried fathers, and our family courts.
We are doing the same things we always did. But this time we do it to fathers.
That said, we also expect mothers to be perfect. They are not. I’m not. No one is.
My own partner felt much shame at not being able to breastfeed our child years ago. She did everything ‘right’. But on occasion there was no milk and a screaming baby. The pressure she felt, was enormous. She felt like a failure as a mother and cried her eyes out at 3am with a hungry baby and neither of us knowing what to do.
She has pressures I’m unaware of. I’m aware of that.
Does your compassion extend to men Mary?
Yes it does, especially when the man wants to take his fair share and either the mother of his child or society prevent him from doing so. However in this case it seems the father just fecked off and let this poor woman go through a completely traumatic exoerience on her own. It may be that her family are very conservative and would have made things impossible for her. I just think there are very black and white reactions to what is a very sad story for all concerned. Judge not etc, etc…
This is what happens when people feel they have no other options and no support,
There is always a solution if you should open up. There are a lot of women in poor countries who manage to give their babies a chance no matter what.
Indeed Mila , there are always solutions , babyhatches are making a big resurgence in Europe , perhaps every hospital should have one http://www.dailymail.co.uk/news/article-2521538/The-revolving-door-baby-hatches-abandoned-newborns-German-hospitals-mothers-weeks-change-mind.html
This is not the fist case in Spain in recent times of this happening. Something similar happened when a mother threw an 18 month old out the window of a first floor and the Grandfather managed to catch her by sheer luck.
Well done to those cops for resuscitating the baby. Certain death otherwise.
I just give birth last week, my second baby. Excuse me but I don’t feel sorry for her, I hope she ends up in jail and throw away the key. She asked her parents to take her to hospital so obviously she only thinks about herself and nothing wrong with her head. Hope baby makes a full recovery.
Exactly Blondie! Quite willing to expose her secret to save herself when it came down to it. Vile creature who should go to prison. Hope poor child recovers.
My sister gave birth just 3 days before this animal, the thoughts of doing that to a poor defenceless little baby, a similar size to my tiny nephew boggles the mind. Hopefully he’ll recover well and be adopted by lovely people and have a great life :-)
I hope all involved get the help they need, there must be something terribly wrong with the mother for doing this to her baby, was she afraid of her own parents reaction to the pregnancy, why hide it??
A 35 year old who manage to have sex and get pregnant, carry the baby till full term, gone to labour, gave birth to a full live baby then just toss it away like a rug? The victim is the baby not the mother.
Poor woman no one in the right mind would do this, if you have the thought she is bad your just the same what she needed and needs is human compassion.
Very few of us are bad, on till you are unfortunate to be put some were, were a person takes your weakness and use them against you till you snap you cant judge.
My heart is with both of them, my mind won’t allow me go there until I know more.
How heartless!! No words for this!
What a tragedy. What must the woman have been going thru to make her hide this then go thru the agony that is labour alone and then discard of the baby. I feel sympathy for her. Hope the baby pulls thru but also that the family pull together and support them both.
Given that it’s referred to as an umbilical “chord” I’m not taking the article above as 100% fact.
Comparing a woman who has just given birth to a father is ridiculous.
Puerperal psychosis is very real but hey, in a grand little country like Ireland, why would we attempt to understand mental illness? Ignorance, knee jerk reactions from idiots are par for the course.
Couldn’t agree more – no one In Their right mind would do that. Who knows what her circumstances are- but straight away she’s the devil incarnate – she obviously wasn’t thinking straight. I fell sorry for both & I hope the poor baby will recover. Very sad.
She asked her parents for medical help, her mother being a mother herself by instinct went looking for the newborn and rush the baby to hospital. Realistically, that’s the fact of life. We always have an excuse but we are missing the focal point of importance here, the baby”s life !
Tell you what Conor… based on this article, ill condemn her and I think she should be stripped naked, bundled in a pair of jeans and dropped out a……lets say a 50 foot window onto concrete in the freezing cold, hopefully breaking a bone or two. …Then I’d probably drive over her in my car and drag her till I need diesel.. ill explain my reasons to her when I stop at the garage … fair ?
Erica, with all due respect, if your answer is not tongue in cheek, then I think it’s very blood thirsty and judgemental. Psychotic behaviour might try to find a legitimate home in ‘righteousness indignation?’
Puta madre
You think you are being funny and clever Simon, but perhaps she was. We don’t know the facts of this case, and probably never will know the full and true facts. Been seeing as people are commenting and jumping to judgement it is worthwhile examining some of the more likely scenarios.
Perhaps this woman was a prostitute (Simon’s hilarious comment ‘puta madre’ means prostitute mother in Spanish and i roughly equivalent to saying motherfuc*er in English). Thousands of woman are forced trough economic necessity to sell themselves. Perhaps she was doing this to keep her and her parents alive, unbeknownst to them.. Perhaps her intention was lot to harm the child. Maybe she thought the baby was dead. Perhaps she was stupid and naive and thought se could hide the baby on the terrace until her parents were away. Who knows?
On a side note, how media relate stories is interesting. Here we are told that she ‘threw’ the baby out a window. Given that the baby was later found, a nobody witnessed the throw, is it not possible that she ‘placed’ the baby, or in pain and panic ‘dropped’ the baby. We’ll never know, but the verb ‘throw’ makes a better story and attracts more comments from judgmental hypocrites who would see weak and vulnerable people hang for actions they would most likely do themselves if in a similar situation.
lets not condemn this woman with evidence taken from a Journal.ie article, our own imagination, and society’s prejudices.
Are you well ? , or has the eggnog gone straight to your head , lock the bitch up and throw away the key , child endangerment and attempted murder charges need to be brought , any medical help for mental health issues can be administered from inside prison , this freak had no problem seeking medical help for herself and having her “secret” exposed when she felt herself in imminent danger , abortion , infanticide and child euthanasia seem to be the order of the day for all these progressive liberals , let me tell you all this is not progress but genocide
Ironic.
You tell us we dont know the facts (The ones the police gave).And then you continue your retort with an essay of hypothetical situations.
It’s also possible that this woman has a learning disability and does not understand her actions. Let’s wait and see.
Stephen, I acknowledged the potential for irony in my comment. Re-read it of needs be. I said that while some are assuming a clear cut attempted murder scenario, without it being possible to definitely know, I would suggest some other potential scenarios. So actually not ironic..
Whatever this is Deasun it’s not genocide. The definition of genocide is the systematic attempt at the wiping out of an entire people, ie, Hitler’s ‘final solution’ or the dreadful slaughter in Rwanda. This hasn’t even got as far as infanticide yet and hopefully it won’t.
Thats fU ck3d up
Hope the baby survives. Sick young girl.
What a rotten woman!
If true it sums up the state of degradation we the human race continue to be in. Savages, that’s what we are – still in the cave.
We need to introduce a proper programme of education for all human beings instead of the garbage taught in schools.
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