Fees paid to pharmacists by State grow by €113m as sector warns of closures

Fees paid to pharmacists by the State have increased by €113 million a year in the space of four years, new figures show.

Total payments under eight different drug schemes, but excluding Covid 19-related services, amounted to €423 million last year, up from €310 million in 2018 and €323 million in 2019, according to an internal Department of Health note seen by The Irish Times.

With talks due shortly on a revision of fees paid to the sector, the note suggests the Department may resist any increase in the current level of payments. The Irish Pharmacy Union claims outlets will close if current payment arrangements are not changed.

Last year, payments included €285 million under the General Medical Services (GMS) scheme, €45 million relating to the High-tech Drugs Arrangement (HTA) and €44 million for the Long-term Illness (LTI) scheme.

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GMS scheme fees have increased by 31.5 per cent since 2018, and HTA fees by 94 per cent. The Drugs Payment Scheme (DPS) spend more than doubled, from €13 million to €29 million as the threshold for qualifying for the scheme was reduced in successive budgets.

The overall spend on pharmacy fees is up 37 per cent since 2018.

The fees paid to pharmacists are due to be reviewed shortly, initially by the Department of Health, the HSE and the Department of Public Expenditure, and thereafter in a statutory consultation process with the IPU.

The Department of Health believes that while the review must be completed this year, “there is, in principle, no obligation to revise the fees upwards or otherwise,” according to its briefing note.

This claims the IPU’s proposals for fee increases would increase the cost of the various schemes by over €160 million a year.

The IPU says more than 10 per cent of pharmacies are currently losing money, especially in rural areas. “There will be an impact on patient care if these issues are not addressed as pharmacists cannot continue to operate a model that simply is not viable. This will include reduction in hours, weekend closure and ultimately, pharmacy closures in certain areas,” a spokesman told The Irish Times.

The IPU says revenue generated by each pharmacy under the drug schemes has fallen by 29 per cent, while labour costs have risen by 29 per cent. The sector wants a flat-fee model introduced, with reimbursement at €6.50 per item.

There are almost 2,000 pharmacies in Ireland, almost all of which hold HSE contracts to provide medicines reimbursed by the State. Some 23 new pharmacies opened in 2021, 20 last year and 11 so far this year. The IPU is seeking a streamlined accreditation process for overseas pharmacists coming to work in Ireland due to a shortage of staff.

Ireland appears to be relatively over-provided with pharmacists, going by the Department’s figures. The average number of pharmacists per 100,000 population is 107, compared with 87 in the UK and 86 among OECD members.

Pharmacists receive a variety of fees under the various schemes, including €5 for dispensing each item up to €1,667 per month, and slightly reduced fees in respect of items over that amount. Emergency contraception attracts a fee of €11.50 plus a dispensing fee, and eye drops €13.68. HTA drugs attract fees of up to €62.03.