Ireland’s medicines reimbursement system faces fresh scrutiny after the Minister for Health, Jennifer Carroll MacNeill, declined to provide an Irish deputy with costings for lowering the Drug Payment Scheme threshold, even as the government advances a sweeping new framework with the pharmaceutical industry aimed at speeding patient access to new treatments.

David Cullinane, Sinn Féin’s health spokesman, had asked the minister to set out in tabular form the estimated cost of cutting the DPS threshold – which caps monthly out-of-pocket spending on prescribed medicines – to €60, €40, €20, €15, €10, €5 and zero The written reply offered no such table, citing the “many challenges” of costing future eligibility changes.

Carroll MacNeill instead pointed to recent investment, noting that Budgets 2021 to 2025 added €158mn for new drugs, enabling 270 medicines to reach patients, while Budget 2026 set aside €30mn of a wider €217mn package for new treatments.

Ireland, she said, remains among the EU’s highest health spenders and has the third-highest rate of state-funded pharmaceutical coverage in Europe.

Close state – industry collaboration

The exchange came as separate parliamentary answers detailed the substance of two Framework Agreements on the Supply and Pricing of Medicines, signed on 3 March with the Irish Pharmaceutical Healthcare Association and Medicines for Ireland, covering 2026 to 2029.

The deals commit the state to a structured process toward an 180-day timeline for reimbursement decisions by the first quarter of 2029.

Responding to a separate question from Fianna Fáil deputy, Pádraig O’Sullivan, the minister said the agreements were designed to strengthen medicine supply security, encourage off-patent launches and support the financial sustainability of Irish health services, while signalling that Ireland remains “an attractive market” for innovators.

A parallel commitment will see IPHA member companies aim to submit reimbursement applications within six months of European Commission authorisation, in line with European Medicines Agency recommendations.

The state and industry have also agreed to develop a strategic partnership to pilot an early-access programme for rare diseases.

On the institutional architecture underpinning these reforms, the minister confirmed to Naoise Ó Cearúil, Fianna Fáil, that a strategic end-to-end review of the pricing and reimbursement system, beginning this year, will examine the functioning of the Rare Disease Technology Review Committee. The review will assess whether the committee’s role should be formalised and more closely integrated with the health technology assessment process.

O’Sullivan’s question on the operational record of the HSE Drugs Group – including meeting frequency, items reviewed between 2023 and 2025, and outstanding rebate debts under the framework – went largely unanswered in substance, with the minister directing the deputy to HSE corporate pharmaceutical unit data published online.

The written answers, all dated this week, underscore a tension in Irish health policy: ambitious multi-year commitments to faster, cheaper medicines access sit alongside persistent gaps in the granular costing and performance data deputies say they need to hold the system to account.

[VA]