OPINION: The Free HRT Scheme is not actually free

It was only a few weeks ago that the women of Ireland breathed a collective sigh of relief when the now-outgoing Minister for Health Stephen Donnelly announced that the Dáil had passed legislation to allow for the free provision of hormone replacement therapy (HRT) to women.
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.
In fact, many patients and colleagues have remarked to me, a ‘Subsidised HRT Scheme’ would have been a more reflective name for what the scheme actually covers. I hypothesise here, from the media commentary provided by Stephen Donnelly, as no formal communication regarding said scheme was sent to either the GPs prescribing for this scheme or the pharmacists dispensing the medication.
To explain, with the Free Contraception Scheme, the fees for doctor consultations, the pharmacists 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, what we know so far, is that the ‘Free HRT Scheme’ will only cover the medication or medical devices that are licensed by the Government of Ireland. 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 licensed in Europe is sourced by your pharmacist and agreed with your prescribing doctor.
Pharmacies across Ireland have experienced HRT supply issues every day for the last three years or more. (You would think this would have been sorted out before announcing a ‘Free HRT Scheme’.) This means that the HRT product the patient receives most often will be unlicensed, and therefore, the cost will then have to be borne by them and not the State. Most women are on two to three different HRT products every month, and so this cost can really add up.
Then there is the fee for a prescribing doctor’s HRT consultation and in some cases a menopause specialist, as not every GP is happy to assess a patient for menopause treatment. If you have never been assessed before, you may require blood tests and interim follow-up appointments in the first year.
Lastly, there is the dispensary fee from the pharmacist and the prescription tax by the State. Neither are covered under the ‘Free HRT Scheme’ (even though they’re fully covered under the Free Contraception Scheme).
Understandably, women are cross that come January, there will be an inequity in society with regards what the State supports in terms of women’s reproductive health and hormones. The divide is between women who can reproduce but choose not to, with the Free Contraception Scheme, and those who are near or at the end of their reproductive years, who must pay for their ‘Free HRT Scheme’.
Not only is it unfair, it was also short-sighted on Stephen Donnelly’s part. Many women and pharmacist colleagues cite his premature ‘Free HRT Scheme’ announcement as ill thought-out at best, and political gaslighting for votes in the recent election at worst.
Let’s hope the next government can do better for women. Their first job should be to sort out the mess that has been left behind them in terms of rolling out this so-called ‘Free HRT Scheme’, that is due to start in January 2025 and was announced with much public fanfare and back slapping.
With cost a barrier for so many women wanting to seek help for their menopause symptoms, the Free HRT Scheme announcement was set to be a godsend. The reality seems to be far from that.

Sheena Mitchell is a pharmacist at Milltown Totalhealth Pharmacy and a passionate public speaker on healthcare challenges and reform, with a particular focus on family and female health. For more, see her healthcare platform and podcast at WonderCare.ie or follow @wondercare_irl on Instagram.