Reforms in Phased Dispensing Welcomed

Niamh Cahill reports on recent reforms in the area of phased dispensing and enhanced medicine supports

Reforms in the phased dispensing process took effect at the beginning of June. It followed a delay in implementation due to anger from political opposition parties and patient groups about the decision to remove free blister packing services for medical card patients.

The new arrangements, which are part of the Community Pharmacy Agreement, do not exclude blister packing, but introduce a structured medicines optimisation support service (see panel).

According to the Department of Health, blister packs will remain “a last resort in line with the international evidence” due to associated risks including reduced patient autonomy and potential safety concerns. Where clinically required and deemed appropriate, blister packs will be provided free-of-charge to eligible medical card patients in identified cohorts.

New system

Phased dispensing has been supported for medical card patients since 1996.

Under the new agreement, it has been agreed to largely limit phased dispensing fees to specified high-risk medications, where a patient safety concern may exist.

In late May 2026, the HSE wrote to GPs clarifying that the existing phased dispensing arrangements would cease from June and the new medicines optimisation support service would come into effect.

In a circular to GPs, Mr Shaun Flanagan, Assistant National Director, HSE Primary Care Reimbursement Service (PCRS), stated that the existing phased dispensing approval system would be stood down and phased dispensing approval no longer applied.

“For those patients who are dispensed high-risk medicines more frequently than weekly (eg, daily, several times per week) as requested by their prescriber and specified on the prescription, community pharmacies are permitted to continue dispensing high-risk medicines in this manner,” according to the circular.

“There is no application process or approval required by GPs. Reimbursement data has informed HSE PCRS of who the patients are in community pharmacy that require more than weekly dispensing.”

An IMO spokesperson told Medical Independent (MI) the previous phased dispensing system included a facility for a GP to go online and request phased dispensing approval. “This system no longer applies. The previous system was causing unnecessary GP workload and administration,” the Organisation’s spokesperson stated.

History

In an earlier circular to GPs, issued at the end of 2025, Mr Flanagan explained the history of phased dispensing and outlined why the changes were being introduced.

He stated that the supply of medication in instalments – known as phased dispensing – was introduced for patient safety reasons.

“Phased dispensing can support patients prescribed certain high-risk medications, who are at risk of medication misadventure when these medications are supplied in the typical monthly instalments.”

Monitored dosing systems (MDS) are systems that allow the individual medicine doses to be organised according to the prescribed dose schedule. Blister packs are one form of MDS, which can also include disposable trays and sealed pod systems.

“MDS and phased dispensing are two separate processes,” the circular stated.

“Phased dispensing requires the patient to present to the pharmacy on multiple occasions in the month, eg, each week, for dispensing of medicines. Phased dispensing is in place where it is unsafe for the patient to have the totality of their medication in one supply occasion, eg, psychotropic drugs. An MDS is ordinarily provided in one visit and packaged to indicate when medication should be taken to facilitate compliance.

“In recent years, a practice has developed whereby MDS are inappropriately associated with the phased dispensing process. The Department of Health and HSE have never approved reimbursement arrangements for the filling of MDS by community pharmacy contractors.”

In December 2025, Minister for Health Jennifer Carroll MacNeill said that some pharmacies had submitted phased dispensing claims to the HSE, when they were using MDS, a practice not agreed with the State.

‘Well-received’

Speaking to MI just before the new arrangements were introduced, Ms Kathy Maher, a community pharmacist and former President of the Irish Pharmacy Union (IPU), said the agreement has been “well received by pharmacists”.

The changes offer pharmacists an opportunity to discuss medication optimisation with patients in a meaningful way, Ms Maher stated.

She pointed out that international evidence does not support the widespread use of MDS to support medication management.

“What the evidence supports mostly is the intervention by pharmacists, having a conversation with patients. I think this new arrangement will facilitate that happening better,” she said.

“There isn’t any evidence to support the use of blister packing, and in some cases, it can be detrimental to patients.

What this does is it takes the ownership back to patients in terms of what their prescription is and what their medicines are for… the pharmacist can recommend something that might be better than blister packing.”

The IPU has also referenced international evidence that MDS should be a last resort because of the risks associated with their use, such as the deterioration of medicines removed from their original packaging.

Nevertheless, the use of MDS remains common practice in community pharmacy and, anecdotally, it is a system that is preferred by some patients. However, it is understood that many pharmacies do not encourage or promote blister packing.

Commenting on the new agreement on 31 March, the then IPU President Mr Tom Murray said: “Pharmacists use their expertise every day to support those managing complex medicines, living with cognitive or physical impairments, or facing significant social challenges. This agreement strengthens our ability to protect vulnerable patients while supporting the safe, effective, and evidence-based use of medicines.”

‘Flexible’

According to the Department, the new approach “focuses on outcomes for GMS patients, not the number of items dispensed or blister packs”.

“The new flexible system is also designed to help pharmacists in their direct patient care role as it supports professional judgement and reduces administrative burden.

“The funding provided will support a range of appropriate and practical interventions and adherence supports, for example: Medication reminder charts, easy-open packaging, large print or braille labels, medication alarms, phased dispensing, and blister packs (where clinically appropriate).

“It is important to remember that the available evidence and international practice recommends that blister packs are only used as a last resort because they can negatively impact patient independence.”

This agreement strengthens our ability to protect vulnerable patients while supporting the safe, effective, and evidence-based use of medicines