2026-04-23

Menopause has recently begun to receive the recognition that it deserves in this country. The introduction of the free HRT scheme was a significant and welcome step forward. However, the policy has always contained a clear and acknowledged gap for women who are medically contradicted from taking hormonal treatments. The National Centre for Pharmacoeconomics last week published its assessment on Veozah, a non-hormonal treatment for moderate and severe symptoms associated with menopause. This medication is particularly relevant to women for whom HRT is not clinically appropriate, including women who have oestrogen-positive cancers and other medical contradictions. This is a situation I have raised on the floor over a prolonged period. While last week's NCPE assessment raises concerns about cost-effectiveness, it is notable these concerns are framed around individuals who can take HRT. That wording is critical because it highlights that the medication is being assessed against a comparator that a significant cohort of women simply cannot safely use. That is not an abstract concept. The Minister for Health has repeatedly acknowledged on the Dáil record and in reply to my parliamentary questions that not all women are clinically eligible for HRT, and that women who are contradicted must pursue non-hormonal options with their GP or oncologist, and that there are currently no plans to modify the free HRT scheme to include those alternatives. That leaves women, often cancer survivors, with fewer treatment options, greater financial burden, and unequal access to menopause care. The NCP process on Veozah should not be viewed as a single, narrow reimbursement decision. It presents an opportunity to address the wider policy issue on how the State supports menopausal women who are excluded from HRT on medical grounds. I ask that the Government ensure that Veozah is, at a minimum, included in the drugs payment scheme, and for a commitment to formally review the free HRT scheme so that women who cannot take hormonal treatments are not structurally excluded from State-funded menopause care. Tá druga ar fáil gur féidir tacú le mná leis an athrú saoil, go háirithe mná atá tar éis ailse a chur díobh. Ní féidir leo an gnáth-HRT a úsáid de bharr na hailse. Mar sin, ba chóir go mbeadh an druga sin, Veozah, á chur ar fáil dóibh.

I thank the Deputy very much for raising this important matter. I acknowledge that, as he rightly reminded the House, this is not the first time he has raised this issue here, and directly with the Minister for Health as well. There has been a welcome and renewed policy focus in this House and from the Government on the importance of HRT treatment and accessibility to the free HRT programme. I thank my colleague the Minister, Deputy Carroll MacNeill, for the work she has done in getting this programme up and running that is helping many women across the country. I say that before getting to the Deputy's specific point. He raised the medicine, Veoza. My understanding is that the HSE received an application for pricing and reimbursement of Veoza on 9 February 2024 from the pharma company. It is for the treatment of moderate to severe vasomotor symptoms associated with menopause. On foot of a rapid review by the NCPE, the body that reviews medicines on behalf of the State, the HSE commissioned a full health technology assessment, HTA, on 8 April 2024, as per agreed processes. Often the State gets blamed for being slow but it is important to say that 16 months passed before the company submitted the completed HTA dossier. I say that because people often ask why the Government does not move quicker. Sixteen months passed from when the NCPE said it was going to carry out the HTA to when the company submitted the dossier. That fact should be made known as well. When the NCPE did receive the full dossier it carried out its work and, as the Deputy says, it issued a report. I thank the NCPE for the work it is doing. The factual position now is that the HSE will contact the company with a view to commencing commercial negotiations. I want to be very careful not to interfere with that. The Deputy is not doing that either. We need to allow the HSE to do its job in terms of carrying out that commercial negotiation. We are now spending €4 billion a year on drugs, which is good, as we need to do so. That is more than the budget of many stand-alone Departments. The budget for the Department of justice is probably around €6 billion. We are spending €4 billion on our drugs budget, so we have to allow the HSE do its commercial negotiation and get the best value for the taxpayer because obviously if it does not, it will affect the ability to purchase other drugs as well. I recognise the importance of timely access to new medicines. I take the point the Deputy made about certain women who cannot access other treatments. I take very seriously the point he made about cancer patients and also cancer survivors. In terms of modifying the free HRT programme to include non-hormonal treatment - I will not comment on the specific drug given the negotiations, as I do not want to cut across that - but any of the more broad matters concerning the programme and the likes are a matter for budget time. I am very happy to engage with the Deputy on that then. The main thing now is for the HSE to contact the company and get into commercial negotiations.

A significant milestone was reached last week with the NCPE report. Ultimately, this is a question about fairness and equality. Women who are medically eligible for HRT now receive their treatment free of charge, whereas women who cannot take HRT, often because of hormonally sensitive cancers, are directed towards non-hormonal alternatives, yet those alternatives are not treated equally by the State. That is not a position that should continue, especially when there is an alternative available with Veoza. I have raised this repeatedly with various Ministers for Health, including questions on medications prescribed through specialist menopause services for women who are HRT contraindicated. The response has consistently been that no expansion of the scheme is planned. That cannot continue. The assessment of non-hormonal menopause treatment such as Veoza has fundamentally changed the context.

I thank the Deputy.

The scheme needs to be reopened at this point to ensure equality.

I call on the Tánaiste to respond.

The Deputy is right. It is always a milestone moment in relation to the consideration of any new medicine for Irish patients when the NCPE produces its report and that has obviously happened. The next step is for the HSE to invite the company to initiate commercial negotiations. Following that step, clinical submissions are considered and so too are patient submissions. That is important so that the voices of the women the Deputy referenced can be heard in this process. Clinical submissions and patient submissions are considered, as well as the outworkings of the commercial negotiation. Ultimately, the HSE drugs group sends its recommendation to the HSE leadership team. That is the process that will be undertaken. I am very proud of the work we have done together, as a Government, in terms of the free HRT scheme. I think we all are. It is very important that Deputies come to this House and highlight where they believe there is room for improvement or gaps where people cannot qualify. That is separate to the drugs piece, which I am not getting involved in because they are commercial negotiations. We can of course have those broader conversations about how we help all our citizens in the context of the upcoming budget.