Medicine Optimisation Support Service

From 1 June 2026, a significant reform of phased dispensing arrangements alongside the introduction of a new patient-centred Medicine Optimisation Support Service, will come into effect.

The Department of Health, the Health Service Executive (HSE) and the Irish Pharmacy Union (IPU) have agreed to these changes, which are designed to strengthen supports for vulnerable patients who hold a medical card, and will ensure a more robust system in the future.

The reforms see rigid phased dispensing fees replaced with a more flexible patient focused model - which empowers pharmacists to use their professional judgement to support patients most in need. It will also reduce administrative burden and further support the profession in the delivery of frontline patient care.

Medical card holders in the following vulnerable patient groups will be supported to receive one of a range of tailored supports, free-of-charge, where the pharmacist deems it clinically appropriate:

• Patients with physical impairment affecting the ability to use conventional packaging (who do not have carers that could support them to use original packs)
• Patients diagnosed with cognitive impairment or dementia who have carers to support them (including home care) by prompting them to take their medications at the appropriate intervals
• Patients with an intellectual disability. For the purposes of the Medicine Optimisation Support Service, the following definition applies: Intellectual Disability is characterised by lifelong limitations in cognitive and adaptive functioning and experiences of social and environmental restrictions which create barriers to effective participation in daily life. *1
• Patients who, for social inclusion reasons, including homeless or marginalised people, are unable to appropriately manage their medication.
• Patients who are on high-risk medicines and are at risk of misuse and/or abuse of those medicines.
• Importantly, all patients who were receiving phased dispensing or blister packs free-of-charge prior to the Community Pharmacy Agreement (in August 2025) can continue to do so.

• Adjustments to facilitate use of original packaging for example:
  • Reminder charts
  • Winged bottle caps / easy open lids
  • Large print labels, braille and talking labels
  • Alarms (such as notifications on mobile phones)
  • Tablet splitters.
• Dosette boxes.
• Administration charts.
• Instalment dispensing; and
• Blister packs where clinically necessary.

Blister packs should remain a last resort in line with the international evidence due to associated risks including reduced patient autonomy and potential safety concerns.

It is important to note that not all medicines are suitable for blister packs. Pharmacists will consider relevant medicine-specific factors to assess if all the patient’s individual medicines are suitable for supply in a blister pack.

For example, the following are NOT suitable to be provided in a blister pack:

• Some medicines are greatly affected by light or moisture and therefore must be kept in their original packaging.
• Certain medicines which are prescribed to be taken on an “as required” basis (e.g. medicines for severe pain, constipation, sleeping tablets).
• Medicines which frequently change dose (e.g. warfarin).

Where clinically required, and deemed appropriate, blister packs will be provided free-of-charge to eligible medical card patients, in identified cohorts.

1. What is the difference between blister packs and phased dispensing?

Phased dispensing and blister packs are both used to help patients manage medication, but they serve different purposes:

• Phased dispensing: Medicines are supplied in smaller, scheduled amounts (for example daily or weekly pick-up), usually for high-risk medications like antipsychotics or opioids.
• Blister packs: Pre-organised packs showing what medicines to take and when, typically prepared weekly to support patients who might need help remembering when to take their medicines or those who have complex medication routines.

Phased dispensing has been supported by the State for GMS (medical card) patients since 1996. Community pharmacists receive an additional fee to provide the service. Blister packs have never been State funded.

2. What exactly is changing?

• Better clarity and flexibility for how pharmacists can engage with and support their vulnerable patients who hold a medical card, using their professional and expert judgement.
• The agreement reached between the parties will see rigid phased dispensing fees replaced with a flexible, patient focused Medicines Optimisation support framework that will allow community pharmacists to focus on direct patient care.

3. Why is the system changing?

The old system linked payment too closely to phased instalments rather than care. The new approach focuses on outcomes for GMS patients, not the number of items dispensed or phased instalments.

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 adherence supports, for example:

• Medication reminder charts
• Easy-open packaging
• Large print or braille labels
• Medication alarms
• Phased dispensing
• 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.

4. Will vulnerable patients still be supported?

Vulnerable patients who hold a medical card, including those with diagnosed cognitive impairment or dementia, intellectual disability, physical impairment or those patients at risk of medication misuse can be supported with optimisation aids where indicated. The reform ensures that resources are targeted towards those who genuinely need them.

If, after an assessment, a pharmacist determines, using their professional and clinical judgement, that a GMS patient requires a blister pack for clinical or patient safety reasons, it will be provided without charge.

It has also been agreed that all GMS patients who were getting phased dispensing or a blister pack free-of-charge in August 2025 (i.e. immediately prior to the Community Pharmacy Agreement (CPA) can continue to receive those supports free of charge.

5. Will a medical card holder be able to get their medicines in a blister pack from their pharmacy free-of-charge?

Patients are encouraged to talk to their pharmacist about any difficulties they may have in managing their medicines. Pharmacists will be able to advise patients of the different options that are available to help with managing their medication.

Supports to help patients take their medicines are varied and include interventions including reminder charts, easy open lids and reminder alarms. Blister packs should only be used as a last resort.

Pharmacists will be able to advise patients about the risks and benefits of different supports, in order to determine the most appropriate one for them.

If a medical card holder is recommended to use a blister pack by their pharmacist, it will be provided free-of-charge.

6. If a patient receives their medicines under the Long-Term Illness Scheme; will they be able to get their medicines in a blister pack, free-of-charge?

No, the service applies to GMS patients only. However, if a patient needs help managing their medicines their pharmacist will be able to advise them about the risks and benefits of different supports, in order to determine the most appropriate one for them.

If a pharmacist recommends a blister pack this will be provided free-of-charge only if the patient is in receipt of a medical card.

If the patient does not have a medical card, their pharmacist will be able to advise them on the supports that are available and the associated cost.

7. If a patient does not have a medical card, will they be able to get their medicines in a blister pack free-of-charge?

Patients are encouraged to talk to their pharmacist about any difficulties they have managing their medicines. Their pharmacist will be able to advise them of options which may help.

If a patient does not have a medical card, their pharmacist will be able to advise them on the supports that are available and the associated cost.

8. How much can a pharmacist charge a patient for putting their medicines in a blister pack, as a private service?

Pharmacies are independent businesses and set the price for the services they provide. As a result, prices may vary from pharmacy to pharmacy. All pharmacies are required to provide clear and accessible pricing information to the public, in accordance with regulatory guidance.

As has been the case heretofore, medical card patients who do not require medicines optimisation support for clinical or patient safety reasons, but who wish to avail of optimisation supports (e.g. as a convenience), may choose to engage with their pharmacist on whether the service can be paid for privately as a private service.

9. If a patient’s doctor has always recommended that they receive their medicines in a blister pack, and the pharmacist gives it to them free-of-charge, will this continue?

If a medical card patient was receiving their medicines in instalments or in a blister pack free-of-charge in August 2025 they can continue to receive their medicines in this way. They will not be charged for this service.

10. If a patient has home carers who remind them to take their medicines, will the patient receive their medicines in a blister pack free-of-charge?

Supports to help patients take their medicines are varied and include interventions including reminder charts, easy open lids and reminder alarms. Blister packs should only be used as a last resort.

Pharmacists will be able to advise patients about the risks and benefits of different supports, in order to determine the most appropriate one for them.

If a patient is a medical card holder and their pharmacist recommends a blister pack, this will be provided free-of-charge.

If a patient was receiving their medicines in a blister pack free-of-charge in August 2025 they can continue to receive their medicines in this way. They will not be charged for this service.

11. Can patients living in residential care settings receive blister packs free-of-charge?

Medications for those living in residential care settings are managed in line with HIQA standards

1. If a pharmacist determines that a blister pack (MDS) is not clinically appropriate, but the patient or their carer insists on one, is the pharmacist required to provide it?

As with any decision to dispense or not dispense, this is at the pharmacist’s discretion. It is important to note here that there is no change with the current process - MDS/blister packs are currently managed by pharmacies and therefore processes will be in place for circumstances where the pharmacist determines the MDS is not appropriate, in line with the Code of Conduct.

2. If so, can it be provided on a private basis?

While the pharmacist may decide to provide the MDS on a private basis, as with any decision to dispense or not dispense, this is at the pharmacist’s discretion. It is important to note here that there is no change with the current process - MDS/blister packs are currently managed by pharmacies and therefore processes will be in place for circumstances where the pharmacist determines the MDS is not appropriate, in line with the Code of Conduct.

3. If a patient falls within the defined cohorts, but the pharmacist considers another support (e.g. medication chart) more appropriate, and the patient insists on a blister pack, can the pharmacist charge the patient?

As per b) above.

4. If a prescriber indicates please blister, and the patient is outside the cohort, can the pharmacist charge for this service?

Patients are encouraged to talk to their pharmacist about any difficulties they have managing their medicines. Their pharmacist will be able to advise them of options which may help and may also wish to engage with the patients GP on the available supports.

Where the patient is outside of the cohort and not clinically indicated, but the patient and their GP wish to avail of a blisterpack, the pharmacist can choose to charge for the service or provide it for free – subject to the patients’ individual circumstances. That will be a private arrangement between the pharmacist and the patient.

5. If a prescriber indicates please blister, and the pharmacist, through consultation, determines that another intervention is needed, where does the responsibility for the decision rest?

The pharmacist should engage with the prescriber to discuss concerns and considerations relevant to the patient and how their medicines are most appropriately optimised.

Where agreement is not reached, the pharmacist must determine the most appropriate support, cognisant of the medical evidence on blister packs, the individual patient needs and their Code of Conduct.

Responsibility for the decision sits with the pharmacist.

6. Will patients currently receiving medicines under generic GMS numbers be included under the new arrangements?

Regarding the use of social inclusion numbers/generic medical cards, individual patient arrangements cannot be sought under these numbers. If the patient has an individual valid medical card number, this should be used in all cases against that patient.

As previously with phased dispensing, generic medical cards are temporary cards for use in emergency situations and were not intended to open up access to services requiring individual approval including phased dispensing. This also applies to other individual arrangements such as special drug requests and discretionary hardship arrangements. An application can only be made against an individual who has a medical card in their own right.

7. When there is no nursing supervision in a residential care setting can pharmacists charge for blister packs?

Regarding sheltered accommodation or supportive living arrangements: the pharmacist can charge in circumstances where the patient either has no medical card or GMS patients do not meet the “clinically indicated” criteria

Further information for patients/ their families/carers can be found here.

Further information for community pharmacists can be found here.