Fiona Hayden explains the recent changes to charges for medical card prescriptions & their implications for the families of those with an intellectual disability.


Access to healthcare and medicines is an important, and sometimes worrying, issue for people with intellectual disabilities. The introduction and subsequent increases in the prescription charge for medical card prescriptions is controversial and runs the risk of those in financial difficulty not being able to afford vital medicines. This could pose serious problems for those with intellectual disabilities who also have physical health concerns. Recent changes in eligibility for the Long Term Illness Scheme and medical card have implications for those with intellectual disability, and have caused confusion.

The Long Term Illness (LTI) scheme covers specific illnesses:
■ Mental Handicap
■ Hydrocephalus
■ Cerebral Palsy
■ Epilepsy
■ Mental illness under sixteen years
■ Spina Bifida
■ Diabetes
■ Haemophilia
■ Muscular Dystrophy
■ Multiple Sclerosis
■ Cystic Fibrosis
■ Parkinsonism
■ Acute leukaemia
■ Phenylketonuria.

Anyone with any of the above conditions, regardless of income or financial situation, is entitled to have a LTI number, which is written into a LTI book, often known as the green book. Under the LTI scheme, all medication, medical and surgical appliances, such as needles and syringes or catheters, related to the illness, or disability, are provided to the patient free of charge. Prescriptions for medications presented to the pharmacy may be from a GP, or from a hospital. Medical appliances are provided by local health offices. Applications for a LTI book are made to the Local Health office.

A medical card entitles the holder to free medical care from their GP, certain procedures, and certain dental, ophthalmic (eye) and aural (ear) services. Certain medical appliances, such as nebulisers, are also covered from local health offices. Medical card entitlement is means-tested on the basis of income after tax and PRSI and Universal Social Charge deductions, and expenses such as rent, mortgage repayments, childcare and travel expenses. Medical card prescriptions must be written on a specific form (the green prescription form), by the GP with whom the patient is registered. There is a government levy of €2.50 per medicine, with a limit of €25 per family per month. In order to avoid spending over €25, the prescriptions for all family members must be from the same pharmacy. If a patient or family pays over €25, the HSE will refund the excess charges. Some medicines are not covered on the medical card. In this case, applications can be made to local health offices to have them covered, on what is called the Hardship Scheme.

Recent controversy over the government’s withdrawal of discretionary medical cards caused outrage, and the decision was eventually overturned. The HSE may issue discretionary medical cards after taking into account an illness or medical circumstances which would result in financial hardship. The HSE consider the cost of medical, surgical, nursing and dental treatment, physiotherapy, speech and language therapy, as well as transport costs to and from hospitals and clinics. The cost of medical aids and appliances is also considered.

Until recently, the HSE only allowed for a person to hold either a medical card or an LTI book, not both, and this was a problematic and difficult decision for many to make. However, this is no longer the case; now someone may have both a medical card and LTI number. This means a person with a listed long-term illness will not have to pay the prescription levy of €2.50 for medicines for their listed illness. Also, it removes the need to have hospital prescriptions rewritten by their GP onto medical-card prescription forms. This allows for much easier access to medicines. Any medicines or appliances not related to the Long Term Illness will be covered on the medical card, as well as free GP care.

If you think you, or a family member may be entitled to a LTI book, the application forms can be printed from the HSE website, or ask in your pharmacy or local health centre for a form. It must be signed by the doctor caring for the person with the Long Term Illness. If you have questions about medical card entitlements, ask at you pharmacy, GP’s office, or check the website:


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