The free HRT controversy: 'I am tired of pharmacists being taken for granted by the State'

The women of Ireland are losing out because the Government does not value our work 

On Budget Day 2025, then health minister Stephen Donnelly announced the rollout of free HRT products.

I’m sitting here, after a gruelling week, on top of what has been an exhausting few months for the Irish Pharmacy Union trying to resolve the initial promise of free HRT.

Last week, more than 600 pharmacists joined a webinar outlining why we could not endorse the minister’s €5 dispensing fee. One email captured the mood perfectly — "I am tired, after devoting the last 31 years to the profession, of being taken for granted by the State".

So why did the union say no? 

Where do I start?

Budget Day is a good place to start. The then minister for health announced free HRT. However, the fine print clarified “Free HRT products”. That detail was lost, and our patients expected no costs from January 1.

Community pharmacists were understandably angry and took to the airwaves. We held back, believing a solution matching public expectations would come through engagement, not confrontation. This decision was made despite a familiar pattern: no consultation with the profession before the announcement.

Pharmacists are the most accessible healthcare professionals, but ironically have the least engagement with the Department of Health and the HSE.

In August 2024, we saw for the first time in my lifetime as a pharmacist a clear government policy direction from the Department of Health led by the previous minister for health, Stephen Donnelly, with the publication of the expert taskforce report.

For the first time in my career, there was real optimism. We thought they were finally listening — maybe I’d get to use all my skills before I retire.

There was further optimism arising from the programme for government: less admin, recognition of our role in managing medicine shortages, a common conditions service, and — at long last — a commitment to review our fee structure.

Like many colleagues, I was beginning to believe our political system was seeing our value.

Then we watched as legislation to enable free HRT products passed through the Oireachtas at speed. No one contacted the pharmacists who were expected to deliver the service. In fact, it took 56 days from the budget to secure our first meeting with officials, who were asking for a scheme to begin within weeks.

Tom Murray: To the women of Ireland, we are truly sorry you are caught in the middle. We are not saying no because we want to. We are saying no because we must.

Since then, we have spent months in discussion with officials and the new minister, trying to find a resolution. Despite our genuine efforts, agreement could not be reached.

Do I blame the minister or the officials? No. They are doing their jobs. I blame the system, and the successive and consistent undervaluing of our professional role. This did not happen overnight, it has been years in the making.

When you see that the briefing given to the minister at the start of her tenure stated that “pharmacy fees are a further demand on the health budget”, how can we not feel reduced to a cost rather than a healthcare service?

No other healthcare profession is described this way — their fees weren’t even mentioned in the same report.

When the minister offered €5 to deliver the HRT service, the mood among pharmacists plummeted to an all-time low.

This professional fee rate was set during the financial crisis under emergency legislation that has since been repealed and has been reversed for all other healthcare professions. This rate simply does not reflect the value of the service. Once again, we are being asked to fund the State.

We asked why the €6.50 fee set just two years ago for contraceptive service is now considered inappropriate. We have received no answer. Meanwhile, inflation and pharmacy costs have only increased.

The policy vision for pharmacy is clear. A chief pharmacist must be appointed by both the department and the HSE to fully understand our sector and service costs. We cannot provide more services without more staff. We cannot pay our teams without a sustainable funding model.

We have been presented with an offer that cannot be accepted. The women of Ireland will lose out. So will pharmacists. Our exhausted, undervalued members will face the frustration of women who were promised something the Government will not deliver. 

Meanwhile, the decision-makers are far removed from the reality of healthcare delivery.

To the women of Ireland, we are truly sorry you are caught in the middle. We are not saying no because we want to. We are saying no because we must.

What's your view on this issue?

You can tell us here

The June 1 is a long time in a political sense. We are still hoping for a resolution to this issue and, more importantly, recognition of our profession.

• Tom Murray is president of the Irish Pharmacy Union (IPU)