HSE settles action against Hickey group of pharmacies

A test case over dispensing fees claimed by one of the group’s pharmacies at Abbey Road, Navan, Co Meath had opened before Mr Justice Michael Quinn late last month.

In outlining the claim, Eileen Barrington SC, for the HSE, argued that pharmacy had received more than €419,000 fees for phased dispensing that it was not entitled to.

The claims were denied.

The case was regarded as a test case for 29 other cases initiated against DGM Pharmacies in relation to the system of phased dispensing fees.

Ms Barrinton said the net issue was whether DGM was entitled to submit, and be paid, fees for phase dispensing in addition to the standard dispensing fee in circumstances where medication was supplied to the client on just one occasion.

She said DGM had advanced a “completely artificial” interpretation of the rules in arguing it was entitled to claim for phased dispensing where all medication was dispensed on one single occasion in what were known as “blister packs”.

The case was at hearing for several days when the judge was told today by Nathy Dunleavy BL, also for the HSE, it had settled.

Counsel said the sides had agreed the court could make a declaration on consent.

The judge made that declaration which stated that, under the 1996 Community Contractor Pharmacy Agreement, phased dispensing fees were, and are, payable for GMS patients only where an item on a single prescription form is dispensed across multiple supply occasions.

Mr Dunleavy said there were 28 other sets of proceedings dealing with similar issues and they could also be struck out.

Previously, the court heard phased dispensing is generally used to prevent excessive or incorrect dosing by the patient. Instead of giving patients a month’s supply of their tablets, they are given one week’s supply at a time.

When the patient or a family member visits the pharmacy weekly, the pharmacist can check on their adherence to their medication.

In a grounding affidavit, Anne Marie Hoey, HSE assistant national director of the primary care reimbursement service, said a payment mechanism was established in mid-1996.

Under that, enhanced dispensing fees became payable to community pharmacist contractors for general medical services patients where an item on a single prescription fee is dispensed across multiple supply occasions.

She said it had emerged from inspections of pharmacies within various groups, including the Hickey Group, claims were allegedly made to the HSE for phased dispensing claims where supply allegedly occurred on a single occasion.

The Hickey Group’s standard operating procedure for monitored dosage systems stated a month’s supply would usually be provided to the patient by way of a blister pack and yet fees were charged by the Hickey Group for phased dispensing, she said.

The HSE alleged non-compliance with the phased dispensing rules, resulting in the payment of pharmacists for services they did not provide in circumstances where the HSE believed phased dispensing had taken place.

Ms Hoey said every phased dispensing claim will be reviewed but it was estimated the overall amount due from the Hickey Group from June 2011 and August 2016 is more than €5m.

It would appear the Hickey group had taken remedial action so as to no longer routinely claim for phased dispensing when it provides blister packs with a month’s medication to a patient.

Separate proceedings by the Hickey group against the HSE over allegedly wrongfully withholding payment for phased dispensing as of October 2016 have also been struck out as a result of today’s settlement.