Health Insurance (Amendment) and Health (Provision of Menopause Products) Act 2024
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Amendment of section 6A of Act of 1994 | ||
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7. (1) Section 6A of the Act of 1994 is amended, in subsection (1)— | ||
(a) by the substitution of the following definition for the definition of “high cost claim”: | ||
“ ‘high cost claim’ means a claim, or more than one claim, arising in any period of 12 months prescribed for that purpose relating to an insured person under a health insurance contract or contracts effected by the same registered undertaking— | ||
(a) the amount, or the cumulative amount, of which claim or claims, as the case may be, exceeds the high cost claim threshold, and | ||
(b) which has or have been paid by the undertaking, | ||
other than a claim for the cost of drugs that are not Health Service Executive approved drugs;”, | ||
and | ||
(b) by the insertion of the following definition: | ||
“ ‘Health Service Executive approved drugs’ means— | ||
(a) drugs which are included in one or more of the following lists: | ||
(i) the Reimbursement List established and published by the Health Service Executive under section 17 of the Health (Pricing and Supply of Medical Goods) Act 2013 ; | ||
(ii) the list maintained by the Health Service Executive under the programme commonly known as the National Cancer Control Programme; | ||
(iii) the list maintained by the Health Service Executive under the programme commonly known as the HSE Access and Integration Drug Management Programme (formerly known as the Acute Hospitals Drugs Management Programme); | ||
(iv) the list maintained by the Health Service Executive under the programme commonly known as the HSE Medicines Management Programme, | ||
(b) drugs which— | ||
(i) are normal human immunoglobulin products assigned the code J06BA under the Anatomical Therapeutic Chemical classification system established by the World Health Organisation, and | ||
(ii) were granted a marketing authorisation (within the meaning of Regulation 3(1) of the Medicinal Products (Control of Manufacture) Regulations 2007 ( S.I. No. 539 of 2007 )) prior to the commencement of section 17 of the Health (Pricing and Supply of Medical Goods) Act 2013 , | ||
or | ||
(c) drugs which have been approved for reimbursement or funding through the public health system by the Health Service Executive having regard to the criteria set out in Part 3 of Schedule 3 to the Health (Pricing and Supply of Medical Goods) Act 2013 ;”. | ||
(2) The amendments effected by subsection (1) shall be deemed to have come into operation on 1 April 2022. |