The HSE has provided the following information about changes in Oral Nutritional Supplements (ONS) policy. CFI would welcome feedback on these how these changes affect our members.
HSE Advice on ONS Policy changes
'From 1st July 2019, there are changes to the way that some standard Oral Nutritional Supplements (ONS) are reimbursed under GMS and Community Drug Schemes.
Standard ONS products have been divided into first line List A products (comparable, in some cases clinically superior, and more cost effective) than List B products. If List A products are prescribed, there is no change to current reimbursement arrangements at all – if the patient has been historically approved outside of Core List L. From 1st July 2019, if a patient is prescribed a standard ONS on List B, the patient’s GP, HSE dietitian or clinician must apply online for continued reimbursement approval of this product under their LTI eligibility. List A and B are attached for your information (see below).
Reimbursement approval for ONS on List B is based on whether the patient has a clinical (medical) requirement for that specific product rather than an alternative comparable product.
Where the patient is subsequently approved for an ONS on List B, the pharmacy can continue to dispense this product under the patient’s LTI eligibility. This ONS will be reimbursed for a period of up to six months from the date of approval. The maximum validity for any prescription is six months.
If an ONS on List B is not approved, and it is unlikely that would be the case if the applicant outlines a CF diagnosis, the doctor or dietitian can recommend an ONS from List A or they may appeal the reimbursement decision.
A patient information leaflet has been developed to assist with these changes. I have attached this leaflet for your information. Further information can also be found on the HSE website (nutrition supports) at https://www.hse.ie/eng/services/list/2/primarycare/community-funded-schemes/nutrition-supports/public/ and the HSE Medicines Management Programme webpage at https://www.hse.ie/eng/about/who/cspd/ncps/medicines-management/oral-nutritional-supplements/.