Question No. 526
Parliamentary Question - Oireachtas

To ask the Minister for Foreign Affairs and Trade the detail of his recent discussions with the authorities in the United States of America on the implementation of a Visa Waiver Programme for the undocumented Irish; and if he will make a statement on the matter.
- Darragh O'Brien.
* For WRITTEN answer on Tuesday, 31st May, 2016.
Ref No: 12724/16 Proof: 552

Question No. 527
Parliamentary Question - Oireachtas
To ask the Minister for Foreign Affairs and Trade the detail of his discussions with the Embassy of the United States of America on the Implementation of a Visa Waiver Programme for the undocumented Irish; and if he will make a statement on the matter.
- Darragh O'Brien.
* For WRITTEN answer on Tuesday, 31st May, 2016.
Ref No: 12725/16


REPLY

I propose to take questions number 526 and 527 together.

Achieving relief for undocumented Irish migrants in the US and agreement on a facility for future legal migration between Ireland and the US remains a priority in the new Government’s relationship with the United States. 
 
Our Embassy in Washington and Consulates elsewhere in the US are active in advocating immigration reform and the issue is also the subject of high level political contacts between Ireland and the US Government. Meetings such as those the Taoiseach and I held with President Obama, Vice President Biden, Speaker Ryan, Senator Schumer and other key Congressional contacts around St Patrick’s Day have provided an important opportunity to reiterate our concerns in relation to the undocumented Irish and to encourage progress on a comprehensive legislative package by Congress.
 
Additionally, the Government is aware of and has raised the matter of waivers of three and ten-year travel bans imposed by the US authorities on Irish undocumented who have overstayed their visa in the United States, most notably with President Obama during the Taoiseach’s visit to Washington for St Patrick’s Day last year.  
 
At my request, the Secretary General of the Department of Foreign Affairs and Trade wrote to the US Ambassador to ask him to explore the question of such waivers further. I have also had the opportunity to directly discuss the matter with the US Ambassador on a number of occasions.
 
In response to the Government’s representations the US Embassy has pointed out that the US waiver system operates uniformly worldwide and is applied in strict accordance with US laws and regulations.  Individuals who have received a three or 10 year ban for overstaying a visa in the US can apply for a waiver and these applications are assessed individually on a case-by-case basis, with the final decision on each a matter for the US authorities in Washington. The US Embassy also noted it was not possible for applicants to predict with any degree of certainty whether they would be successful in this process.

The Government has been assiduous in seeking to advance all viable opportunities to achieve relief for our undocumented citizens in the United States. While I am disappointed that representations to the US on this matter have not resulted in a more encouraging outcome, ultimately it is a matter for the US Government and US Embassy to interpret and implement their immigration laws.

The new Government, the Department of Foreign Affairs and Trade and our Embassy in Washington, will continue to actively pursue all opportunities to achieve relief for the undocumented with the US Administration and the US Embassy in Ireland

REPLY.
A key challenge for the health system is ensuring timely access to health services. There has been a considerable increase in demand for care in our health system in recent years.  In order to effectively manage waiting lists, those patients waiting longest must be prioritised, once emergency and urgent cases have been dealt with.  The Programme for a Partnership Government (PfPG) emphasises the need for sustained commitment to improving waiting times for patients, with a particular focus on those patients waiting longest.  

No scheme currently exists to commission treatment at individual patient level within the Republic of Ireland for persons resident here. The Health Service Executive does, however, operate the EU Directive on Patients' Rights in Cross Border Healthcare in Ireland.  Under the Directive, patients are entitled to have costs of cross-border healthcare services reimbursed if the healthcare service in question is among the benefits to which they are entitled in their Member State of affiliation. The HSE is proactive in advising potential users of the Scheme that reimbursement will be at the cost of the treatment availed of abroad or the cost of providing the healthcare in Ireland, whichever is the lesser. Information on the Scheme, and its administration, is available from the National Contact Point of the HSE, details of which are on the HSE website.  The NCP is happy to advise patients of the reimbursement rate that will apply to the assessment/treatment being accessed.  The HSE endeavours to reimburse the cost of treatment incurred or the cost of providing such healthcare in the State, which ever is the lesser, to the applicant within 30 days of receipt of a claim for reimbursement, in line with Prompt Payment Legislation.

The 2016 HSE Service Plan undertakes to maintain 2015 levels of service in respect of scheduled care and to continue to address waiting times as part of the regular performance and accountability process.  Currently, 94% of patients wait less than the maximum waiting time of 15 months for inpatient, daycase or outpatient procedures, with c.60% of patients waiting less than 6 months for their required care. With regard to the PfPG commitment to provide €15m in funding to the NTPF in 2017, the Department will engage with the National Treatment Purchase Fund and the HSE to deliver on this commitment. As outlined in the Programme, this initiative will commence in 2017 and focus on those patients waiting longest. The PfPG also contains a commitment to continued investment of €50m per year to address waiting lists.

​For WRITTEN answer on Thursday, 9th June, 2016.

Details Supplied: Vertex pharmaceuticals
 
    
REPLY.
The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. Prior to deciding whether to reimburse a medicine, the HSE considers a range of statutory criteria, including clinical need, cost-effectiveness and the resources available. 
The decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds by the HSE, on the advice of the National Centre for Pharmacoeconomics (NCPE). The NCPE conducts health technology assessments (HTAs) of pharmaceutical products for the HSE, and can make recommendations on reimbursement to assist the HSE in its decision-making process. The NCPE used a decision framework to systematically assess whether the drug  is cost-effective as a health intervention
I am informed that, following a request from the HSE, the NCPE carried out an assessment of the manufacturer's economic dossier submitted in March 2016 on the cost effectiveness of lumacaftor/ivacaftor (Orkambi). This dossier included details on all relevant costs and relevant cost offsets including hospitalisation, disease management costs, intravenous antibiotics, adverse events and any additional costs arising in patients not taking Orkambi.
The NCPE has completed its HTA and submitted it to the HSE. The NCPE determined, following an evaluation of the economic dossier, that the  manufacturer failed to demonstrate cost-effectiveness or value for money from using the drug. The NCPE have confirmed that  all relevant costs were included in the analysis.
A summary of the HTA has been published on the NCPE website and is available at: http://www.ncpe.ie/wp-content/uploads/2015/12/Website-summary-orkambi.pdf.
The HSE will now enter into negotiations with the manufacturer, to seek very significant price reductions.  The HSE will then consider the outcome of these negotiations, together with the NCPE recommendation, in making a final decision on reimbursement.