PCRS is part of the HSE. It processes payments to all of the GPs, Dentists, Pharmacist and other professionals who provide free or reduced cost services to the public. You get the service, and the PCRS pays for it on behalf of the HSE.
The HSE, Finance Shared Service, Primary Care Reimbursement Service (PCRS) supports the delivery of primary healthcare by providing reimbursement services to primary care contractors for the provision of health services to members of the public in their own community.
In addition to the processing and making of payments on a national basis to key customers, including General Practitioners, Pharmacists, Dentists and Optometrists / Ophthalmologists, the PCRS compiles statistics and trend analyses which are provided to other areas within the HSE, the Government, customers, stakeholders and to members of the public.
Community Based Services – Payment Arrangements
Almost all payments for services provided in the community by General Practitioners, Community Pharmacies, Dentists and Optometrists/ Ophthalmologists are made by the PCRS. Claim data is processed and payments are made by the PCRS under the following Schemes/Payment Arrangements:
General Medical Services (GMS)
People who are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants may be granted a medical card and receive a free general medical service. Drugs, medicines and appliances supplied under the Scheme are provided through retail pharmacies. In most cases the Doctor gives a completed prescription form to a person, who takes it to any pharmacy that has an agreement with the Health Service Executive to dispense GMS prescription forms. In rural areas the Doctor may dispense for those persons who opt to have their medicines dispensed by him/her. All GMS claims are processed and paid by the PCRS.
Drugs Payment Scheme (DPS)
Under the Drugs Payment Scheme persons who are ordinarily resident in the State and who do not have a current medical card can benefit. An individual or family has now to pay no more than the monthly threshold amount in a calendar month for approved drugs, medicines and appliances for themselves or their family. In order to benefit under this Scheme a person must register themselves and their dependants with their Local Health Office. Items currently reimbursable under the Drugs Payment Scheme are those listed in the GMS Code Book. Other items, which were reimbursable under the DCS and Refund of Drugs Schemes, continue, in certain circumstances, to be reimbursable under the Drugs Payment Scheme. DPS claims are processed and paid by the PCRS.
Long Term Illness Scheme (LTI)
On approval by the Health Service Executive persons who suffer from one or more of a schedule of illnesses are entitled to obtain, without charge, irrespective of income, necessary drugs/medicines and/or appliances under the LTI Scheme. All LTI claims are processed and paid by the PCRS.
Dental Treatment Services Scheme (DTSS)
Under the Dental Treatment Services Scheme GMS eligible adults have access to a range of treatments and clinical procedures comprised of Routine Treatments and Full Upper and Lower Dentures. Routine Treatments are now available for all eligible persons. Dentists may also prescribe a range of medicines to eligible persons. All claims under the DTSS are processed and paid by the PCRS.
European Economic Area (EEA)
Residents from one of the other states of the European Economic Area, with established eligibility, who require emergency general practitioner services while on a temporary visit to the State are entitled to receive from a General Practitioner a GMS prescription form for necessary medication and to have such medication dispensed in a Pharmacy that has entered into an agreement with the Health Service Executive within the State. Students, posted workers and their dependants are entitled to full services on presentation of a valid Form E128. EEA claims are paid by the PCRS.
High Tech Drugs (HTD)
Arrangements are in place for the supply and dispensing of High Tech medicines through Community Pharmacies. Such medicines are generally only prescribed or initiated in hospital and would include items such as anti-rejection drugs for transplant patients or medicines used in conjunction with chemotherapy or growth hormones. The medicines are purchased by the Health Service Executive and supplied through Community Pharmacies for which Pharmacists are paid a patient care fee: the cost of the medicines and patient care fees are paid by the PCRS.
Primary Childhood Immunisation Scheme
A National Primary Childhood Immunisation Scheme provides for immunisation of the total child population with the aim of eliminating, as far as possible, such conditions as Diphtheria, Polio, Measles, Mumps, Rubella and Meningococcal C Meningitis. Payments under this Scheme to Doctors in some of the HSE Areas are made by the PCRS.
Health (Amendment) Act 1996
Under the Health (Amendment) Act 1996 certain health services are made available without charge to persons who have contracted Hepatitis C directly or indirectly from the use of Human Immunoglobulin - Anti D or the receipt within the State of another blood product or blood transfusion. General Practitioner services, pharmaceutical services, dental services and optometric/ophthalmic services provided under the Act are paid for by the PCRS.
Methadone Treatment Scheme
Methadone is prescribed and dispensed by Doctors and Pharmacists for approved clients under the Methadone Treatment Scheme - capitation fees payable to participating Doctors and Community Pharmacists and claims by pharmacies for the ingredient cost of the Methadone dispensed and the associated dispensing fees are processed and paid by the PCRS.
HSE Community Ophthalmic Services Scheme (HSE-COS)
Under the Health Service Executive Community Ophthalmic Services Scheme, adult medical cardholders and their dependants are entitled, free of charge, to eye examinations and necessary spectacles/appliances. Claims by Optometrists/ Ophthalmologists are paid by the PCRS. Claims for spectacles provided under the Children’s Scheme are also paid by the PCRS.
Immunisations for certain GMS Eligible Persons
Agreement was reached between the Department of Health & Children and the Irish Medical Organisation on fee rates to be applied to certain immunisations for GMS eligible persons. The immunisations encompassed by the agreement are: - Pneumococcal, Influenza, Hepatitis B and the combined Pneumococcal/Influenza. The Health Service Executive facilitated claiming for any of these immunisations by extending the range of codes for ‘Special Items of Service’.
General Practitioner Visit Card (GPVC)
Certain people in Ireland who do not qualify for a medical card may apply to the Health Service Executive for a GP Visit Card. GP Visit Cards allow individuals and families who qualify, to visit their General Practitioner for free. All GP claims are processed and paid by the PCRS.