The Framework Agreement on Medicines: Where things stand.
In January, we published our initial response to the announcement of new framework agreements on the pricing and supply of medicines between the State and the pharmaceutical industry. You can read that piece here.
The full text of the agreement was published on 3rd March. We want to give our members an update on where things are at — what we welcome, and where our concerns remain.
What we welcome
The tone of the agreement is genuinely different to what has come before. There is a more explicit acknowledgement of the patient interest, a stated commitment to partnership, and greater engagement from both industry and the State side than we have seen in previous agreements.
The renewed commitment to the 180-day timeline for reimbursement decisions is also significant — because the current reality remains deeply inadequate. As we noted in January, Irish cancer patients are waiting an average 644 days for access to new medicines, and only around 25% of innovative oncology medicines approved at European level are available here. The distance between that reality and the 180-day standard is the space in which patients are waiting, and in some cases running out of time.
This was also the context for Miriam’s contribution at a recent conference on access to medicines, covered by RTÉ, where she welcomed the intent behind the agreement while being direct about the distance still to travel. You can read the RTÉ coverage here.
Our concerns
We welcome the direction of travel. But there are three specific areas where we have significant concerns.
1. The 180-day commitment won’t be reached until the end of March 2029
This is the most fundamental issue. The 180-day timeline for reimbursement decisions has been a legislative requirement — written into the Health Act 2013 — for well over a decade. It has never been met. The new agreement commits to achieving it on a phased basis, with the target reached by end of March 2029. That is almost three years away.
We understand that building a functioning system takes time. But patients cannot afford to wait three more years for a standard that should have been in place for more than ten. Every month of delay is a month in which patients are waiting for treatments that may be available elsewhere in Europe. The phased timeline needs to be accelerated, and there must be transparency about progress at every stage so that patients and patient organisations can track whether milestones are being met.
2. Drugs Group expansion — no patient or public interest call yet
One of the most important structural changes in the agreement is the proposed expansion of the Drugs Group, the body that makes reimbursement recommendations. Including patient and public interest members in that process is essential to ensuring decisions reflect more than just clinical and economic criteria. We are aware that this work may be underway. But to date, there has been no expression of interest request issued for patient or public interest members of the Drugs Group, which leads to concerns that the expansion of the group is not yet underway. The lack of public transparency on this key issue is concerning.
3. Early access — mentioned but not moving
The agreement references early access to medicines — the mechanism by which patients can access treatments while a formal reimbursement decision is underway. We have been calling for a functioning early access scheme for some time. It was referenced in the January announcement. It appears in the full agreement text.
But there has been no visible progress since publication. No pilot has been announced. No design process has been initiated that includes patients or clinicians. The absence of any progress on early access in the months since the agreement was published is a gap we will continue to flag.
What we are doing
We are engaging with this process constructively but with clear expectations. Miriam raised these concerns directly at the recent conference on access to medicines and made clear UCAN’s position: we welcome the intent, we recognise the improved tone and the commitment to partnership, but the delivery timeline on the 180-day standard is too slow, expansion of the drugs group is a key enabler and we have not seen public progress yet, and early access cannot remain a statement of intent indefinitely.
We will continue to monitor progress, raise concerns through every appropriate channel. If you have a direct experience of waiting for a medicine under consideration — or if you are currently navigating an access issue — we would like to hear from you. Your experience is the evidence that drives this work.
Patients have heard commitments before. Delivery is what matters now.
Links: UCAN January update: What does the new framework agreement on medicines mean for patients? RTÉ coverage — April 2026: New access system for drugs for public patients announced Miriam’s speaking event — LinkedIn: Conference on access to new drugs