[
    {
        "role": "user",
        "content": "I%20have%20a%20long%20term%20illness%20book%20for%20one%20of%20my%20conditions%20but%20can%20a%20second%20condition%20be%20added%20at%20the%20moment%20I%20am%20paying%20for%20some%20of%20my%20med%20one%20is%20eltroxin%20for%20thiroid%20gland%20is%20that%20covered%20under%20the%20long%20term%20illness%20in%20ireland%20who%20would%20I%20speak%20to"
    },
    {
        "role": "assistant",
        "content": "Here\u2019s what I found about the Long-Term Illness (LTI) Scheme in Ireland and how it might apply to your situation, based on official sources as of mid-September 2026. I also explain whom to speak to and what options you may have. If you tell me exactly which second condition you have, I can help you check more precisely whether it might be covered.\n\n---\n\n## What the Long-Term Illness Scheme is\n\n- The LTI Scheme provides **free drugs, medicines, and medical/surgical appliances** for certain specified chronic conditions. It covers only those medicines and appliances directly related to treatment of the illness listed, not necessarily every medical condition the person might have. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))  \n- It is **not means-tested**; eligibility depends on having one of the listed illnesses, rather than income. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))  \n\n---\n\n## Which conditions are covered\n\nThere are **16 specific conditions** listed for this scheme. If your illness is *one of those*, medicines needed for it should be covered under LTI; if it's *not on the list*, then generally no. The current list includes:\n\n- Acute leukaemia  \n- Diabetes mellitus (note: *does not* include gestational diabetes)  \n- Diabetes insipidus  \n- Epilepsy  \n- Muscular dystrophy  \n- Multiple sclerosis (MS)  \n- Parkinsonism  \n- Spina bifida  \n- Intellectual disability  \n- Cystic fibrosis  \n- Hydrocephalus  \n- Haemophilia  \n- Phenylketonuria  \n- Spina bifida  \n- Mental illness (if under 16 years old)  \n- Cerebral palsy  \n- Conditions arising from Thalidomide use. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))  \n\n---\n\n## Is levothyroxine (Eltroxin) covered?\n\n- **Eltroxin** (levothyroxine) is used to treat *hypothyroidism* (an underactive thyroid). ([www2.hse.ie](https://www2.hse.ie/medicines/levothyroxine/?utm_source=openai))  \n- *Hypothyroidism* is **not** on the current list of diseases covered by the LTI Scheme. The scheme covers *diabetes mellitus*, but that doesn\u2019t include thyroid conditions. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))  \n\nSo, if your **first condition** is one of the listed ones, LTI will cover the treatment for that condition. But if your **second** condition is hypothyroidism and you need levothyroxine, that specific medicine **would not be covered** under the LTI scheme, because hypothyroidism isn\u2019t a listed illness. That means you\u2019d likely have to pay for Eltroxin via the normal prescription route (or medical card, if that applies), or any other relevant scheme.\n\n---\n\n## Can you add a second condition under LTI?\n\n- **Yes**, in the application form for LTI there\u2019s a space to tick all the listed illnesses you have\u2014if you have more than one of the 16, you can get them included. ([assets.hse.ie](https://assets.hse.ie/media/documents/Long-Term_Illness_Scheme_App_Form.pdf?utm_source=openai))  \n- **However**, the second condition must be one of the *pre-specified illnesses*. If it is not in the list, you can\u2019t add it\u2014at least not under existing regulations. Expanding the list of covered illnesses is something that has been raised in Parliament, but *there are currently no plans to add conditions* like Polycystic Ovary Syndrome, Crohn\u2019s disease, etc. ([oireachtas.ie](https://www.oireachtas.ie/en/debates/question/2025-02-05/1179/?utm_source=openai))  \n\nSo: if your first booked LTI condition is one on the list, and your second is also one of the listed illnesses, you *can* have both covered. But if the second is *not* on the list (for example, hypothyroidism), then LTI won\u2019t cover medication for that second condition under the scheme.\n\n---\n\n## What you can do\n\n1. **Check whether your second condition is one of the 16** listed. If it is, you can apply to have it added under LTI.\n\n2. If it's **not** listed, you\u2019ll need to explore other ways to reduce your costs. These might include:\n   - **Medical card**, if eligible (means-tested, but covers more fully).\n   - **Drugs Payment Scheme (DPS)**, which caps monthly costs for medicines. ([data.oireachtas.ie](https://data.oireachtas.ie/ie/oireachtas/debateRecord/dail/2021-07-27/writtens/mul%40/main.pdf?utm_source=openai))  \n   - Other supports from the HSE, charities, or local health offices.\n\n---\n\n## Whom to speak to / what to do now\n\n- Talk to your **GP or consultant**: ask if your second condition is one of the listed ones for LTI, and if so have them include it on your LTI application or update your existing one. You might need a GP or hospital consultant to fill out the doctor section of the application. ([assets.hse.ie](https://assets.hse.ie/media/documents/Long-Term_Illness_Scheme_App_Form.pdf?utm_source=openai))  \n- If in doubt, contact your **local HSE Primary Care Reimbursement Service (PCRS)** \u2014 the department that handles the LTI scheme. They can tell you whether a specific condition and medicine are covered.  \n- Also, get a copy of or check **the LTI list of medicines approved for your illnesses** (available on HSE\u2019s website) to see if anything similar to your meds is listed. ([www2.hse.ie](https://www2.hse.ie/documents/1746/LTI_List_N_February_2025_by_ATC_including_Non_GMS_Items.pdf?utm_source=openai))  \n\n---\n\nIf you tell me exactly *which second condition* you have besides the first, and maybe the name(s) of other meds you take, I can check and help you see if there\u2019s *any chance* it might be covered, or which route would probably help you most to reduce costs."
    },
    {
        "role": "user",
        "content": "I%20have%20Diabetes%20insipidus%20and%20got%20the%20thiroid%20issue%20from%20thatI%20have%20no%20thyroid%20gland"
    },
    {
        "role": "assistant",
        "content": "Thanks for explaining more about your health conditions. Here\u2019s a breakdown of how this situation works under the Long-Term Illness (LTI) Scheme in Ireland, and what\u2019s likely possible for you.\n\n---\n\n## What we know for sure\n\n**Diabetes insipidus** *is* one of the 16 conditions that qualify for an LTI Book/Card. That means medications related directly to treating diabetes insipidus (and related medical supplies or surgical appliances) should be covered, free of charge. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))\n\n**Hypothyroidism (no thyroid gland)** is *not* currently on the statutory list of illnesses covered by the LTI Scheme. It doesn\u2019t appear among the 16 prescribed conditions under Section 59 of the Health Act 1970 that are eligible. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))\n\n---\n\n## What this means for your situation\n\n- Since you already have **diabetes insipidus**, you *do* have an eligible condition under LTI, so that\u2019s good \u2014 you can continue to use your LTI Book for that illness.  \n- But because **hypothyroidism** (including being without a thyroid gland) is not one of the listed illnesses, the levothyroxine (Eltroxin) you use for thyroid hormone replacement will *not* be covered under LTI. That treatment would not be among the medicines the LTI scheme supplies for free. \n\n---\n\n## Are there any exceptions or workarounds?\n\n- As of now, there are **no plans** to broaden the list to include thyroid conditions. Parliamentary questions in recent years confirmed that hypothyroidism and hyperthyroidism are *not* going to be added. ([data.oireachtas.ie](https://data.oireachtas.ie/ie/oireachtas/debateRecord/dail/2017-12-13/writtens/mul%40/main.pdf?utm_source=openai))  \n- Sometimes pharmacies may make mistakes or be confused about the rules (e.g. seeing your LTI Book). If that happens, they may sometimes dispense your levothyroxine without charge, but that would be outside formal policy.  \n- You could check **if you qualify for a medical card** or **the Drugs Payment Scheme (DPS)**, which limit how much you pay per month for all your prescriptions combined. If your total medical costs are high, these might help reduce your out-of-pocket expenses substantially.\n\n---\n\n## What to do now / whom to speak to\n\n1. **Confirm with your GP or hospital consultant** that your diagnosis is diabetes insipidus and hypothyroidism due to no thyroid gland. Make sure your LTI Book is in order for your diabetes insipidus.\n\n2. **Speak to your pharmacy** when getting your prescription for Eltroxin: ask them to check whether it shows up as covered in any scheme. Sometimes confusion or mis-coding could lead to inconsistent charges.\n\n3. **Contact the HSE\u2019s Primary Care Reimbursement Service (PCRS)**: they administer the LTI scheme. They can tell you definitively what is in or out, and whether there are any exceptional supports for people in your situation.\n\n4. **Explore alternative supports** like medical card, GP visit card, or the Drugs Payment Scheme, if eligible.\n\n---\n\nIf you like, I can check your estimated cost savings if you moved to using DPS or if you qualify for a medical card, so you can see what would be the most helpful route to reduce your medicine costs. Would you prefer me to do that?"
    },
    {
        "role": "user",
        "content": "but%20if%20i%20got%20a%20medical%20card%20i%20would%20lose%20my%20long%20term%20illness%20what%20other%20drugs%20are%20covered%20under%20Diabetes%20insipidus%20I%20am%20also%20on%20Ozempic%20which%20is%20158%20euro%20a%20month"
    },
    {
        "role": "assistant",
        "content": "Here\u2019s what I found about what drugs are covered under **Diabetes Insipidus** in the Long-Term Illness (LTI) Scheme, whether getting a Medical Card would affect your situation, and how **Ozempic** (semaglutide) is handled in Ireland.\n\n---\n\n## What drugs are covered under Diabetes Insipidus on the LTI Scheme\n\nIf you have been approved under the LTI for **Diabetes Insipidus**, the following are specifically listed as medicines covered:\n\n- **Desmopressin** \u2014 available in various forms: tablets, nasal spray, or injection. ([www2.hse.ie](https://www2.hse.ie/documents/1740/LTI_List_G_July_2024_by_ATC_including_Non_GMS_Items.pdf?utm_source=openai))  \n- **Potassium supplements** \u2014 such as tablets (Slow-K etc.) or syrup like Kay-Cee-L, etc. ([www2.hse.ie](https://www2.hse.ie/documents/1740/LTI_List_G_July_2024_by_ATC_including_Non_GMS_Items.pdf?utm_source=openai))  \n\nThese are the core medication treatments for Diabetes Insipidus under the LTI. In addition, any **medical or surgical appliances** needed to treat that illness (for example something prescribed by a doctor for that condition) should also be covered. ([assets.hse.ie](https://assets.hse.ie/media/documents/Long-Term_Illness_Scheme_App_Form.pdf?utm_source=openai))\n\n---\n\n## What you *won\u2019t* get covered automatically under the LTI for Diabetes Insipidus\n\n- Any treatment or medication for other health conditions not directly related to Diabetes Insipidus will **not** be covered under LTI. For example, your thyroid medication (Eltroxin/levothyroxine) is *not* included because thyroid disease is not one of the 16 qualifying conditions. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))\n\n---\n\n## What happens if you get a Medical Card \u2014 would you lose LTI benefits?\n\n- No, you **would not lose LTI benefits** by getting a Medical Card. You can hold both a Medical Card (under the General Medical Services, GMS) *and* an LTI Card/Book at the same time. They cover different things. ([readkong.com](https://www.readkong.com/page/medical-card-and-gp-visit-card-2314287?utm_source=openai))  \n- Having a Medical Card gives you broad coverage under GMS for many medicines, GP visits, hospital services, etc., but LTI covers very specific treatments *for the qualifying illness* at no charge \u2014 even if you change or lose your means test for the Medical Card, the entitlement under LTI remains (for approved meds for the condition). ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/lti/about/?utm_source=openai))\n\nSo, you don't need to choose one or the other; they can work together to reduce costs.\n\n---\n\n## What about Ozempic (semaglutide)?\n\nThis depends on *why* you are using Ozempic.\n\n- **If you have Type 2 Diabetes (insulin-resistant etc.)** and Ozempic has been prescribed for that, then it **is reimbursed** under the LTI Scheme (and GMS where applicable) *for the treatment of diabetes*. ([oireachtas.ie](https://www.oireachtas.ie/en/debates/question/2024-04-23/670/?utm_source=openai))  \n- However, **if you are using Ozempic primarily for weight loss or obesity (without a diabetes diagnosis)**, it is **not covered** under LTI, Medical Card, or the Drugs Payment Scheme (DPS). Ozempic is *only reimbursed* when used for **approved indications** (which in Ireland means treatment of Type 2 Diabetes). ([www2.hse.ie](https://www2.hse.ie/conditions/obesity/medicines/?utm_source=openai))\n\nYou mentioned Ozempic costs \u20ac158/month. If your prescription is for diabetes and you're eligible under LTI, then you shouldn\u2019t be paying that amount \u2014 it should be free of charge under LTI for that use. If it's for non-diabetic use, unfortunately you\u2019ll likely need to pay.\n\n---\n\n## Summary of what seems to apply in your case\n\n- You **do** have Diabetes Insipidus, so you get **desmopressin** and related treatments fully covered by LTI.\n- You **do not** have a listed thyroid disease under LTI, so Eltroxin won\u2019t be free under LTI.\n- If your Ozempic is prescribed for Type 2 Diabetes (and licensed for that), then it **should** be free under LTI / GMS. If it's for weight-loss in absence of diabetes, then probably not covered, and you\u2019d still pay about what you are now.\n\n---\n\n## What you should do next\n\n1. Check with your doctor whether Ozempic was prescribed *for diabetes* and that\u2019s the diagnosis they have on file.\n2. Contact your pharmacy or the PCRS (Primary Care Reimbursement Service) to see exactly how Ozempic is coded for you \u2014 whether it is reimbursable under your LTI status.\n3. If you don\u2019t have a Medical Card already and think you might qualify, consider applying \u2014 it helps for other medicines not related to LTI.\n4. Review the **approved medicines list** on the HSE website for Diabetes Insipidus under LTI to make sure any other treatments you take for that condition are covered. ([www2.hse.ie](https://www2.hse.ie/documents/1740/LTI_List_G_July_2024_by_ATC_including_Non_GMS_Items.pdf?utm_source=openai))\n\n---\n\nIf you want, I can look up exactly what Ozempic costs would be with LTI vs with Medical Card in your area, so you can clearly see your potential savings."
    },
    {
        "role": "user",
        "content": "how%20can%20I%20find%20out%20if%20I%20would%20qualify%20for%20a%20medical%20card%20at%20the%20moment%20I%20am%20working%20do%20Ineed%20to%20earn%20a%20certain%20amount%20I%20am%20on%20Hydrocortisone%20nordearuine%20and%20other%20drugs"
    },
    {
        "role": "assistant",
        "content": "Here\u2019s how to check if you might qualify for a **Medical Card** in Ireland, what the income rules are, and what you should gather to make the process easier.  \n\n---\n\n## How qualification for the Medical Card is assessed\n\nEligibility primarily depends on a **means test** done by the HSE, which looks at your:\n\n- Net income (income after deductions like tax, PRSI, Universal Social Charge \u2014 if you\u2019re under 70) ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/?utm_source=openai))  \n- Household income (yours and any partner\u2019s income combined) ([api.uat.citizensinformation.ie](https://api.uat.citizensinformation.ie/en/health/medical-cards-and-gp-visit-cards/medical-card/?utm_source=openai))  \n- Allowable expenses, e.g. rent/mortgage payments, travel to work, childcare, maintenance payments, any large medical expenses. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/?utm_source=openai))  \n- Savings and investments (excluding your home), but there are limits up to which they are ignored. ([benefitcheckireland.ie](https://www.benefitcheckireland.ie/medical-card?utm_source=openai))  \n\nYou need to be **ordinarily resident** in Ireland \u2014 meaning living here with intention to stay a year or more. ([api.uat.citizensinformation.ie](https://api.uat.citizensinformation.ie/en/health/medical-cards-and-gp-visit-cards/medical-card/?utm_source=openai))  \n\nThere are also special cases where you might automatically qualify without the full means test (if all your income is social welfare, or certain illnesses or disabilities) or gain a card due to **financial hardship** even if you exceed the usual thresholds. ([benefitcheckireland.ie](https://www.benefitcheckireland.ie/medical-card?utm_source=openai))  \n\n---\n\n## What the income limits are (2026)\n\nIf you\u2019re under 70, the net weekly income (after tax, PRSI, USC) must be **below** certain thresholds. The specific threshold you fall under depends on your living situation. ([benefitcheckireland.ie](https://www.benefitcheckireland.ie/medical-card?utm_source=openai))\n\nHere are a few examples:\n\n| Situation | Weekly limit (younger than 70, net income) |\n|-----------|----------------------------------------------|\n| Single person, living alone | **\u20ac184.00** ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/medical-cards/applying/how-much-you-can-earn/?utm_source=openai)) |\n| Single person, living with family | **\u20ac164.00** ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/medical-cards/applying/how-much-you-can-earn/?utm_source=openai)) |\n| Couple / single parent with dependants | **\u20ac266.50** ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/medical-cards/applying/how-much-you-can-earn/?utm_source=openai)) |\n\n- If you\u2019re **70 or over**, the rules are different: Medical Card thresholds are based on **gross weekly income**. For example, single persons can earn up to **\u20ac550/week**, couples up to **\u20ac1,050/week**. ([benefitcheckireland.ie](https://www.benefitcheckireland.ie/medical-card?utm_source=openai))  \n\n---\n\n## Do you need to earn less than a certain amount to qualify if you're working?\n\nYes, if you are working, your take-home pay (after deductions) is one of the key factors. You\u2019ll need to compare your own income (plus any partner\u2019s) to the thresholds above.\n\nHowever:\n\n- Even if you earn more than the threshold, if you have **high medical costs** or other significant expenses, you can apply under **\"financial hardship\u201d**. If medical conditions (like yours), ongoing medications or treatments cost a lot, that may count. ([data.oireachtas.ie](https://data.oireachtas.ie/ie/oireachtas/debateRecord/seanad/2026-06-16/debate/mul%40/main.pdf?utm_source=openai))  \n- If **all your income comes from social welfare** (i.e. not working income), you may qualify automatically. But since you said you're working, your wages will count. ([benefitcheckireland.ie](https://www.benefitcheckireland.ie/medical-card?utm_source=openai))  \n\n---\n\n## What to gather / check\n\nTo see if you might qualify, collect the following:\n\n1. **Proof of income**  \n   - Recent payslips  \n   - Any other income (pension, investments, etc.)\n\n2. **Proof of deductions and expenses** you can claim:  \n   - Current rent or mortgage payments  \n   - Travel cost to work  \n   - Childcare costs  \n   - Maintenance payments, etc.\n\n3. **Medical cost evidence** (if you consider hardship: list your regular prescriptions, health treatments, etc), especially expensive ones like Ozempic, hydrocortisone, etc.\n\n4. **Savings, investments**, and property (excluding main home) details. If you have savings under \u20ac36,000 (single) or \u20ac72,000 (couple) these usually won\u2019t affect much. ([benefitcheckireland.ie](https://www.benefitcheckireland.ie/medical-card?utm_source=openai))  \n\n---\n\n## What you should do next\n\n- Use the official HSE tool on **\u201dHow much you can earn and still qualify for a medical card\u201d** to see an estimate based on your income and expenses. ([www2.hse.ie](https://www2.hse.ie/services/schemes-allowances/medical-cards/applying/how-much-you-can-earn/?utm_source=openai))  \n- Apply at **mymedicalcard.ie** or get the MC1 form via your GP or your local health centre. ([specsavers.ie](https://www.specsavers.ie/prsi-and-medical-cards/medical-cards?utm_source=openai))  \n- When filling in the form, be clear and include all medical costs you have \u2014 sometimes these outweigh the extra income and help justify granting a card under hardship criteria.  \n- If your first application is rejected because of income, you can file an **appeal** or ask for a discretion-based review explaining your medical costs. ([www2.healthservice.hse.ie](https://www2.healthservice.hse.ie/organisation/national-pppgs/hse-national-assessment-guidelines-for-medical-card-and-gp-visit-card/?utm_source=openai))  \n\n---\n\nIf you prefer, I can run some scenarios with your monthly income, expenses (drugs, travel, rent etc.) and show whether you *might* qualify. Want me to do that?"
    }
]