MEDICAL card holders are to shell out €77m in prescription charges in 2013 as severe hikes come into force.
Budget measures, which signalled the prescription charge would treble from 50c to €1.50 per item, were aimed at bringing in €50m on top of the annual €27m medical card charges they were already paying.
However, family doctors fear the extent of the hike, effective from today, could push many of the 1.8 million people covered by the scheme, particularly the elderly, to start rationing drugs they need.
Dr Niall O Cleirigh, a Dublin GP, said: "The people who can least afford it and the elderly are going to be on maximum medication.
"People who are on 10, 12 or 15 products per month are the elderly."
He is also concerned that doctors will be under pressure to prescribe large boxes of extra items such as painkillers to avoid having to pay several prescription item charges on smaller packages of the drug.
A spokesman for the Department of Health told the Irish Independent: "The prescription charge is intended to address rising costs in the medical card scheme and to influence, to some degree, demand and prescribing patterns.
"The proposed new rate is €1.50 per prescribed item with a monthly cap of €19.50 per person or family."
Costs will also increase for private patients who are on a lot of medication or taking expensive drugs as they pay out an extra €10m in 2013.
This is due to changes in the Drug Payment Scheme, which will hike the amount they are liable for each month from €132 to €144.
And in a further blow, the upfront cost per night for a patient admitted to a public hospital will rise from €75 to €80.
The charge is imposed on people without a medical card or private health insurance and is capped at €800 in one calendar year.
The €80-a-day charge is also now being controversially imposed on cancer patients who have to attend for chemotherapy sessions.
Healthcare costs will also rise this year for 20,000 people over 70 who are going to lose their full medical card and will be reduced to a GP visit card.
This will mean their GP visits will continue to be free but their medication costs could be as high as €144 a month.