Thousands of people who currently get free drugs under the medical card scheme are set to lose their entitlement in the coming months as a result of changes to eligibility rules.

This will mean that in future they will only get their drug costs covered by the State where these costs exceed the Drugs Payment Scheme €144 per month threshold. They will also continue to pay the prescription charge of €1.50 per item.

The changes, announced in December's Budget, came into effect during April. They apply to all those under 70 years of agebeing assessed when their full medical card comes up for renewal and to new applications for medical cards.

Separate eligibility changes will also affect many over 70s entitlement to a full medical card.

Many people under 70 and currently with full medical cards are set to have them downgraded to doctor visit only cards as a result of new eligibility changes just introduced. This means they will have to foot the bill for drug costs.

For under 70s, home improvement loan payments and €50 per week previously allowed for travel-to-work expenses are no longer taken into account as part of the medical card means test assessment.

This essentially means that these expenses are added where applicable, rather than subtracted, from a person's income when assessing their eligibility for a card, meaning they will go over the income limit for a full card and be offered a doctor visit card instead.

The Department of Health told irishhealth.com that if, as a result of this change, a person's income would now be over the relevant limit due to the exclusion of these expenses, he or she may be considered for a 'discretionary' full medical card, where the case is deemed to be one of 'undue hardship'.

A spokesman said medical expenses would be taken into account when assessing these hardship cases.

The Department said it was not possible to give a firm estimate of the numbers of people who currently have full cards who would be affected by this eligibility change, as this was dependent on the number of applicants for new cards and renewals who would include these expenses in their applications.

Under other changes affecting those with over 70s cards, those with a gross income between €600 and €700 per week are to have their full medical cards downgraded to doctor visit only cards. Those over 70 earning over €700 are already not entitled to any type of medical card.

However, the Department says those with over 70s medical cards who have incomes in excess of the limits and have high medical expenses can be assessed as hardship cases and may still be granted medical cards or GP visit cards.

When the medical card changes were announced last December, it was estimated that they would save the health service around €40 million a year.

Currently, those aged under 66 must reapply for their medical cards every three years, and every four years if they are over 66.