Charging for Medical Card Prescriptions

anotherlostie

Mary Harney is proposing a charge of 50c per item dispensed to medical card patients. Personally I don't see much harm in it. Years ago when my Dad's uncle died (he was a GMS patient), we found boxes and boxes of unused medicines in his house. Now some of these may have been due to poor patient compliance, but some were not (e.g. NSAIDs which he did not take every day but were prescribed every month, antibiotics prescribed monthly and never touched). In pharmacy, it is very rare for medical card (and to a slightly lesser extent DPS when they are above the threshold) patients not to take everything on the script (maybe Warfarin being an exception). If items had to be paid for, even a nominal fee, people might be more judicious in asking for what they need rather than what the doctor's secretary wrote by repeating the previous (3) month's script.

However I would also be mindful of a couple struggling to get by suddenly being faced (as we all suspect) with a cut in their social welfare payments now potentially having an extra outgoing (and there would be many pensioners who between them would be on 15-20 drugs per month). I'm also not sure how much the annual saving would be (there would be the collective 50c's as well as the knock on reduction, whatever that might be, in the drugs bill).

So in these recessionary times, would this charge be fair? Could it adversely affect patient health?

angeldelight

I wholeheartedly agree with this. My only stipulation would be that there's a maximum monthly charge for families maybe - I'm thinking of a family I know where both parents are on approx. 10 items each month and each of the 3 kids is on 3 items a month. However I hate the amount of wastage I've seen from working in pharmacy. You could build a house with the amount of ensure, calogen, aqueous cream, emulsifying ointment I've seen returned by patients who were all asked about medicines use, any problems, any they didn't need that month etc. Not to mention the painkillers shared around that some people get every month but rarely need so they supply anyone in the vicinity with a headache/toothache/flu with their paracetamol/difene etc!

Laydee

anotherlostie wrote: »

Mary Harney is proposing a charge of 50c per item dispensed to medical card patients.

I didn't hear that bit but I didn't catch the whole clip on RTE news anyway. I thought that they would be charged full price & I didn't agree with it. But a nominal fee, yes I would agree with that.

My parents weren't impressed, mam is on BP prescription etc but the cuts have to come in somewhere.

Jessibelle

Is it not to be capped at a maximum charge though, of, I think I heard €15.00 per card holder? (I'm not certain, I just caught the end of the bullitin). If thats the case then, €15 for a months medication is in many cases a bargain. Would it have an incremental knock on effect for the DPS if it was introduced though?

locum-motion

In principal, I don't disagree with this.
However, I would as a pharmacist be very concerned with how it was to be implemented.
Effectively, pharmacists in the UK act as an unpaid tax collector for the government, and I don't want to see that happen here.
Judging by the behaviour of Mary Harney and the HSE in the last 6 months, I wouldn't be at all surprised if they just deducted 50c automatically from every item they pay pharmacists for, and said "off you go, you take 50c from each person".
The problem with this is all the people who would say "but I can't afford to pay 50c for each of my x medicines, my pension's only y per week" or "Ah sure go on, it's only 50c" (we've seen this happen already with the bag tax, where some places don't charge the 22c anymore because they're pi**ed off with all the people objecting to it)
Are pharmacists then supposed to say "Arra sure go on, I'll let you off and pay your tax myself" - because effectively a tax is exactly what it would be - when they've already had their gross profit reduced by 34% on average this year already?
(And before anyone comes back with "you're all greedy ba**ards who are minting it anyway, over a tenner for a tube of Zovirax when in Spain they pay you €3 to take it off them, and look at your 09 reg BMW standing outside the door", please do some research before you post anything like that. There's plenty of information on this site already about precisely how much pharmacists get paid { http://www.boards.ie/vbulletin/showthread.php?t=2055245327&goto=nextoldest for example} and why drugs are more expensive here than in Spain.)

bleg

Agreed locum-motion. It really does depend on how this is going to be organised. Collecting 50c per item from people who have been used to getting their scripts for free isn't going to be the easy.

drzhivago

Agree it will be difficult to collect-maybe charge more

Agree it will be unpopular

Is done in NHS and a lot of people in this fora harp on about what if we were like the NHS, well sometimes you get what you wish for

I ECHO earlier points made about hoarding medications

Many times have had patients come in and asked children to get the medication for me as parent cant talk, they come back with bags and bags of the same medications, much unopened. not the time to talk to the patient about it but was such a regular occurrence in A&E I wondered how much it was costing the state

People go to GP to collect regular script and sometimes dont own up to not taking the medication, BP high, get a second one they dont take

The problem will be sometime when they actually take whats prescribed they will get sick from overtreatment

nesf

It's going to initially be a problem but it's essentially necessary to put some cost on prescription meds because otherwise the State ends up paying for meds that are never used. A cap is probably needed for families, or just those very unusual individuals on multiple drugs simultaneously.

Honestly, I'd say people would have to have some gall to say they couldn't afford 1.50 for their 3 meds each month tbh.


That said, I'd be a bit sceptical about how behaviour changing such a small charge would be. I mean we still get people going unnecessarily into A&Es despite it being far more expensive than going into a GP.

drzhivago

nesf wrote: »

Honestly, I'd say people would have to have some gall to say they couldn't afford 1.50 for their 3 meds each month tbh.

Agreed

nesf wrote: »

That said, I'd be a bit sceptical about how behaviour changing such a small charge would be. I mean we still get people going unnecessarily into A&Es despite it being far more expensive than going into a GP.

I think its difficult to say unnecessary as few of them get sent away without any treatment to go back to GP the next day which they could be if it was unnecessary

There is an access issue or at least a perceived access issue to GP services now

we are a consumer society and people want services immediately no matter if it is not important

30 years ago there werent as many big casualties, people didnt call GPs at night, GPs delivered babies a lot at night

Now people want treatment immediately hence they go to A&E, very little simple treatment measures at home,

How many of us get an accountant at night, a solicitor at night, a plumber at night

Its not easy getting anyone hence when you have a problem and no once else can solve it, if you can find it maybe you can hire the 'A&E" team

dah da dah--poor effort at music

nesf

drzhivago wrote: »

I think its difficult to say unnecessary as few of them get sent away without any treatment to go back to GP the next day which they could be if it was unnecessary

There is an access issue or at least a perceived access issue to GP services now

we are a consumer society and people want services immediately no matter if it is not important

30 years ago there werent as many big casualties, people didnt call GPs at night, GPs delivered babies a lot at night

Now people want treatment immediately hence they go to A&E, very little simple treatment measures at home,

How many of us get an accountant at night, a solicitor at night, a plumber at night

Its not easy getting anyone hence when you have a problem and no once else can solve it, if you can find it maybe you can hire the 'A&E" team

dah da dah--poor effort at music

Agreed. Personally as a non-medical person it's something that annoys me a lot that people abuse A&E services in this matter especially considering the spread of out-of-hours services in the past 5 years.

bounceymousey

Maybe now some people will actually use their medications, instead of hoarding them away in some cupboard. But 50c per item is a small fee. Its not asking much in this area. Of course, its another small fee on top of a large shopping list of expenditure and costs.

locum-motion

Please, don't call it a 'fee' or a 'charge'.
Call it what it is: a TAX.

nesf

locum-motion wrote: »

Please, don't call it a 'fee' or a 'charge'.
Call it what it is: a TAX.

Seriously, the literal definition of a tax is a fee charged by the State on income or on a service. Calling it a fee or charge is as correct as calling it a tax. Unless you want to play word games and worry about fee or charge not having enough of a negative connotation for people. :rolleyes:

locum-motion

nesf wrote: »

Seriously, the literal definition of a tax is a fee charged by the State on income or on a service. Calling it a fee or charge is as correct as calling it a tax. Unless you want to play word games and worry about fee or charge not having enough of a negative connotation for people. :rolleyes:

And this isn't going to be charged by the state for a service?

nesf

locum-motion wrote: »

And this isn't going to be charged by the state for a service?

You miss my point.

Look it's just word games whether you call it a fee, charge or tax. Similar to how it makes little difference whether you call the plastic bag levy a fee, levy or tax. Insisting on using one word is a bit pointless when they all effectively mean the same thing, unless there's some ambiguity where someone might think it's the greedy conspiracy cabal of pharmacists behind this rather than the Department of Health...

AmcD

If this fee is introduced, sales of Nizoral shampoo, aqueous cream and PPIs are going to plummet.

beeno67

AmcD wrote: »

If this fee is introduced, sales of Nizoral shampoo, aqueous cream and PPIs are going to plummet.

No they won't. Unless you are implying that GPs are so poor they are dishing out PPIs when they are not necessary. Nizoral has clear indications. Anyway both cost way above 50c.

anotherlostie

50c charge for GMS items confirmed in budget with a maximum monthly payment of €10 per family. I can see this causing problems because it will force families to stick to the one pharmacy in the same way as the DPS scheme operates. But at least there is a threshold.

DPS increase is €20, up to €120 per month. Quite a hike. I remember when it was £90 every quarter and you claimed back the rest...

bleg

Happy with both measures.