Drugs payment scheme

bob50

Talking to local pharmacy today She was telling me her chemist prefers to dispense a private script ie when you pay 120 per month for long term illness as they get a better margin on these as against a medical card script Surely Not ??

Kristopherus

Yep, thats true. Under the GMS (Medical Card Scheme), the pharmacist gets about 40% of the retail price, maybe even less since the 2009 cuts,wheras under the Drugs Refund And LTI schemes the pharmacists get to charge the full retail price.

angeldelight

Not quite...

For a medical card the pharmacist gets no mark up so they get reimbursed the cost price -6.5% (i.e. don't even get paid the full amount they may have paid for the drug if they don't have much of a discount from their wholsaler) plus a dispensing fee - in the region of 4 euro.

For DPS they get the cost price -6.5% but they also get a 20% mark up on this and a dispensing fee so in effect the more DPS they have generally is better as it's needed to subsidise the medical card part of the business (i.e. pay for wages, rent, electricity etc.)

bob50

angeldelight wrote: »

Not quite...

For a medical card the pharmacist gets no mark up so they get reimbursed the cost price -6.5% (i.e. don't even get paid the full amount they may have paid for the drug if they don't have much of a discount from their wholsaler) plus a dispensing fee - in the region of 4 euro.

For DPS they get the cost price -6.5% but they also get a 20% mark up on this and a dispensing fee so in effect the more DPS they have generally is better as it's needed to subsidise the medical card part of the business (i.e. pay for wages, rent, electricity etc.)

Many thanks

So in effect the DPS scripts pretty much subsidises the medical card scripts

angeldelight

Yes.. which makes it very difficult in areas of the country where the GMS to DPS ratio is very high

Mary Hairney

angeldelight wrote: »

Yes.. which makes it very difficult in areas of the country where the GMS to DPS ratio is very high

The real answer as to why we pay more for medicines in ireland is, ultimately, down to Government incompetence and inability to regulate the right things. Sunday Business Post has revealled the tip of the Iceberg today in 3 articles on Pharmacy, two involving the wholly legal and unregulated connection between Pharmaceutical wholesalers and their pharmacy customers which has elevated the price of entry for young pharmacists into the retail market to the benefit of (many of) the wholesalers older pharmacist customers and shareholders

Pharmacy Ownership schemes were ramped up by the wholesalers after the loss of Pharmacy Licensing in the wake of the Unicare/O'Riada sale to Gehe/Cahill May Roberts Wholesalers. Licenses made Pharmacy businesses expensive to buy and sell and Mary harney stepped in to deregulat the industry as she felt the sale for 160 million euros was an abuse of the licensing system for profit and would ultimately lead to the purchase price being set off to the state in claims and price hikes.

That week, GeHe- CMR cancelled the wholesale accounts of Uniphar and United Drug, their rivals, in the Unicare branches thus reducing the sales of their rivals by 40 million euros in one blow. At the same time, a lot of experienced retail pharmacists saw the loss of licensing as the writing on the wall for their businesses and approached their wholesalers e.g. united pharmacists co-op (uniphar) in a bid to sell their pharmacies now virtually worthless without licensing protection. This was a win-win situation for all as it allowed one generation of pharmacists to retire out of the business at a price they could define with the wholesaler they were intimately involved with while for the wholesalers, they could now directly purchase pharmacies under an employee purchase scheme guise, cancel CMR wholesale accounts and obtain the benefit of the turnover of their new pharmacies. Thus FF incompetence allowed a situation of non competition to arise where wholesalers and their clients were now one and the same. The result was spiralling prices for pharmacy sales and a drugs bill that grew accordingly that you and I and the state have been paying for. Many of the government schemes are largely unpoliced, for example the DPS where the government accepts all claims submitted to it electronically and has no way of verifying their validity and has no interest in ever having the scheme vouched for by prescription in the way the GMS has to be.

The IPU and the wholesalers are heavily involved and during the recent strike a newspaper questioned a well known IPU member often commenting on radio/newspaper about his role as a board member of Uniphar and a member of its Retail IPOS scheme in the light of his criticism of the cuts. Pharmacies were doomed to closure it seemed back then.

But a relative few did close and mainly those associated with Uniphar-IPOS. Why is that so...... well read page 12 of todays Sunday Business Post. Pharmacists were able to adapt their computer systems to still charge cost+50%+old fee on schemes like the DPS and then only submit claims >120 euro. And its not illegal. Therefore, if your pre-strike medicine under the DPS scheme cost 84 euro your post-strike medicine still cost 84 euro with no benefit to Joe soap in the public from Harney's decimation of the IPU strike. More Government incompetence because they never stipulated the new cost structure should apply from the first penny spent by customers upwards.

So next time you pay 84 euros for your Lipitor 80 with the arabic writing on it, parallel imported from a dirt cheap for medicines country by your pharmacist and priced at the Irish cost price base just for you (already an 8 % profit) or swallow down your atenolol 50 mg Irish branded generic ( where the pharmacist has purchased 12 packs to get a minimum of 12 more packs free..and hence their eagerness to give you "a brand that is just the same and supports Irish jobs" as its cost price to them is zero) think of the incompetence of FF and harney, twarted at every avenue by one of the slickest professional outfits in the world and do like I'm going to do- vote FG and Labour.

mossfort

i think what the pharmacists lose on medical cards they more than make up for it in the ridicolous prices they charge for over the counter medicines like pepcid and nurofen for example and cosmetics etc.
also there is the problem where we cant purchase generic medicines in ireland that cost a fraction of the prices of branded products but the blame for that lies with mary harney.

locum-motion

mossfort wrote: »

i think what the pharmacists lose on medical cards they more than make up for it in the ridicolous prices they charge for over the counter medicines like pepcid and nurofen for example and cosmetics etc.

A pharmacy buys an item of stock in for one price, adds a percentage to that (and VAT if applicable, but we'll ignore it for now) and that's how they get the selling price.
There's no rule about what the percentage is - in fact it would be illegal under competition law if there was - but most places use approximately 50% (ie. what the pharmacy buys for €10, they sell for €15).
Other retail outlets use different, sometimes higher percentages.
Clothes shops routinely use at least 100% and I've heard stories of some of them using 200% (ie. what they buy for €10, they sell for €20 {100% markup} or €30 {200% markup})
I know 50% sounds high, but it's not really when compared to other retail sectors.

mossfort wrote: »

also there is the problem where we cant purchase generic medicines in ireland that cost a fraction of the prices of branded products but the blame for that lies with mary harney.

Who said you can't get generics? Of course you can. Just get your doctor to prescribe them. What we don't have in this country is an automatic right for the pharmacist to substitute the (usually cheaper*) generic.

*However, and the timing of your post is quite ironic when you think about it, the bit I put in brackets in the above sentence became obsolete today.
Effective today, most patent-expired proprietary medicines (ie the same ones that have generic versions thereof available), have been reduced in price at the factory gate due to a new agreement between the manufacturers and the Govt.
As and from today, many generic versions are now more expensive than their proprietary versions.

Only in Ireland!

mossfort

im taking nexium at the moment for stomach problems which costs over 70 euros for a 28 day supply. i see from the list of medicines which have been discounted that nexium is not included. if i ask my doctor to write me a prescription for a generic equivalent will it work out cheaper than nexium and will it do the same job?

locum-motion

mossfort wrote: »

im taking nexium at the moment for stomach problems which costs over 70 euros for a 28 day supply. i see from the list of medicines which have been discounted that nexium is not included. if i ask my doctor to write me a prescription for a generic equivalent will it work out cheaper than nexium and will it do the same job?

The active ingredient in Nexium (R) is called 'esomeprazole'.
Esomeprazole is still a relatively young invention, so AstraZeneca'a patent for it has not yet expired. Therefore, there is no generic equivalent available for it. By all means ask your doc to write it generically (this means that s/he would write "Esomeprazole" on the script instead of "Nexium"), but it won't make any difference as it will still be Nexium that's dispensed as that's the only brand available.

Dablet

locum-motion wrote: »

The active ingredient in Nexium (R) is called 'esomeprazole'.
Esomeprazole is still a relatively young invention, so AstraZeneca'a patent for it has not yet expired. Therefore, there is no generic equivalent available for it. By all means ask your doc to write it generically (this means that s/he would write "Esomeprazole" on the script instead of "Nexium"), but it won't make any difference as it will still be Nexium that's dispensed as that's the only brand available.

Ask your doctor if he would prescribe omeprazole instead. Esomeprazole is one of the enantiomers of omeprazole, patented by AstraZeneca just as the patent was expiring on omeprazole. Much of the clinical data suggests there is little difference in efficacy for most patients; yet omeprazole is a fraction of the price.

If you want the absolute best deal, ask your doctor to look up the prices in an up-to-date (Feb 2010 +) copy of MIMS (or see www.checkthelist.ie), and to prescribe to you the specific brand of omeprazole that is cheapest.

Another thing is to check with your pharmacist whether he is planning to charge you a 20% mark-up or a 50% mark up. It should be 20% but the legislation is somewhat ambiguous, and pharmacists may charge any mark-up they like. Call around.

And if you want to hang onto every last penny, pharmacists charge a dispensing fee that varies between 5 Euro and 3.50 Euro per item depending how many items they have dispensed that month already. It may be cheaper to fill a prescription later in the month, or from a large pharmacy with higher drugs turnover.