Check your Pharmacist has an honest relationship with you the customer.

locum-motion

liam84 wrote: »

First one sounds like a plan. An illegal one. It would also mean relying on the pharmacist to come clean on their profit margin/mark-up which they're unlikely to do. and to provide itemised bills on each of the meds as opposed to lumping them all into one total so the customer can't see what they've been charged for each med (sneaky)

Second one involves doing something illegal as well. If I buy some meds in the first week of the month that costs 90 incl private mark-up; then I get a scond lot for my family and it comes to say 65, this would take me over the limit. The total month should be marked up only at 20% as per State agreement. If the pharamcist has charged me 50% on the first transaction, then should he/she refund me the difference, since I would have paid it. Presume this has to happen on a regular basis where a family might buy drugs/meds over a month, and they might only hit the 120 mark towards the end, but they've been paying higher mark-ups up to that point.

Several pharmacists have posted on threads here explaining how it works. I think that counts as coming clean. Don't you?

locum-motion

I think it's supremely ironic that the OP started this thread with a title suggesting that all pharmacists are being dishonest with their customers, then started suggesting that those same pharmacists should commit fraud (Post #28) against the government, before finally deciding that what she actually wanted to do was investigate (Post #30) on behalf of the government.

liam84

penguin88 wrote: »

Just to pick out one point above, this kind of sums up what ye are discussing, yes? I'm not sure if I'm missing something but I don't know what the problem is that you're trying to solve.

Taking your example above, where the private mark up the pharmacy is charging is 50%. When you come in to buy the 2nd lot of medicines, this brings you over the €120 threshold. So you paid €90 initially, then when you come in the second time it's simply a case that instead of paying €65 for the medicine, you will pay €30, since no DPS patient (household) has to pay over this per month. So there's no need for any refunds or anything, you've paid your €120 and it does not really matter how you got there.

When the pharmacist claims for the DPS that month, instead of their private mark up they get 20% mark up on the amount. So to work it out:

(€155 / 1.5) x 1.2 = €124

So having being paid the €120 from you, the patient, the pharmacist will be paid €4 from the government for the above example.

Don't know if that helps! If you have any other qs just shoot.

It does help. You're saying the customer is blind to what mark-up they've been charged if they exceed the DPS threshold - they still have to pay out €120. The State (acting for us the taxpayers) picks up the rest at a reduced mark-up. The customer is also blind to the scalable dispensing fee €3.50 - €5 since it's based on volumes - and this is only calculated at point of reimbursement, not at point of sale to the customer.

It's only when it's under €120 that the customer has any say in what they pay or whether they pay a particular pharmacy.

It all depends on how motivated you are as a customer to seek out value for money.

To assist this, pharmacies should be required to provide itemised receipts for the drugs they dispense instead of just gross totals. And an itemised price list of drugs should be made available in stores so that customers can compare. And someone should put together a website that lists all the prices of these drugs for even greater transparency.

Effectively this is a commoditised market. Same drugs available in the same locations, with the same type of qualified person dispensing them. The only difference to the customer is the quality of the pharmacist (difficult to distinguish/assess and one assumes they should all be of similar professional quality) and the price of the prescription products. What other value difference is there between them except for guff about how they take better care of you? I'm leaving out the assorted hairbrushes, nail clippers, plastic bags, emergency kits, cosmetics, etc that they sell front of house.

angeldelight

liam84 wrote: »

To assist this, pharmacies should be required to provide itemised receipts for the drugs they dispense instead of just gross totals. And an itemised price list of drugs should be made available in stores so that customers can compare. And someone should put together a website that lists all the prices of these drugs for even greater transparency.

In general if it is not going to reach the €120 limit most receipts will have the individual amounts. Eg I'm sitting here looking at a receipt I got myself a while ago with 3 items on it and each one has the price beside it.

An itemised price list of drugs really wouldn't work - the prices change a little every month, there's thousands of them, for each drug there can be 3/4 suppliers, if a patient gets more than one month at a time they only pay one dispensing fee... there's way too many variables. However if you were to ask your pharmacist what price your medicines were in that pharmacy I'm sure they'd let you know. You could then choose to check other places if you wished. It does take a bit of work on the customers part but it is doable.

liam84

locum-motion wrote: »

Several pharmacists have posted on threads here explaining how it works. I think that counts as coming clean. Don't you?

Well no it doesn't. We're told that pharmacists don't act in concert, so we presume they don't collude on the mark-ups they charge private customers. Therefore, the information should be made visible in the store and at the till.

One or two pharmacists explaining how they charge does not reflect how the whole market acts or charges, nor should it - if it is truly competitive. In fact, I'd assume any pharamcist worth their salt would keep secret what they charge their private customers in order to remain competitive in the public eye.

On the other hand, pharmacists are working with commodities providing a commoditised service. (I realise you have to have some kind of third level degree over the door before you can dispense medicines - even if it only means filling bottles of pills correctly from a prescription.)

So how do you choose which pharamcy to use? The personality of the person behind the counter? Whether they say "Are ya ok?" or "Can I help you?" when you walk in the door? The kind of cosmetics they sell? Or the price they charge for filling your prescription and/or any word of advice about their use as they are professionally required to do?

If you're a regular meds buyer, then price is going to be the main factor. So the more information I have to see which delivers the best value, the better.

liam84

angeldelight wrote: »

In general if it is not going to reach the €120 limit most receipts will have the individual amounts. Eg I'm sitting here looking at a receipt I got myself a while ago with 3 items on it and each one has the price beside it.

An itemised price list of drugs really wouldn't work - the prices change a little every month, there's thousands of them, for each drug there can be 3/4 suppliers, if a patient gets more than one month at a time they only pay one dispensing fee... there's way too many variables. However if you were to ask your pharmacist what price your medicines were in that pharmacy I'm sure they'd let you know. You could then choose to check other places if you wished. It does take a bit of work on the customers part but it is doable.

You say in general, but only have your own receipt as evidence that it happens. I have receipts from the last three years from four different pharamcies that says they don't. Now maybe I've picked on unusual pharamcies, and the general practice is that prices are itemised sufficiently.

If what you say about the prices changing every month is accurate then a price list would be difficult but not impossible. I presume there must be a Top 20 or 30 drugs prescribed all the time. Those are the ones to publicise within your store and grab customers attention.

locum-motion

liam84 wrote: »

... Therefore, the information should be made visible in the store and at the till...

When you buy half a dozen eggs in Tesco, Dunnes or the corner shop, do you insist on knowing how much they bought the eggs for? No, you don't.

If you asked them, do you think they'd tell you? You can be bloody sure they wouldn't. They'd tell you to fcuk off, and they'd be dead right.

Did the Irish Farmers' Association set up a website last monday listing the price that the farmers sell the eggs to the distributors at? No they didn't.

Did the IFA tell the public that they should insist on paying no more than a particular amount for their eggs? No, they didn't, because
a) the price at which Tesco, Dunnes and your corner shop sell the eggs at is none of the farmer's business.
b) that would probably be illegal under the Competition Act.

If the above did happen, would the Minister for Agriculture come out in public and agree with the farmers? No way. Most Ministers have the cop on to recognise that that would be a bad thing.

Now, in all the above scenarios;
substitute IPHA (the organisation that represents Big Pharma) for the IFA,
substitute pharmacists for Tesco, Dunnes and the corner shop, and
substitute a certain fat cow independent TD/Minister for the Minister for Agriculture.

That is exactly what has happened in the last few days.


EDIT: PS; I thought you made some good points in the remainder of your post.

locum-motion

liam84 wrote: »

You say in general, but only have your own receipt as evidence that it happens. I have receipts from the last three years from four different pharamcies that says they don't. Now maybe I've picked on unusual pharamcies, and the general practice is that prices are itemised sufficiently.

If what you say about the prices changing every month is accurate then a price list would be difficult but not impossible. I presume there must be a Top 20 or 30 drugs prescribed all the time. Those are the ones to publicise within your store and grab customers attention.

My esteemed colleague has only recently joined the profession, so she won't be aware of the history here.

At the time the DPS was set up, a thing called the 'Unified Claim Form' was invented. It's the blue and white receipt that you get with your medicines. It's called the Unified form coz the same piece of paper can have different data printed on it according to which of the various Community Drugs Schemes the patient is on.

Look near the top right corner.
Liam, I bet your paper with no individual prices on it has the letters DP or DPS in a box there.
Angel, I bet yours - that has the prices on - has DR printed there.
(Angel, at work tomorrow, have a look at each receipt before you bag it and you'll see the truth of this)

DR is printed on 'Private' prescription receipts. It stands for Drug Refund.
DP is printed on DPS receipts. The data thereon is the data that the Dept of Health wanted printed on it when the scheme was set up.
There's no mystery or conspiracy there, I'm afraid.

I should point out that I mean absolutely no disparagement of Angeldelight above. Her RW identity is known to me. Although she's only recently qualified, she is already very well regarded by those colleagues who know her.

angeldelight

Sorry yes you're right, mine is drug refund. Ignore that post of mine so! However the pharmacist will give you a break down of the price if you bring your prescription in

liam84

locum-motion wrote: »

When you buy half a dozen eggs in Tesco, Dunnes or the corner shop, do you insist on knowing how much they bought the eggs for? No, you don't.

If you asked them, do you think they'd tell you? You can be bloody sure they wouldn't. They'd tell you to fcuk off, and they'd be dead right.

Did the Irish Farmers' Association set up a website last monday listing the price that the farmers sell the eggs to the distributors at? No they didn't.

Did the IFA tell the public that they should insist on paying no more than a particular amount for their eggs? No, they didn't, because
a) the price at which Tesco, Dunnes and your corner shop sell the eggs at is none of the farmer's business.
b) that would probably be illegal under the Competition Act.

If the above did happen, would the Minister for Agriculture come out in public and agree with the farmers? No way. Most Ministers have the cop on to recognise that that would be a bad thing.

Now, in all the above scenarios;
substitute IPHA (the organisation that represents Big Pharma) for the IFA,
substitute pharmacists for Tesco, Dunnes and the corner shop, and
substitute a certain fat cow independent TD/Minister for the Minister for Agriculture.

That is exactly what has happened in the last few days.


EDIT: PS; I thought you made some good points in the remainder of your post.

Locum-motion - thanks for the responses. Clearly, the aggrieved tone of your response indicates that you're a pharmacist (and I think you said as much in an earlier post) - so you'll excuse my initial response of 'well you would say that, wouldn't you?'

You say that I make some good points in the remainder of my post - my key point was that price is the deciding factor in what is essentially a commoditised service. Therefore price and visibility for the customer about same is essential.

Your response to this is to ask rhetorical questions about buying eggs.

Eggs? Eggs!! You have to be joking.

I'm not buying or choosing from a variety of protein products when buying eggs - I'm buying the same product, albeit with some questionable assertions about their size and origin. But that's it. It's not the same as buying a complex drug that impacts directly on my health. There has to be over 5,000 different drugs available for treatment of different illnesses in Ireland (maybe a lot more?) - most of which are prescribed to you by another professional working in a surgery. And as a pharmacist you compare that to buying eggs? That says far more about how you perceive the value of your products and the service you provide than anyone else.

Unless pharmacists change the type of dispensing service in their shops, and how they behave as trained professionals, they will continue to be judged on price, and price alone.

Some pharmacists may feel that their winning personality and charm - the customer experience - might win them a few customers, and no doubt that helps - I've met a few. But it seems to me that in a profession that has allowed itself to be put into a place where the only real difference is about how much they charge - no doubt the Govt and IPHA have contributed to this recently but ultimately they ain't to blame - then they need to take action and do something about how their profession is perceived.

As far as the public is concerned, pharmacies - and owner-pharmacists by assumption - have been profiteering big-time over the last decade. No doubt there have been smaller pharmacies who haven't enjoyed all the benefits but if large salaries and extraordinary prices for pharamcies are any indicator, then chemists have been making it large for the last while.

Suddenly that's changing as the Government belatedly copped on and started changing things, knowing they were being fleeced (and the taxpayer). New rules got established. Manufacturers got partly kicked into line, new policies emerged, etc, etc. But what changed for the customer? Practically nothing. Because either they weren't paying for their drugs in the first place and so couldn't be bothered about what they paid, or else they had to shrug at either the Govt changing their limit on DPS - 80 odd to 120 in my case - and nothing else of import. Pharmacists hunkered down and tried to protect a shrinking area of profit for themselves - that's now down to the private customer.

Suddenly there seems to be a change that will have a positive impact on the paying customer (and the indirect paying customer who are paying through their taxes if they thought about it) and the pharmacists are up in arms at having the cosy relationship with their private paying customer disturbed.

As a paying patient, who does have DPS in the corner of his Unified Form - I'm suddenly interested in seeing what's what.

So what if a unified form was issued by the Govt? Does that stop pharmacies presenting itemised receipts to their customers? I never mentioned mystery or conspiracies, just give me information. You can whinge about how the Govt has behaved or anyone else, but the reality is that if it wasn't this IPHA thing, it would have been something else that would have inevitably caused greater transparency in a market largely governed by price.

Recession has a great habit of making people stop and think about what they're handing over - that's the free market. I've no problem with pharmacists making a profit - they're entitled in running a business. But they knew the rules when they got into it about it being a state-involved service and receiving monies from it.

There's obvious patterns of settled or defensive behaviour amongst a group of professionals that has allowed itself to become commoditised in its actions and responses to events beyond its control. If ever there was a sign that a supposedly competitive industry or sector was behaving like a commoditised herd of cows plaintitively mooing, but shuffling resignedly in the one direction, pharmacy is it.

Nobody is preventing them from acting differently in how they treat patients, as long as they work within legal requirements. I bet every recent change has been greeted with groans of dismay, muttered curses and paranoiac accusations of people out to get the profession.

the title of this thread is interesting and what grabbed my attention in the first place. "An honest relationship with you the customer". what's an honest relationship? Possibly it's one that involves things like trust, reassurance, dignity, respect, fairness, value and equity. Do all of those involve money? Not in my book.

If I walked into my pharmacy and I knew that the man/woman behind the counter had more than how many 'eggs' they were going to sell me on their mind, I might sit up and take notice. Maybe they'd be aware of the illness I had. Maybe they'd know about the effects other drugs might have on me. Maybe they'd be willing to take the time to talk about that and what impact it was having on my life. Maybe they'd be willing to get involved in what they are actually dispensing drugs for, and provide some value around the product they were otherwise mindlessly shovelling into a pill bottle on my behalf. Maybe they might come up with some added-value service that I'd be willing to pay for because my GP is too busy or hasn't enough time to take time out to discuss things. Maybe they've forgotten things they were taught when they were learning months, years or decades ago, that actually might make a difference in a patient's day or life. Maybe my pharmacy might become a place that I might welcome visiting for my healthcare, as opposed to somewhere to stop off to 'colllect my scrip'.

Eggs?

Should I be surprised that some chickens are coming home to roost.

Alicat

As someone who works in pharmacy (not a pharmacist), I've found the last few days particularly difficult dealing with customers demanding to know the prices of their drugs. I say "demanding" because the attitude of a lot of these customers has been absolutely disgraceful. I've had people shouting down the phone at me, cursing at me and hanging up.

It's the start of the month, the busiest time of the month for any pharmacy, I haven't had time to study the list and know immediately offhand what prices have been reduced. The disk with the updated prices arrived today but it has been so busy we didn't even have time to install it until the shop closed this evening. So don't shout at me! If you could calmly tell me your query, I'll go find out and call you back later or you can call me. One absolute cow said to me today "Can you not just look at the bloody list in front of you for God's sake??"

No I can't you silly, rude, ignorant woman, the shop is packed, I have a dozen HUGE prescriptions waiting on the bench and here you are in my face about the price of your bloody Zirtek! Chill! I am responsible for none of this, I work here yes but I am trying to get my head around it too so back the f*ck off for two minutes

The worst businesses to work in are those which involve either people's health or their money. Somehow it seems to give them all an excuse to be an absolute @sshole to anyone and everyone. The media are getting everyone in a tizzy and giving incorrect or incomplete information and telling everyone to storm their local pharmacy and give them hell.

I had a bad day today, sorry if it comes out as a big rant.

Alicat

liam84 wrote: »

Your response to this is to ask rhetorical questions about buying eggs.

Eggs? Eggs!! You have to be joking.

I'm not buying or choosing from a variety of protein products when buying eggs - I'm buying the same product, albeit with some questionable assertions about their size and origin. But that's it. It's not the same as buying a complex drug that impacts directly on my health. There has to be over 5,000 different drugs available for treatment of different illnesses in Ireland (maybe a lot more?) - most of which are prescribed to you by another professional working in a surgery. And as a pharmacist you compare that to buying eggs? That says far more about how you perceive the value of your products and the service you provide than anyone else.

Talk about over-reacting! Sorry, but the discussion was about prices/discounts/mark ups/profits, a discussion about the business end of the pharmacy world. He responded with an analogy relating to the business end of it. What's the problem? I'm sure he could go into a huge post about the service he provides but that's not what was being discussed.

the title of this thread is interesting and what grabbed my attention in the first place. "An honest relationship with you the customer". what's an honest relationship? Possibly it's one that involves things like trust, reassurance, dignity, respect, fairness, value and equity. Do all of those involve money? Not in my book.

I laughed at this. Do you know how hard it is to gain these traits/qualities FROM customers?

Respect? Dignity? Fairness? Is this yelling at ME in front of all the other customers when the government puts the DPS threshold up? Giving out to me about the price of a drug? Calling me an ignorant bast*rd because your prescription isn't due yet? Is this throwing the money on the counter at me? Not looking me in the eye like a person?

It's my job to treat the customers with respect, dignity and fairness but let me tell you a lot of customers are absolute misers when it comes to returning the favour.

If I walked into my pharmacy and I knew that the man/woman behind the counter had more than how many 'eggs' they were going to sell me on their mind, I might sit up and take notice. Maybe they'd be aware of the illness I had. Maybe they'd know about the effects other drugs might have on me. Maybe they'd be willing to take the time to talk about that and what impact it was having on my life. Maybe they'd be willing to get involved in what they are actually dispensing drugs for, and provide some value around the product they were otherwise mindlessly shovelling into a pill bottle on my behalf. Maybe they might come up with some added-value service that I'd be willing to pay for because my GP is too busy or hasn't enough time to take time out to discuss things. Maybe they've forgotten things they were taught when they were learning months, years or decades ago, that actually might make a difference in a patient's day or life. Maybe my pharmacy might become a place that I might welcome visiting for my healthcare, as opposed to somewhere to stop off to 'colllect my scrip'.

Well maybe you're in the wrong pharmacy! Don't tar them all with the same brush. My boss spoke to a woman in the shop for about half an hour about problems with her son. She came back in a few days later looking for more advice but the boss was off so we took her number and passed it on to him. He rang her on his day off and talked to her for another half an hour on the phone because he cares and is good at his job.

liam84

Alicat wrote: »

Talk about over-reacting! Sorry, but the discussion was about prices/discounts/mark ups/profits, a discussion about the business end of the pharmacy world. He responded with an analogy relating to the business end of it. What's the problem? I'm sure he could go into a huge post about the service he provides but that's not what was being discussed.

Alicat - it's not over-reaction. Look at the specific response regarding eggs - it was a post on its own. Asking people rhetorical questions about whether I or anyone else would ask these price questions of egg producers.

Surely you recognise that this is a laughable response from a trained professional. I don't view pharmacy as the equivalent of an egg producer so why make the comparison?

What analogy do you think he was making relating to the business end of it - as you put it?

Kurtosis

liam84 wrote: »

Alicat - it's not over-reaction. Look at the specific response regarding eggs - it was a post on its own. Asking people rhetorical questions about whether I or anyone else would ask these price questions of egg producers.

Surely you recognise that this is a laughable response from a trained professional. I don't view pharmacy as the equivalent of an egg producer so why make the comparison?

What analogy do you think he was making relating to the business end of it - as you put it?

Just curious about the above liam. I assumed the poster was drawing the analogy to try and see would you feel the same way about other retail environments as you do about a pharmacy with regards to cost, mark-up etc. (Again this is just my assumption, I do not want to put words in locum's mouth if (s)he intended something different.)

Fair enough eggs might be a bit of a wacky example (but a very valid example nonetheless), but would you ask for a cost and profit breakdown for any other services you avail of or goods you buy?

liam84

Alicat wrote: »

As someone who works in pharmacy (not a pharmacist), I've found the last few days particularly difficult dealing with customers demanding to know the prices of their drugs.....
I haven't had time to study the list and know immediately offhand what prices have been reduced. The disk with the updated prices arrived today but it has been so busy we didn't even have time to install it until the shop closed this evening.

I had a bad day today, sorry if it comes out as a big rant.

Alicat - what you describe is not fair behaviour by customers towards you so the rant is allowable.

If it's of help, I found the list here - www.checkthelist.ie - and was able to print it off - 6/7 pages at most. You could print this off and use it as a quick check for phone queries - it shows pretty quickly whether an item is on the list or not, and how much is has dropped by for DPS patients. Obviously you'll know how much extra your pharmacy charges people who aren't covered by DPS. It's fairly straightforward.

Alicat

liam84 wrote: »

Alicat - it's not over-reaction. Look at the specific response regarding eggs - it was a post on its own. Asking people rhetorical questions about whether I or anyone else would ask these price questions of egg producers.

Surely you recognise that this is a laughable response from a trained professional. I don't view pharmacy as the equivalent of an egg producer so why make the comparison?

What analogy do you think he was making relating to the business end of it - as you put it?

Ok I think you've been blinded by the eggs. It was not a laughable response. Locum-motion has provided a lot of answers/discussions regarding pharmacy and it's dealings on this forum over the past while. Some people reading these threads may not have any idea about how pharmacy works, whether it's about prescriptions or prices or the legal aspect of it. He provided an analogy that is EXTREMELY easy to understand, from anyone's point of view.

Were you looking for something more complex?

The analogy clearly relates how ridiculous the government's attempted stranglehold on Pharmacy is when you consider applying it to any other business. Such as egg farming! I'm not against prices being tightened in pharmacy and cut backs made where necessary but they are taking the p!ss.

Alicat

liam84 wrote: »

Alicat - what you describe is not fair behaviour by customers towards you so the rant is allowable.

If it's of help, I found the list here - www.checkthelist.ie - and was able to print it off - 6/7 pages at most. You could print this off and use it as a quick check for phone queries - it shows pretty quickly whether an item is on the list or not, and how much is has dropped by for DPS patients. Obviously you'll know how much extra your pharmacy charges people who aren't covered by DPS. It's fairly straightforward.

I have the list, I think it was the IPHA that sent it out but it's actually in TINY print and not even alphabetical for some reason. And I mean tiny, and my eyesight simply couldn't pick out the one tiny listing for Zirtek. If the customer had just given me a moment to look slowly through it I would have found it but that's not the point. It's the absolute disregard and disrespect from customers such as this who shouted at me when I couldn't find the listing within 30 seconds or whatever. THAT's what really gets my goat. Do I have 'SLAVE' printed across my forehead? No? Good, well treat me with some respect and WAIT while I try to sort your query.

(obviously not directed at you but at customers such as that in general!)

Edit: And actually may I point out that lots of these queries seem to be coming from people who are NOT regular customers but people merely calling around the find prices for the smallest of things.

liam84

Alicat wrote: »

Ok I think you've been blinded by the eggs. It was not a laughable response. Locum-motion has provided a lot of answers/discussions regarding pharmacy and it's dealings on this forum over the past while. Some people reading these threads may not have any idea about how pharmacy works, whether it's about prescriptions or prices or the legal aspect of it. He provided an analogy that is EXTREMELY easy to understand, from anyone's point of view.

Were you looking for something more complex?

The analogy clearly relates how ridiculous the government's attempted stranglehold on Pharmacy is when you consider applying it to any other business. Such as egg farming! I'm not against prices being tightened in pharmacy and cut backs made where necessary but they are taking the p!ss.

You seem to be missing the point. You ask was I looking for something more complex? Well no I wasn't necessarily - I was looking for something more comparable.

Comparing the pricing structure of an egg producer - a single product in a number of sizes that are a basic commodity with an established price range, with a retail outlet selling (I assume) thousands of different medicines, of different quantities, for different illnesses, with different price structures, discounting, bonuses, along with all the other front of shop items does not make sense to me. Maybe it does to you.

If anything, it seems that the Govt is intent on making the complex price structure around drugs - and this extends well beyond the pharmacy - a little simpler for everyone. With the various schemes in place, though, they've a lot of work to do yet. (If pharmacy is a commodity business, maybe it needs to become more streamlined like an egg producer where there is much greater clarity and transparency around production and margins, and as a result much less oversight required as a result.)

EDIT: Oh - the print off list from the actual IPHA website is done alphabetically - well the one I did is, and I was able to increase the size in Excel before printing it off - just took a minute to adjust before I did it and it was easy enough to read.

bleg

liam84 wrote: »

If anything, it seems that the Govt is intent on making the complex price structure around drugs - and this extends well beyond the pharmacy - a little simpler for everyone.

HA!!!! What an absolute joke!

Making the complex price structure simpler. That's why some branded medicines now cost more than their generic equivalents.

The ineptitude of the government and the DoHC in this instance is staggering.

The pharmaceutical companies are laughing all the way to the bank. their products will get a renewed increased market share, they get a boost in public opinion and get their trademarks increased exposure.

In fact I'd put my house on IPHA going to the negotiations willing to put more on the table but pulled back during the negotiations when they realised they could get away with this token gesture.

liam84

bleg wrote: »

HA!!!! What an absolute joke!

Making the complex price structure simpler. That's why some branded medicines now cost more than their generic equivalents.

The ineptitude of the government and the DoHC in this instance is staggering.

The pharmaceutical companies are laughing all the way to the bank. their products will get a renewed increased market share, they get a boost in public opinion and get their trademarks increased exposure.

In fact I'd put my house on IPHA going to the negotiations willing to put more on the table but pulled back during the negotiations when they realised they could get away with this token gesture.

Well is it not the case that the 600 odd medicines on the HSE list are now cheaper than their generic equivalents cos the generic manufacturers refused to lower them until the autumn when their contract runs out?

Why are the DOHC staggeringly inept on this issue? should they have got a greater reduction or should more drugs have been reduced?

Why would IPHA get increased market share? It's down to the pharmacists as to what they promote to their customers in a lot of cases. Since they've gone doolally over these price cuts, presumably they can retaliate with offering alternatives to customers like my pharmacy does at the moment. As long as it's cheaper than the actual prescribed drug, why would the customer complain? I'm sure the generic makers offer discount deals (e.g. buy 2 get 3 free) which they can then flog to their unknowing customers.

bleg

liam84 wrote: »

Well is it not the case that the 600 odd medicines on the HSE list are now cheaper than their generic equivalents cos the generic manufacturers refused to lower them until the autumn when their contract runs out?

There are only roughly 300 on the HSE list. Some of these have generics that are more expensive. That is ridiculous. The generics prices are being kept artificially high by the previous government agreement.

Why are the DOHC staggeringly inept on this issue? should they have got a greater reduction or should more drugs have been reduced?

Both. It hasn't addressed any drugs that are currently on patent where there is absolutely no price competition.

Why would IPHA get increased market share? It's down to the pharmacists as to what they promote to their customers in a lot of cases. Since they've gone doolally over these price cuts, presumably they can retaliate with offering alternatives to customers like my pharmacy does at the moment. As long as it's cheaper than the actual prescribed drug, why would the customer complain? I'm sure the generic makers offer discount deals (e.g. buy 2 get 3 free) which they can then flog to their unknowing customers.

Because people will check the list, go to their doctor and ask for that drug. The pharmacists cannot substitute that drug for another if the doctor prescribes it by name.

Pharmacists have little involvement in what is prescribed or dispensed despite asking to be involved for years. This has fallen on government deaf ears for years and years.

liam84

penguin88 wrote: »

Just curious about the above liam. I assumed the poster was drawing the analogy to try and see would you feel the same way about other retail environments as you do about a pharmacy with regards to cost, mark-up etc. (Again this is just my assumption, I do not want to put words in locum's mouth if (s)he intended something different.)

Fair enough eggs might be a bit of a wacky example (but a very valid example nonetheless), but would you ask for a cost and profit breakdown for any other services you avail of or goods you buy?

As a consumer, I'll seek any way possible to get the best value for something I'm purchasing.

I don't think people feel they are being ripped off by egg producers. Therefore, I wouldn't seek to subject them to that kind of scrutiny. Nor does it require it. Supermarkets do that job for consumers. An egg is an egg is an egg. It's a basic commodity - on the lowest rung of the retail ladder.

Do pharmacists believe they are providing a similar commoditised service like egg producers? Is dispensing pills largely a pack and wrap service? If they do, then of course, they will be driven on price and their margins - it's the same in any price-driven, small margin business.

In a couple of businesses I've worked in, the cost and profit breakdown is often worked out by the purchaser and you have to negotiate on that basis. Pharmacy is not unique in this.

They just have to get used to it. Unless and until they can prove the service they provide is something more than a commodity service.

Kurtosis

I don't think people feel they are being ripped off by egg producers. Therefore, I wouldn't seek to subject them to that kind of scrutiny. Nor does it require it. Supermarkets do that job for consumers. An egg is an egg is an egg. It's a basic commodity - on the lowest rung of the retail ladder.

You're really getting hung about this egg example! And I think you are confusing it now. I gather from the above that you are feeling ripped off by pharmaceutical manufacturers (if we are still operating on L-M's initial analogy)? So the pharma companies should be subjected to scrutiny? You say above supermarkets scrutinise the egg producers on behalf of the consumers (even though an egg is an egg is an egg), I think it would be more appropriate to say that is the Food Safety Authority does this, quality control etc. The equivalent in the current case would be the Irish Medicines Board. So I am not sure what your quote above has to do with pharmacies...your logic might be a bit cracked.

Do pharmacists believe they are providing a similar commoditised service like egg producers? Is dispensing pills largely a pack and wrap service? If they do, then of course, they will be driven on price and their margins - it's the same in any price-driven, small margin business.

Ok, I'll assume here when you refer to egg producers, you really mean supermarkets and shops selling eggs. Of course pharmacy in general is not providing a purely commoditised service. Since you love L-M's egg example so much can I ask you, when you buy eggs in the supermarket, do they give you advice on how to use the eggs properly in the likes of omelettes, cakes and pasta? Do they look at the rest of your shopping basket and see if the eggs will work with your overall diet? And do they then take any feedback or problems you had with the eggs and deal with them and feed them back to the egg producers, the FSA and the person who recommended you buy eggs in the first place?

In a couple of businesses I've worked in, the cost and profit breakdown is often worked out by the purchaser and you have to negotiate on that basis. Pharmacy is not unique in this.

That's well and good, but as you say yourself, in those businesses it is the purchaser that works out the breakdown themselves and then negotiates on that basis. Fair enough, do that for pharmacy, but what you were asking for earlier was for the pharmacy to do the work for you and give the consumer the breakdown - this is obviously different to what has happened in your businesses.

They just have to get used to it. Unless and until they can prove the service they provide is something more than a commodity service.

And I will put it to you again: would you ask for a cost and profit breakdown for any other services you avail of or goods you buy?

Declaration of interest: I am a pharmacy student. I have worked in pharmacies before. I am not working currently.

liam84

penguin88 wrote: »

You're really getting hung about this egg example! And I think you are confusing it now. I gather from the above that you are feeling ripped off by pharmaceutical manufacturers (if we are still operating on L-M's initial analogy)? So the pharma companies should be subjected to scrutiny? You say above supermarkets scrutinise the egg producers on behalf of the consumers (even though an egg is an egg is an egg), I think it would be more appropriate to say that is the Food Safety Authority does this, quality control etc. The equivalent in the current case would be the Irish Medicines Board. So I am not sure what your quote above has to do with pharmacies...your logic might be a bit cracked.



Ok, I'll assume here when you refer to egg producers, you really mean supermarkets and shops selling eggs. Of course pharmacy in general is not providing a purely commoditised service. Since you love L-M's egg example so much can I ask you, when you buy eggs in the supermarket, do they give you advice on how to use the eggs properly in the likes of omelettes, cakes and pasta? Do they look at the rest of your shopping basket and see if the eggs will work with your overall diet? And do they then take any feedback or problems you had with the eggs and deal with them and feed them back to the egg producers, the FSA and the person who recommended you buy eggs in the first place?



That's well and good, but as you say yourself, in those businesses it is the purchaser that works out the breakdown themselves and then negotiates on that basis. Fair enough, do that for pharmacy, but what you were asking for earlier was for the pharmacy to do the work for you and give the consumer the breakdown - this is obviously different to what has happened in your businesses.



And I will put it to you again: would you ask for a cost and profit breakdown for any other services you avail of or goods you buy?

Declaration of interest: I am a pharmacy student. I have worked in pharmacies before. I am not working currently.

You miss the point. I'll happily drop the egg example since I didn't provide it. I don't love it at all. It was irrelevant in my view. And I'm not sure what the point of your questions were. You'll find sources that would answer yes to most of them.

Your last comment makes you sound like a lawyer, not a pharmacy student. :0 And the answer is of course I would, if I thought it appropriate. But I haven't done so with pharmacy. Asking about why I should pay a higher mark-up (i.e. price) than someone else is a valid question. A pharmacy's cost and profit breakdown is based on much more than selling drugs, as you'll discover when you get around to owning and running a pharmacy, if that's your ambition. It's likely that there's greater profit margins in the front of shop stuff since 70% of the space in a shop is given over to it. Cosmetics, for example.

Take off your pharmacy hat, and act like a consumer of goods and services. Maybe that way you'll understand it better.

Kurtosis

liam84 wrote: »

You miss the point. I'll happily drop the egg example since I didn't provide it. I don't love it at all. It was irrelevant in my view. And I'm not sure what the point of your questions were. You'll find sources that would answer yes to most of them.

Not missing the point at all. Was trying to show that getting hung up on an example provided to try clarify matters was not progressing anything. My questions were (in an indirect way) trying to establish pharmacies do more than just sell goods.

Your last comment makes you sound like a lawyer, not a pharmacy student. :0

Well apologies then for trying to inform you of my background, I think openness is important and you will see a number of posters here do similar when there may be a conflict of interest in the discussion.

And the answer is of course I would, if I thought it appropriate. But I haven't done so with pharmacy. Asking about why I should pay a higher mark-up (i.e. price) than someone else is a valid question. A pharmacy's cost and profit breakdown is based on much more than selling drugs, as you'll discover when you get around to owning and running a pharmacy, if that's your ambition. It's likely that there's greater profit margins in the front of shop stuff since 70% of the space in a shop is given over to it. Cosmetics, for example.

Ok you haven't asked in a pharmacy, but you said earlier pharmacies should have to provide a breakdown for everyone. And thank you, I'm well aware that a lot of the income is actually independent of medicines. But how does this apply to the point at hand?

Take off your pharmacy hat, and act like a consumer of goods and services. Maybe that way you'll understand it better.

I understand the situation perfectly well, and I can see it from both sides. Look I'm just wondering why you think there should be double standards exacted on pharmacies. As in you want pharmacies to all provide a breakdown of the cost and margin etc straight off the bat. Do you think any other specific industries should have to do the same? I think if any patient wants a breakdown, go for it, ask for it. But why enforce automatic provision of a cost breakdown on pharmacies and pharmacies only?

liam84

bleg wrote: »

There are only roughly 300 on the HSE list. Some of these have generics that are more expensive. That is ridiculous. The generics prices are being kept artificially high by the previous government agreement.

'Artificially high? They were acceptable prices two weeks ago. From what I read in the newspapers, the manufacturuers refused to lower their prices at the same time as the IPHA ones. The same manufacturers who no doubt give out about artificial high prices from brand drug companies any other time. Of course it's ridiculous. But they signed an agreement and presumably they're entitled to do it legally until the Autumn. I don't know why they refused - unless they think they can persuade pharamcists to keep selling them because they're somehow more profitable for the pharmacist. I don't know - go ask them.

bleg wrote: »

Both. It hasn't addressed any drugs that are currently on patent where there is absolutely no price competition.

Ok - so how much do you think the brand patent drugs should be cut by?

bleg wrote: »

Because people will check the list, go to their doctor and ask for that drug. The pharmacists cannot substitute that drug for another if the doctor prescribes it by name.

There's a world of difference between they shouldn't and they wouldn't. My own pharmacy did exactly that the other day - and not for the first time. And I don't believe that they are an exception.

bleg wrote: »

Pharmacists have little involvement in what is prescribed or dispensed despite asking to be involved for years. This has fallen on government deaf ears for years and years.

Well that is partly a professional argument, and I'm not an expert on whether pharmacists should be allowed prescribe. No doubt GPs would differ with you. But I would have thought they should have some expertise and involvement in what is dispensed.

However, if pharmacists have failed to make any progress for years and years as you say, that does tell me something about how well they're organised and run and their failure to persuade others of the value they believe they contribute.

That brings us back to the commodity argument. Pack & Wrap merchants or specialised professional health/medicine consultancy? I wonder how people view their local pharmacy/pharmacist?

Think about what happens at the moment. You walk into your average pharmacy, the first 80 feet is wall to wall goods that you could largely buy in a supermarket. Right at the back is stuck the dispensing counter. You walk the length of the shop to get there where a young wan says 'yeah, are you okay?' Can I get my prescription please? What's your name? Right, wait a minute. ...... Here you are. €96 euro please. Sign here please. Thanks, bye.

That is pretty much word for word my experience for the last five and half years - 66 visits and pretty much the same thing with only the person greeting you changing from time to time. That's fine - if that's what they want to provide.

I sometimes wonder why don't they provide some kind of organised pharma care or consulting service to patients to discuss their overall health, the impact or side effects that various drugs are having, other lifestyle/health issues, etc. People not taking all their medication because it disagrees with them, but not telling anyone. I'm sure this may happen on an ad hoc conversational basis, but what value is placed on it - by pharmacist or by customer? You could argue this is what GPs are for, but they've been diminished as well in stature over the years.

Tree

I really dont see why a pharmacist should have to explain their charges. The pharmacists can't collude on prices, so you could shop around to find someone you prefer the prices of.

Noone else has to explain their charges, and no one pharmacist has a monopoly on your custom.

liam84

penguin88 wrote: »

Not missing the point at all. Was trying to show that getting hung up on an example provided to try clarify matters was not progressing anything. My questions were (in an indirect way) trying to establish pharmacies do more than just sell goods.

I wasn't getting hung up on it. I gave one response, and others responded to that. It didn't clarify matters - it obscured them. The point I've been making is through asking the question about whether pharmacy is a commoditised service. Which it seems to be, in my view.

penguin88 wrote: »

Well apologies then for trying to inform you of my background, I think openness is important and you will see a number of posters here do similar when there may be a conflict of interest in the discussion.

Understood. That's why I put a smiley thing at the end of it.

penguin88 wrote: »

Ok you haven't asked in a pharmacy, but you said earlier pharmacies should have to provide a breakdown for everyone. And thank you, I'm well aware that a lot of the income is actually independent of medicines. But how does this apply to the point at hand?

Yes I did say that pharamcies should have to provide a breakdown - see below. And the point in hand is that's why I'm not interested in knowing the overall profitability of a pharmacy - too much other financial info unrelated to the sales of the commodity drugs.

penguin88 wrote: »

I understand the situation perfectly well, and I can see it from both sides. Look I'm just wondering why you think there should be double standards exacted on pharmacies. As in you want pharmacies to all provide a breakdown of the cost and margin etc straight off the bat. Do you think any other specific industries should have to do the same? I think if any patient wants a breakdown, go for it, ask for it. But why enforce automatic provision of a cost breakdown on pharmacies and pharmacies only?

Well, here's what I actually said: "To assist this, pharmacies should be required to provide itemised receipts for the drugs they dispense instead of just gross totals. And an itemised price list of drugs should be made available in stores so that customers can compare. And someone should put together a website that lists all the prices of these drugs for even greater transparency."

I didn't say anything about cost and margin. Maybe go back and read the context in which I made this statement, cos I don't want to repeat it all again and clog up the discussion.

liam84

Tree wrote: »

I really dont see why a pharmacist should have to explain their charges. The pharmacists can't collude on prices, so you could shop around to find someone you prefer the prices of.

Noone else has to explain their charges, and no one pharmacist has a monopoly on your custom.

Agreed. They don't have to. As I understand it, there appears to be a 'standard industry mark-up' of 50% on the wholesale drug price plus their dispensing fee, under €120. For all I know that may increase or decrease depending on the product, the pharmacist and the customer.

The State makes them charge 20% mark-up on the total bill once it goes over €120.

What the State pays should be open and transparent because it's public money.

Kurtosis

Well, here's what I actually said: "To assist this, pharmacies should be required to provide itemised receipts for the drugs they dispense instead of just gross totals. And an itemised price list of drugs should be made available in stores so that customers can compare. And someone should put together a website that lists all the prices of these drugs for even greater transparency."

I didn't say anything about cost and margin. Maybe go back and read the context in which I made this statement, cos I don't want to repeat it all again and clog up the discussion.

liam84 wrote: »

It does help. You're saying the customer is blind to what mark-up they've been charged if they exceed the DPS threshold - they still have to pay out €120. The State (acting for us the taxpayers) picks up the rest at a reduced mark-up. The customer is also blind to the scalable dispensing fee €3.50 - €5 since it's based on volumes - and this is only calculated at point of reimbursement, not at point of sale to the customer.

It's only when it's under €120 that the customer has any say in what they pay or whether they pay a particular pharmacy.

It all depends on how motivated you are as a customer to seek out value for money.

To assist this, pharmacies should be required to provide itemised receipts for the drugs they dispense instead of just gross totals. And an itemised price list of drugs should be made available in stores so that customers can compare. And someone should put together a website that lists all the prices of these drugs for even greater transparency.

Effectively this is a commoditised market. Same drugs available in the same locations, with the same type of qualified person dispensing them. The only difference to the customer is the quality of the pharmacist (difficult to distinguish/assess and one assumes they should all be of similar professional quality) and the price of the prescription products. What other value difference is there between them except for guff about how they take better care of you? I'm leaving out the assorted hairbrushes, nail clippers, plastic bags, emergency kits, cosmetics, etc that they sell front of house.

This was the context of the post you made. You began the post by talking about mark-up and the customer being blind to it above €120. This led me to believe that the "itemised price list" you wanted instead of gross totals referred to a breakdown of price for each item. Sorry for the misunderstanding, but just showing why I drew that conclusion.

liam84 wrote: »

Agreed. They don't have to. As I understand it, there appears to be a 'standard industry mark-up' of 50% on the wholesale drug price plus their dispensing fee, under €120. For all I know that may increase or decrease depending on the product, the pharmacist and the customer.

The State makes them charge 20% mark-up on the total bill once it goes over €120.

What the State pays should be open and transparent because it's public money.

As you say, the mark up is 20%...that's pretty open and transparent. The dispensing fee? Well it ranges from €3.50 to €5, and unless it's getting towards the end of the month, the pharmacist does not even know what it is (€5 applies to first ~1,500 items in a month, 4.50 to the next ~800 and 3.50 to the remainder). And what's left after that? Well it's the wholesaler price (minus ~6.5%). All open and transparent.

And why should it be open and transparent to the public? It is a transaction between contractors (pharmacists) and a consumer (the State), so if details of the transaction are to be released to a third party (the public) surely it should be up the consumer (the State) to pass on the information if they wish.