Pharmacists Prescription Costs

somesoldiers

Hi Guys

I have been on the same medication for 7 years now and will be for life. I get 6 monthly prescriptions which up til recently I was filling monthly with a local pharmacy. I always ask for generics but here’s the thing, I wentinto a Dublin pharmacy today and the guy told me it would be cheaper if I gotthe 6 month batch in one go. I asked what would be the cost for 1 month and 6months, thinking it would be around €50 for one month so maybe €250+ for the 6months. €30 for 1, €90 for 6!

My local was charging €65 the last time I went for 1 month,they know I am price sensitive and will often say “oh there’s a generic out for that 1 now, these are 50c cheaper” or something, like they are doing me such a huge favour. Aside from the cost issue itself, this would seem to represent excellent value filling the 6 months in 1 go with a 50% saving.

My question is, is the ability to bulk buy a new thing? Why would my long term local never tell me I could do this? Obviously it represents less profit for them if I do but ethically shouldn’t they have told me about this? Would appreciate any advice from someone in the industry or with anyone a similar experience

thanks

Noel

L1011

The normal pricing used by a pharmacy in Ireland has been cost + a markup + a dispensing fee. That fee is once per dispensing, not per box/month.

When drug costs get lower and in particular, as markups get eroded to 0 in some cases, the dispensing fee can be a large percentage of the cost. This has been the case for some time but its becoming more obvious now.

I wouldn't consider it an ethics issue to not mention it at all - many people don't actually have the money to buy 6 months at a time for starters.

locum-motion

With many meds, I would not consider it safe to supply six months' supply in one go.

Ocean Blue

Abby19 wrote: »

Well if you get 6 months supply won't that also push you over the drug limit of €144/month for the Drugs Payment Scheme?

You can't bulk buy on the DPS, it's a monthly scheme - one supply per calendar month

somesoldiers

I have just spoken to the chemist that dispensed my 6 month supply. Apparently this is not a new thing, they offer this to all customers with a prescription > 1 month. The dispensing fee in my case was €5 per item so €15 for this visit- still seems a bit steep to me for what is essentially glorified stock picking. The fact that I got the 6 month prescription in one go means I save 5*€15 or €75, €150 p.a.
The reason, according to the new guy, why some other pharmacies might not offer this is because the prescription might change in the period, as I mentioned in the OP I will be on these for life and would only go back to the doctors for a check up when my 6 month prescription has lapsed anyway so there would be no change.
He did also mention that some people may not be in a position to afford a 6 month supply and this is understandable but at least he offers this to everyone at which point it is up to them to decide.
I believe, though I am open to correction on this that there is a list of medicines approved by the medicines board which are safe to dispense this way.
Those above the DPS threshold would not be able to bulk buy currently though even fewer would fall into the bracket of being able to shell out for 6 months if they were above the threshold.
The ability to bulk buy in my opinion should be advised to everyone as a matter of common decency. Anyone in my category would definitely benefit from the savings. Not mentioning once in 7 years just seems downright low.

Anyhow am off to contact Conor Pope and spread the word. Stay tuned: next week, how much are you paying for your chewing gum?

chinwag

Fair dues to your pharmacist, pity more don't do this. Apart from saving fees @ E15 per month x 5, was there much of a saving on the actual drugs? I'm a bit confused on the E90 in your first post.

somesoldiers

The lowest I price in my local chemist was €65 for 1 month. Whatever about dispensing fees, generics ( which I always ask for) etc my new med bill is €90 for 6 months.

Scortho

Shock horror,different business's charge different prices.

And sorry, but it's a little bit more than glorified stock picking

Nonoperational

Scortho wrote: »

Shock horror,different business's charge different prices.

And sorry, but it's a little bit more than glorified stock picking

Sometimes!

somesoldiers

Scortho wrote: »

Shock horror,different business's charge different prices.

And sorry, but it's a little bit more than glorified stock picking

and some will tell you you can get 6 months in one go so only pay 1 dispensing fee for the period and some won't bother their holes so they can get this off you every month.....

Scortho

somesoldiers wrote: »

and some will tell you you can get 6 months in one go so only pay 1 dispensing fee for the period and some won't bother their holes so they can get this off you every month.....

It happens in all businesses where a service is provided. One charges more than the other. If they all charged the same, people would be giving out that theres no competition and that its a cartel.
They charge different prices and people still give out.:rolleyes:

If it was me, id just reward the pharmacy who significantly cut the cost of your medicines, with any of my future business. Id also spread the word to neighbours, friends, family etc

somesoldiers

somesoldiers wrote: »

and some will tell you you can get 6 months in one go so only pay 1 dispensing fee for the period and some won't bother their holes so they can get this off you every month.....

Sometimes, it is important to get checked a health care professional every month to see how you are getting on with your medication.

Also, it is not "glorified stock-picking". People seem to think pharmacy is a really easy job. It's not at all. Over in every 10 prescriptions has a prescribing error. When a patient is taking over 5 medicines, there is a serious increase in the likelihood of an interaction.

If it was "glorified stock-picking", wouldn't everybody be doing it? Tell me what interactions you should be looking out for with Simvastatin doses above 20mg. How many days after taking a methotrexate dose should you take folic acid?

Patient comes in looking for Phenobarbitone with no prescription but they have ran out, how do you supply this legally?

L1011

somesoldiers wrote: »

and some will tell you you can get 6 months in one go so only pay 1 dispensing fee for the period and some won't bother their holes so they can get this off you every month.....

There is no obligation on any business to inform you of ways to pay them less money.

There are cases when its either not suitable or not possible to give six months anyway
1: Expiry dates - the drugs may not last 6 months
2: Stock - the pharmacy may not have 6 months in stock, particularly if they run aggressive live stock control to control costs
3: Safety - as said just above.

El_Dangeroso

Deleted User wrote: »

Over in every 10 prescriptions has a prescribing error. When a patient is taking over 5 medicines, there is a serious increase in the likelihood of an interaction.

Really? That's crazy. My husband once got a prescription for tablets that stated on the prescription to be administered IN BOTH EYES lol!

Why can't the GP check for interactions before prescribing? Surely even a well designed computer program could flag the issues with interactions?

Nonoperational

The computers do check for interactions in most cases but things still slip through. The majority of mistakes are things like old doses and old drugs being reprinted instead of the most up to date. GP practices are generally very busy and secretaries print repeat prescriptions for the docs to sign. They just don't get scrutinised to the extent that is necessary to avoid errors.

L1011

All ICGP-approved GP systems offer drug interaction checks. Problem is many GPs don't pay for their drug update licences or don't bother performing the check.

echo beach

MYOB wrote: »

All ICGP-approved GP systems offer drug interaction checks. Problem is many GPs don't pay for their drug update licences or don't bother performing the check.

The real problem is that all a computer programme can tell you is that there is a known interaction between two drugs and give an indication of the likelihood or severity of the interaction. You get information overload because almost all drugs interact with each other to some extent but it often isn't clinically important.
A computer can't tell you how relevant the interaction is for a particular patient. Often a young strong person can tolerate both drugs easily but the combination could be dangerous in a frail elderly person or a person with kidney or liver problems, because that is where the drug is broken down. A combination may be safe at low doses but dangerous at higher ones, or may be safe orally but dangerous if given IV and so on.
Knowing that there is an interaction is the easy bit. Knowing what to do about it, or if you need to do anything, is what requires expertise and judgement, and that is what takes years of study and practice to learn and is what you are paying for.

RobFowl

MYOB wrote: »

All ICGP-approved GP systems offer drug interaction checks. Problem is many GPs don't pay for their drug update licences or don't bother performing the check.

Slight generalisation there :rolleyes:

L1011

RobFowl wrote: »

Slight generalisation there :rolleyes:

At most 30% of customers in my previous job had valid drug info subscriptions. Not all of those updated regularly either but no way of knowing the figures there.

Warning checks were only automatic in their newer systems, with a huge legacy base. They'd a market share of about 70%. No generalisation here.

Nonoperational

At the end of the day, there are not that many absolute interactions. It's not that big of an issue. Pharmacists tend to overcall them to be honest. It's more things like doses not being updated etc that slip through.

Abby19

Don't forget not all GPs are computerised, some are still paper based.
And people may have hospital/consultant prescriptions separate from GP precriptions. Unless the patient has a GMS card and they get the GP to reissue the script.

somesoldiers

Thanks for the insight into what goes through a pharmacist's mind while they are charging me a fiver to put a box in a bag plus margin, I never knew it was so complicated. So they are pretty much scanning both my body to see has there been any changes since last month and the latest Lancet ( or whatever the pharmacists weekly is ) to see if there may be any adverse effects of the same meds I have been taking for the last 7 years. It is good to know that I am in safe hands. No business is obliged to tell me how to save money, true but my OP did question the ethics of this approach, "how are you, see the rugby last week, how's the kids, did you realise that by buying 6 months in one go you could save a tidy sum"

somesoldiers

and if more people were aware of this bulk buying available to those eligible wouldn't it cut down on the bill for those above the DPS threshold and those ( like me) who would claim tax back on their yearly med bill. Result: less money in pharmacists pocket and ultimately money saved by the tax payer??

RobFowl

Abby19 wrote: »

Don't forget not all GPs are computerised, some are still paper based.
And people may have hospital/consultant prescriptions separate from GP precriptions. Unless the patient has a GMS card and they get the GP to reissue the script.

90% in Ireland are computerised!

There are only 2 software systems approved and being sold ATM, Socrates has the drug interactions on it and you doe not need to update it as the providers do that automatically. So the point about GP's not checked it simply does not apply to those using that system at least.

somesoldiers

somesoldiers wrote: »

Thanks for the insight into what goes through a pharmacist's mind while they are charging me a fiver to put a box in a bag plus margin, I never knew it was so complicated. So they are pretty much scanning both my body to see has there been any changes since last month and the latest Lancet ( or whatever the pharmacists weekly is ) to see if there may be any adverse effects of the same meds I have been taking for the last 7 years. It is good to know that I am in safe hands. No business is obliged to tell me how to save money, true but my OP did question the ethics of this approach, "how are you, see the rugby last week, how's the kids, did you realise that by buying 6 months in one go you could save a tidy sum"

You do realise you can have adverse effects after 5/10/20 years of no issues. Who said anything about scanning a body? Pharmacists deal with pharmaceutical care. If you work in hospital, you have access to LFT'S, eGFR and CrCl which can help you tell if there are going to be a higher risk of adverse effects. Anyway, you have found out a way of saving money. Also, it's call the pharmaceutical journal.

El_Dangeroso

RobFowl wrote: »

90% in Ireland are computerised!

There are only 2 software systems approved and being sold ATM, Socrates has the drug interactions on it and you doe not need to update it as the providers do that automatically. So the point about GP's not checked it simply does not apply to those using that system at least.

Hate to nitpick but there are 5 systems approved by the GPIT group:

http://www.icgp.ie/go/in_the_practice/information_technology/software_companies

Though I'll completely agree that it's very rare to find a non-computerised practice and Socrates dominates the market.

somesoldiers

Deleted User wrote: »

You do realise you can have adverse effects after 5/10/20 years of no issues. Who said anything about scanning a body? Pharmacists deal with pharmaceutical care. If you work in hospital, you have access to LFT'S, eGFR and CrCl which can help you tell if there are going to be a higher risk of adverse effects. Anyway, you have found out a way of saving money. Also, it's call the pharmaceutical journal.

my prescription is for 6 months at which point it is reviewed by my doctor after I have undergone full blood tests and the results come back. Thanks for the acronym overload

RobFowl

El_Dangeroso wrote: »

Hate to nitpick but there are 5 systems approved by the GPIT group:

http://www.icgp.ie/go/in_the_practice/information_technology/software_companies

Though I'll completely agree that it's very rare to find a non-computerised practice and Socrates dominates the market.

I stand corrected !

Thought Helix and Socrates were the only ones actively being marketed, Health one was bought out I'm fairly sure.

L1011

Helix bought Health1 (but still market and maintain it). Medtech was mostly used by one group customer who have left it, Complete has ~20 surgeries. GPMac is still quite popular but very, very outdated and wouldn't sell much new if any. So realistically there's only two major suppliers with three major systems.

Health1 has automated drug updates (but its optional and an additional charge of about €850 a year). Other Helix systems don't have automated.

El_Dangeroso wrote: »

Socrates dominates the market.

They've about 30% of the market.

El_Dangeroso

MYOB wrote: »

They've about 30% of the market.

Interesting, how do you know that? I work in the west and it would definitely dominate here.

L1011

El_Dangeroso wrote: »

Interesting, how do you know that? I work in the west and it would definitely dominate here.

Market research done by past employers. They're from Sligo and definitely get more share in the northwest as a result.

monkey8

somesoldiers wrote: »

I save 5*€15 or €75, €150 p.a.

you should go to Tesco pharmacy if you are close to one.
dispensing fee is only €3.50 and your medication will be cheaper.

El_Dangeroso

MYOB wrote: »

Market research done by past employers. They're from Sligo and definitely get more share in the northwest as a result.

Actually this weirdly came up at a meeting I was at yesterday, Socrates have 60% of the market in Ireland.

L1011

El_Dangeroso wrote: »

Actually this weirdly came up at a meeting I was at yesterday, Socrates have 60% of the market in Ireland.

Can tell you outright that's numerically impossible - the number of surgeries in the country is not large enough for the customer numbers the other providers have to allow the remainder to be 60%. They are dominant in the West and also, oddly, Laois/Carlow and would also have a higher percentage of newer practices.

Were you by any chance given the figures for the % of electronic referrals via Healthlink? The most recent public set of those is fairly old; and in addition Socrates had the first implementation of that by quite some time and hence had a huge headstart (as well as having newer, fully-computerised practices in many cases). Some of the systems which are still in fairly common use in some regions - GPMac for instance - still don't support them at all. Socrates had about 60%+ in those figures - but they cannot be extrapolated to suggest market share.

El_Dangeroso

MYOB wrote: »

Can tell you outright that's numerically impossible - the number of surgeries in the country is not large enough for the customer numbers the other providers have to allow the remainder to be 60%. They are dominant in the West and also, oddly, Laois/Carlow and would also have a higher percentage of newer practices.

Were you by any chance given the figures for the % of electronic referrals via Healthlink? The most recent public set of those is fairly old; and in addition Socrates had the first implementation of that by quite some time and hence had a huge headstart (as well as having newer, fully-computerised practices in many cases). Some of the systems which are still in fairly common use in some regions - GPMac for instance - still don't support them at all. Socrates had about 60%+ in those figures - but they cannot be extrapolated to suggest market share.

Nope, got the info from the GPIT group in the Irish College of General Practitioners, who would know.

L1011

El_Dangeroso wrote: »

Nope, got the info from the GPIT group in the Irish College of General Practitioners, who would know.

Not necessarily - they don't have any reporting system for starters. There's not a chance they had more than 30% nationwide when I left that industry about 4 months ago.

El_Dangeroso

MYOB wrote: »

Not necessarily - they don't have any reporting system for starters. There's not a chance they had more than 30% nationwide when I left that industry about 4 months ago.

They have 600 practices in Ireland, how does that not mean they are market leader?

L1011

El_Dangeroso wrote: »

They have 600 practices in Ireland, how does that not mean they are market leader?

Not even close. Competition Authority estimate was at over 2000 practices in the country in 2008 and the number has only risen since then.

Bulk of the non-Socrates practices use one of the plethora of systems that Helix supports (Medbase/MedManager, GPClinical, Dynamic, HealthOne, HPM) with a respectable number on GPMac, and small amounts of other systems as well as still a fair number with nothing. 600 would be about a third of the computerised practices I'd guess.

There's a chance it's the most used individual system though - when the other main player still sells two and owns/supports too many to even list it causes serious fragmentation of their numbers.

El_Dangeroso

MYOB wrote: »

Not even close. Competition Authority estimate was at over 2000 practices in the country in 2008 and the number has only risen since then.

Bulk of the non-Socrates practices use one of the plethora of systems that Helix supports (Medbase/MedManager, GPClinical, Dynamic, HealthOne, HPM) with a respectable number on GPMac, and small amounts of other systems as well as still a fair number with nothing. 600 would be about a third of the computerised practices I'd guess.

There's a chance it's the most used individual system though - when the other main player still sells two and owns/supports too many to even list it causes serious fragmentation of their numbers.

Yeah, semantics are coming into play there, they are the leading individual system so.

L1011

El_Dangeroso wrote: »

Yeah, semantics are coming into play there, they are the leading individual system so.

Possibly, not guaranteed to be - Health One is still extremely popular (somehow :pac:). It used to have in excess of 600 practices, I've no idea how many remain.

St.Chivalry

Hi,

For example, you can purchase Chlorphenamine (Antihistamine) in pharmacies for around €6 (x30). They are on the shelf.
They also come in x500... which is much cheaper...

palmcut

St.Chivalry wrote: »

Hi,

For example, you can purchase Chlorphenamine (Antihistamine) in pharmacies for around €6 (x30). They are on the shelf.
They also come in x500... which is much cheaper...

There is no 500 pack of Chlorpheniramine available in Ireland.

locum-motion

St.Chivalry wrote: »

Hi,

For example, you can purchase Chlorphenamine (Antihistamine) in pharmacies for around €6 (x30). They are on the shelf.
They also come in x500... which is much cheaper...

(My emphasis)

palmcut wrote: »

There is no 500 pack of Chlorpheniramine available in Ireland.

As Palmcut points out, they don't, so I would suggest checking your facts before posting. They used to be available in a 500 pack, but the 500 pack (when it was available) was a bulk pack for the pharmacist to use when dispensing prescriptions for say 60 or 90 tablets at a time. It would never (or at least, should never) have been sold to a member of the public without being prescribed, and TBH even if a Dr did write a prescription for 500 tablets, I would have said No.
500 Chlorpheniramine tablets is just simply too large a quantity to be supplied safely, and no member of the public needs 500 tablets.

St.Chivalry

Yes, but Chlorphenamine are very effective as in, if someone has an allergic reaction and has serve swelling that can cause death in hours, Chlorphenamine instantly within 10+ minutes stops that, which is pretty god dam sweet.

locum-motion

St.Chivalry wrote: »

Yes, but Chlorphenamine are very effective as in, if someone has an allergic reaction and has serve swelling that can cause death in hours, Chlorphenamine instantly within 10+ minutes stops that, which is pretty god dam sweet.

Yes. ONE of them does that job very well.

But why the hell are you suggesting to other posters that they should procure 500 of them?

Vorsprung

St.Chivalry wrote: »

Yes, but Chlorphenamine are very effective as in, if someone has an allergic reaction and has serve swelling that can cause death in hours, Chlorphenamine instantly within 10+ minutes stops that, which is pretty god dam sweet.

A cochrane review a few years back suggested that antihistamines had no benefit in anaphylaxis, and that adrenaline was the only treatment.

L1011

locum-motion wrote: »

Yes. ONE of them does that job very well.

But why the hell are you suggesting to other posters that they should procure 500 of them?

There's an obsession with bulk buying and hoarding OTC medications in this country as far as I can tell - look at the sheer panic in threads on Bargain Alerts and Travel on the topic.

I really wouldn't want to trust tablet 500 out of a 500 pack that I'd bought myself however many years ago considering how long it would have had to degrade.

bleg

MYOB wrote: »

There's an obsession with bulk buying and hoarding OTC medications in this country as far as I can tell - look at the sheer panic in threads on Bargain Alerts and Travel on the topic.

I really wouldn't want to trust tablet 500 out of a 500 pack that I'd bought myself however many years ago considering how long it would have had to degrade.

I dunno, I'm a pharmacist working in a non patient facing role and if I'm in the states I'll pick up a tub of 500 ibuprofen 200mg for 16 dollars to bring back. The expiry is usually 2+ years. Between taking them myself or giving to family and friends they tend to get used!