Long term illness? Your pharmacy shouldn't be charging for prescriptions

Pumpkinseeds

I have Epilepsy and before having my medical card I had a long term illness book. I've been paying the prescription charges and until tonight I hadn't realised that I shouldn't be. According to the Citizens Advice website, under the new rules introduced in January of this year, patient with long term illnesses are exempt from the charges.

My pharmacist would have been aware of this and has still been charging me for it, I'm guessing it's a nationwide thing. The Citizens Advice website has the full list of long term illnesses that are exempt from the charges, it's well worth checking to see if you are exempt.

Penny Tration

Epileptics shouldn't be paying for medication anymore?? Must pass that onto my mam, as far as I know she paid full whack for hher medication just the other day. Thanks for this, op!

Pumpkinseeds

Pumpkinseeds wrote: »

I have Epilepsy and before having my medical card I had a long term illness book. I've been paying the prescription charges and until tonight I hadn't realised that I shouldn't be. According to the Citizens Advice website, under the new rules introduced in January of this year, patient with long term illnesses are exempt from the charges.

My pharmacist would have been aware of this and has still been charging me for it, I'm guessing it's a nationwide thing. The Citizens Advice website has the full list of long term illnesses that are exempt from the charges, it's well worth checking to see if you are exempt.

Exempt from a prescription fee. Only for medications relating to the illness ie carbamazepine for epilepsy, I believe.

Penny Tration

[Deleted User] wrote: »

Exempt from a prescription fee. Only for medications relating to the illness ie carbamazepine for epilepsy, I believe.

Does this mean you only pay a dispensing fee?

My mam is epileptic, and paid 146 for her medication (specifically epilepsy medication), or whatever the dps threshold is.

palmcut

For a long time the HSE had directed that those patients who had a medical card and a Long term illness (LTI) book had to use the medical card.
Mr Burke of the PCRS (a subsiduary of the HSE) had written to pharmacists advising that they would not be paid for LTI claims if the patient had a medical card.
In the Autumn of 2013 this decision was challenged and the ombudsman changed the earlier HSE directive. The ombudsman decided that patients could use both their LTI book and medical card.
The HSE have been very tardy in communicating this decision to anyone.
Pharmacists have now been told that dual registered patients have to re-activate their LTI book and submit a new prescription for HSE approval before the patient can again use their LTI book.
Patients who had been receiving weekly dispensing on their medical card cannot receive weekly dispensing on their LTI book. This particular decision by the HSE is being challenged and hopefully will change soon.
Another problem for some dual registered patients is that some of their medication will not be approved for their LTI illness and they will have to get the non-LTI approved medicines on their medical card.
If there is a way to make a mess of anything, you can trust the HSE to find that way.

echo beach

Pumpkinseeds wrote: »

My pharmacist would have been aware of this and has still been charging me for it.

Your pharmacist wasn't charging you, they were collecting the prescription levy on behalf of the government as they are required to do by law for all items written on a GMS prescription. Many anti-epileptic medicines are prescribed for other conditions such as nerve pain so your pharmacist may not even know that you have epilepsy. You have to apply for a Long Term Illness book, get approval for the medicines that they decide are due to your illness and have your GP write a prescription for those items in the book.
Then, and only then, can you get them without paying the levy.

The change to the rules has been mentioned on several threads in this forum and has been highlighted to members by the Diabetic Association, CF Society, etc. The HSE is keeping very quiet about it.

Pumpkinseeds

echo beach wrote: »

Your pharmacist wasn't charging you, they were collecting the prescription levy on behalf of the government as they are required to do by law for all items written on a GMS prescription. Many anti-epileptic medicines are prescribed for other conditions such as nerve pain so your pharmacist may not even know that you have epilepsy. You have to apply for a Long Term Illness book, get approval for the medicines that they decide are due to your illness and have your GP write a prescription for those items in the book.
Then, and only then, can you get them without paying the levy.

The change to the rules has been mentioned on several threads in this forum and has been highlighted to members by the Diabetic Association, CF Society, etc. The HSE is keeping very quiet about it.

I had been using a long term illness book for 2 anti convulsant medications and he was aware of that, as you said above my GP had written the prescription items into the book. It was a pharmacy I had used for a long time and would have checked with him in the past when prescribed medications for other illnesses, that the medications wouldn't cause problems with the epilepsy.

palmcut

Pumpkinseeds wrote: »

I had been using a long term illness book for 2 anti convulsant medications and he was aware of that, as you said above my GP had written the prescription items into the book. It was a pharmacy I had used for a long time and would have checked with him in the past when prescribed medications for other illnesses, that the medications wouldn't cause problems with the epilepsy.

You do have to reapply to the HSE with a new prescription to reactivate your LTI book. The HSE need to approve the medication before the pharmacy can dispense it on your LTI book. You need to get a new prescription every 6 months.
Some HSE areas will allow the approval for 2 years before you have to seek reapproval. However if you have been using your medical card for the past few years then you must get a new approval from the HSE before you can reuse your LTI book.
As already mentioned the HSE have been very tardy in explaining this to pharmacists.

mathepac

Great post thanks. My LTI medicines (diabetes) were transferred to a medical card and I've been paying the prescription levy on them since last year.*

Can this be reclaimed? It's not a huge amount of money I just hate the thoughts of that giant of inefficiency and ineffectiveness, the HSE, having even more money to waste.

EDIT: *should read 2012

Pumpkinseeds

mathepac wrote: »

Great post thanks. My LTI medicines (diabetes) were transferred to a medical card and I've been paying the prescription levy on them since last year.

Can this be reclaimed? It's not a huge amount of money I just hate the thoughts of that giant of inefficiency and ineffectiveness, the HSE, having even more money to waste.

I haven't heard much about it. I don't think anyone really knows what's going on. The government have been very tight lipped on it and I never saw anything in the media about a U turn on the charges in December. What I don't understand is why Pharmacists didn't know about it. Surely if medical card holders were exempt from charges on certain long term illness medications the pharmacists would have been notified, otherwise they would have been illegally charging people for medications?

echo beach

Pumpkinseeds wrote: »

I never saw anything in the media about a U turn on the charges in December.

Do you really expect the media to act in the interest of the public and not the government? You only hear what they want you to hear.

What I don't understand is why Pharmacists didn't know about it. Surely if medical card holders were exempt from charges on certain long term illness medications the pharmacists would have been notified, otherwise they would have been illegally charging people for medications?

If you go into a pharmacy with a medical card prescription the pharmacist is legally obliged to collect the levy and pass it on to the government. If you go in with an LTI book there is no levy to pay. The number in the book is the notification to the pharmacist not to collect the tax for the medicines listed.

mathepac

Pumpkinseeds wrote: »

... Surely if medical card holders were exempt from charges on certain long term illness medications the pharmacists would have been notified, otherwise they would have been illegally charging people for medications?

The issue for me is as a diabetic, I held a long-term illness book for years.

Two years ago I began treatment for two other conditions which were not covered on my LTI book and was assessed as qualifying for a medical card. At that time all my medicines were transferred to the medical card and I have been illegally charged prescription levies on my diabetes medication since, to the tune of 17.50 per month out of a total of 27.50 in levies.

echo beach wrote: »

... If you go into a pharmacy with a medical card prescription the pharmacist is legally obliged to collect the levy and pass it on to the government. If you go in with an LTI book there is no levy to pay. The number in the book is the notification to the pharmacist not to collect the tax for the medicines listed.

Ah yes the myth of the order-following, robotic pharmacist. When I filled my last 28-day prescription, that same pharmacist included a fresh application form for a long-term illness book with my medications!!! Go figure.

mathepac

Hot off the presses, an email response from a local TD, one of 5 whom I contacted, including the minister. This is the only response I received and its limited but definitive:

"I've been in contact today with the ministers office. I'm not certain form your email if you still have a LTI card. You can hold one and a medical card simultaneously. From my information gathering it is the case that medicines obtained under the LTI are exempt from prescription charges."

My response:

"Thanks for your response but you haven’t really addressed the issue.

I am now aware, since yesterday, that I can hold and use a LTI book and a medical card concurrently, but that opportunity was denied to me by the HSE locally when they issued me with a GMS medical card covering all my prescription needs two years or so ago.

I now pay 27.50 euro in prescription levies monthly for my meds, 17.50 euro of which is what I am being illegally charged for my diabetes medication. I know that in your constituency I am not alone.

I would appreciate a response from the Minister as to how this situation came about (who decided) and how and when the illegally gathered prescription levies will be refunded to me and others.

I was puzzled when my pharmacist included a photo-copied “Application Form: Scheme For Free Drugs And Appliances For Long Term Illness” in my bag of medicines last week. I didn’t query it at that time, but now I know why I got it."

TD's name with-held.

locum-motion

Let me spell out some facts to make them very clear, as some people seem to be under the impression that this is all the pharmacists' fault.

You have always been entitled to hold both an LTI book and a GMS Medical Card simultaneously as long as you met both sets of eligibility criteria.

Despite that, the HSE (or their predecessors) determined several years ago (I can't remember how many) that - for patients that held both - the GMS eligiblity was the one that pharmacists had to make use of for those meds that are covered under the GMS.

During those years, pharmacists were not permitted to make use of your LTI eligibility.

The exception to this was where a person needed a medication for the relevant condition (eg diabetes) that was not covered under the GMS, in which case the pharmacy could still provide those items, and only those items, under the LTI.

For patients that did not need such medicines, the HSE started cancelling their LTI cards*. Their argument was "Sure, he doesn't need it, he has a Medical Card." However, they should not have done so. A patient with an LTI card is entitled to it for life.

Now, none of this was a major problem for most people until the GMS Levy (or 'Mary Harney Tax') was introduced. Then, all of a sudden, patients who were by law entitled to free medicines were being charged for them. Naturally enough, this caused more than a few complaints.

What has happened recently is a reversal of the above-mentioned HSE policy. A patient with both eligibilities is now allowed make use of the LTI where previously they weren't. That's it. The HSE reversed their policy.

It is absolutely false to claim or imply that pharmacies were illegally charging you for your prescriptions. Far from pharmacies being the baddies here, the actual truth is that pharmacies are the heroes in this. Every since pharmacies were forced to become unpaid tax collectors by Minister Harney, pharmacists (in the form of the IPU) have been asking the question "What about people who have one of the LTI illnesses?" The answer consistently came back "No exceptions - Collect the tax from everyone."

Even in the last few weeks when the policy was changed, did you hear any HSE press release about it? No, you didn't. Pharmacists are the ones who have been telling their patients about it. Pharmacists are the ones who have downloaded and printed the application form to hand out to affected patients. Was it the HSE who were interviewed in local radio stations explaining the change? Was it f***! It was pharmacists. Those explaining matters in this thread are pharmacists (including me). Is it the HSE who has explained in this thread (see below) how to get a cancelled LTI card reactivated? No it's not. It's me.

So, please, a little bit less of the accusations of pharmacists illegally collecting money, and a little bit more thanks to the pharmacists who are trying to help you out.

*For people whose LTI card was cancelled, it is a relatively simple process to re-activate it. If you know your old LTI number (it should have 6 digits), you can check if it has been cancelled by typing it into this website. If the result that is returned by the website indicates a cancellation or expiry date, ring the local office of the HSE, ask for the person who deals with LTI registrations, and ask them to remove the cancellation date. If you don't actually have your LTI book, check if your pharmacy or your GP has it in their file, but if they don't have it either, then ask the same HSE person to send you a duplicate/replacement book. Once you have a current,valid number and a current, valid book, get your doctor to write your prescriptions for those meds that are for your LTI illness into the book, instead of on a GMS prescription form. Then, you will be able to get those medicines free of charge.

mathepac

locum-motion wrote: »

Mathepac,

Let me spell out some facts to make them very clear, as you seem (from my reading of your posts) to be under the impression that this is all the pharmacists' fault. ....

I am under no such impression, nor did I make any such implication. I have laid the blame squarely at the door of my local HSE (read my posts) and sought clarification from the minister and my local TDs, not the pharmacist.

Just read what I posted, which is crystal clear IMHO and try to avoid imagining what you think I might have meant.

Thanks.

locum-motion

mathepac wrote: »

I am under no such impression, nor did I make any such implication. I have laid the blame squarely at the door of my local HSE (read my posts) and sought clarification from the minister and my local TDs, not the pharmacist.

Just read what I posted, which is crystal clear IMHO and try to avoid imagining what you think I might have meant.

Thanks.

Sorry, if I misunderstood. I'll have another look at them.

EDIT: Looked back at your posts again. Apologies, I had read another thread elsewhere, and I was mixing up what you said with what I read there. I've edited my last post.

mathepac

locum-motion wrote: »

... Apologies, I had read another thread elsewhere, and I was mixing up what you said with what I read there...

Apology accepted thanks. Just to say again my pharmacist, with whom I have a 7-year working relationship, gave me the new LTI book application, not any of those cursed HSEs.

palmcut

I raised the matter of patient refunds with the HSE and was told to put my comments in writing. I also raised the matter with the DOH and was told the same. Their view is that the comment/complaint has to be in writing. I declined as I had already spent a considerable amount of time making verbal comments.

I also raised the matter of refunds with other health authorities and got nowhere. I was told that refunds were not part of Ombudsman's remit.(the HSE told me this)

My own view is that if a patient is seeking a refund that they should contact the Ombudsman as the HSE do not seem to listen to anyone else.

The Ombudsman got the HSE to change their original directive on foot of patient complaints.

mathepac

From the omdudsman's report :-

"Following the intervention of the Ombudsman the HSE agreed to:

• Award Ms Kelly’s son a LTI card,
• Refund Ms Kelly the cost of medications for her son in the period from when she first made an application under the LTI scheme to the time when her application was granted (approximately €3,000),
• Uniformly administer the LTI scheme nationally, thereby including ADHD as constituting a mental illness which, in the case of persons under 16 years, gives entitlement to a LTI card."

Link to the full report

The matter of refunds is resolved as far as I am concerned following the ombudsman's intervention - the HSE owes me for monies collected illegally.

This extract from an email received directly from the offices of Minister James Reilly last night :

"... You should apply again for the LTI book and seek reimbursement from the HSE. ..."

Extract from my response:

"... My application for a return of my LTI book, completed, signed and stamped by xxxx xxxxxxx, my GP, was handed into xxxxxxx HSE Offices this afternoon. Hopefully the very helpful staff there can issue the book before I have to pay out more money unnecessarily.

Is there a specific part of the HSE I can write to to look for a refund? The organisation is so vast that from the outside, it is impossible to know who to contact.

I appreciate your help, Have a good St Patrick’s week-end."

uli84

Wont be surprised if they introduce the levy on LTI soon enough to avoid all this drama

Pumpkinseeds

locum-motion wrote: »

Let me spell out some facts to make them very clear, as some people seem to be under the impression that this is all the pharmacists' fault.

You have always been entitled to hold both an LTI book and a GMS Medical Card simultaneously as long as you met both sets of eligibility criteria.

Despite that, the HSE (or their predecessors) determined several years ago (I can't remember how many) that - for patients that held both - the GMS eligiblity was the one that pharmacists had to make use of for those meds that are covered under the GMS.

During those years, pharmacists were not permitted to make use of your LTI eligibility.

The exception to this was where a person needed a medication for the relevant condition (eg diabetes) that was not covered under the GMS, in which case the pharmacy could still provide those items, and only those items, under the LTI.

For patients that did not need such medicines, the HSE started cancelling their LTI cards*. Their argument was "Sure, he doesn't need it, he has a Medical Card." However, they should not have done so. A patient with an LTI card is entitled to it for life.

Now, none of this was a major problem for most people until the GMS Levy (or 'Mary Harney Tax') was introduced. Then, all of a sudden, patients who were by law entitled to free medicines were being charged for them. Naturally enough, this caused more than a few complaints.

What has happened recently is a reversal of the above-mentioned HSE policy. A patient with both eligibilities is now allowed make use of the LTI where previously they weren't. That's it. The HSE reversed their policy.

It is absolutely false to claim or imply that pharmacies were illegally charging you for your prescriptions. Far from pharmacies being the baddies here, the actual truth is that pharmacies are the heroes in this. Every since pharmacies were forced to become unpaid tax collectors by Minister Harney, pharmacists (in the form of the IPU) have been asking the question "What about people who have one of the LTI illnesses?" The answer consistently came back "No exceptions - Collect the tax from everyone."

Even in the last few weeks when the policy was changed, did you hear any HSE press release about it? No, you didn't. Pharmacists are the ones who have been telling their patients about it. Pharmacists are the ones who have downloaded and printed the application form to hand out to affected patients. Was it the HSE who were interviewed in local radio stations explaining the change? Was it f***! It was pharmacists. Those explaining matters in this thread are pharmacists (including me). Is it the HSE who has explained in this thread (see below) how to get a cancelled LTI card reactivated? No it's not. It's me.

So, please, a little bit less of the accusations of pharmacists illegally collecting money, and a little bit more thanks to the pharmacists who are trying to help you out.

*For people whose LTI card was cancelled, it is a relatively simple process to re-activate it. If you know your old LTI number (it should have 6 digits), you can check if it has been cancelled by typing it into this website. If the result that is returned by the website indicates a cancellation or expiry date, ring the local office of the HSE, ask for the person who deals with LTI registrations, and ask them to remove the cancellation date. If you don't actually have your LTI book, check if your pharmacy or your GP has it in their file, but if they don't have it either, then ask the same HSE person to send you a duplicate/replacement book. Once you have a current,valid number and a current, valid book, get your doctor to write your prescriptions for those meds that are for your LTI illness into the book, instead of on a GMS prescription form. Then, you will be able to get those medicines free of charge.

You may be doing that for your customers, but I can assure you that you are in a minority. There are 3 pharmacies in my local shopping centre and none of them are notifying their customers, none of them. I will happily bring my long term illness book in next month for my next prescription.

In fact, I didn't know about the exemptions for lti illnesses when I had my last prescription filled and he brought it to my attention that the prescription he had just filled was the last one he had on file for me, just chancing his arm on making a few extra quid out of people.

I'll be switching pharmacies.

palmcut

In some health areas this decision imposed on the HSE by the ombudsman has not been conveyed in writing to pharmacists.

locum-motion

Pumpkinseeds wrote: »

... I didn't know about the exemptions for lti illnesses when I had my last prescription filled ...

What exemption? In the post you quoted, I just explained that there is no exemption from the GMS Levy for patients on the GMS scheme. The LTI scheme is an entirely different scheme from the GMS scheme.

Pumpkinseeds wrote: »

...and he brought it to my attention that the prescription he had just filled was the last one he had on file for me, just chancing his arm on making a few extra quid out of people.

I'll be switching pharmacies.

How is he chancing his arm on making a few extra quid?
You do realise that the €2.50 per item is a tax, right?
It doesn't go to the pharmacy. The Government subtracts it from the payment they make to the pharmacy.

As Palmcut has pointed out, though, the HSE has been very slow about publicising this change. It is possible that your pharmacist hasn't heard about it yet. But - believe me - he's not deliberately not informing you to try to get more money out of you.

d9oiu2wk07blr5

mathepac wrote: »

From the omdudsman's report :-

"Following the intervention of the Ombudsman the HSE agreed to:

• Award Ms Kelly’s son a LTI card,
• Refund Ms Kelly the cost of medications for her son in the period from when she first made an application under the LTI scheme to the time when her application was granted (approximately €3,000),
• Uniformly administer the LTI scheme nationally, thereby including ADHD as constituting a mental illness which, in the case of persons under 16 years, gives entitlement to a LTI card."

Link to the full report

The matter of refunds is resolved as far as I am concerned following the ombudsman's intervention - the HSE owes me for monies collected illegally.

This extract from an email received directly from the offices of Minister James Reilly last night :

"... You should apply again for the LTI book and seek reimbursement from the HSE. ..."

Extract from my response:

"... My application for a return of my LTI book, completed, signed and stamped by xxxx xxxxxxx, my GP, was handed into xxxxxxx HSE Offices this afternoon. Hopefully the very helpful staff there can issue the book before I have to pay out more money unnecessarily.

Is there a specific part of the HSE I can write to to look for a refund? The organisation is so vast that from the outside, it is impossible to know who to contact.

I appreciate your help, Have a good St Patrick’s week-end."

No need to wait....the address to write to is the Primary Care Reimbursement Service, Raven House, Finglas, D11....and the refund applies from the date that the levy was first introduced. Also, register the letter because incoming post and documentation has an terrible habit of disappearing in the HSE.

Isn't this something that Diabetes Ireland and the diabetic clinics should really be highlighting?