Is my pharmacy just being underhanded in med dispensing?

ottolwinner

Thinking this might be the right place for the post.
I collect medicines monthly for asthma. My script is for 30 tablets. Depending on whose working one pharmacist gives me an unopened box with 28 in it.
the other adds two in their foil to the box to make up the order to the script.
I’m being charged the same every time.
has anyone else noticed this in their medicines? Is it just the pharmacist being lazy or pulling a fast one to avoid broken packs of a product?
Wrecks my head because over time I need that medicine when I don’t need to order others and it ends up being a second visit in a month.

wandererz

What does the dispensing receipt say in terms of the quantity that was delivered? (the blue receipt)

I would say that you should request the full quantity.

Also, I have heard that there is a dispensing fee for each prescription, so if you order multiple months in one go then you are saving because you only pay one dispensing fee.

If there is a Discount Chemist Wharehouse close to you, then check the price with them. Their brochure says that they don't charge a dispensing fee.

In fact, check the prices with all the pharmacies in your area. You may be surprised.

I've only ever been on inhalers, what tablets are you on for asthma?

ottolwinner

I appear to be only able to purchase them monthly. It’s montleukast tablet. Used to be singulair

ottolwinner

docket says 30 but box is packed and sealed with 28

wandererz

Is the prescription that the doctor provided for multiple months or just one month at a time?

If it is for multiple months then call other pharmacies, ask do they do multiple months at once and what the price is for one, two and three months.

Reason is that you are going travelling.

If the docket says 30, then they should be dispensing 30. Or dispensing 28, charging you for 28 and adding the missed 2 to a future collection.

If you find another place close by that's cheaper then just have your prescription moved there.

airy fairy

I've lost a lot of respect for pharmacies when I've realised recently how much they charge and the clever way they dispense monthly.

They charge a dispensing fee for every item given out, I asked mine for their breakdown and they were upset by giving it, turns out they were adding anything from €5 to €7 per item, not a percentage.

I take a medication that cost me €54 per month. I called into a Warehouse Chemist recently and they can give it to me for €38. I went back to my local chemist and they said they could drop the price by €7 if I stick with them.

You really need to shop around and discuss your needs and question pricing.

L1011

https://www.boards.ie/discussion/comment/122635612#Comment_122635612

Fee per item is the default, there's very few places that don't charge it. Some charge a markup instead, which can make cheaper drugs even cheaper but makes dearer stuff dearer.

In the old days, it was often a 50% markup and a fee per item; there are still pharmacies that charge a markup and a fee.

That model dying off plus the state getting much better buying deals has slashed the price of the most common medicines and we're starting to be one of the cheaper places in Europe for medicines - although the countries most people compare us to for obvious reasons, UK because we have a border with them and Spain because so many people go on holiday there - continue to be exceptionally cheap.

daheff

next time you only get 28 tablets can you ask the pharmacist why?

paddy19

You are paying per tablet. So if you pay for 30 you should get 30.

As a reference it's always worth checking the price the pharmacy gets from the HSE for each drug on the PCRS web site.

https://www.sspcrs.ie/druglist/pub

The pharmacist also gets a max dispensing fee of €5 for each item, mostly it's €3.50 from the HSE.

Defo worth shopping around for multiple months supply. The independent pharmacies often offer a hefty discount, the big chains like Boots, Pure and Lloyds won't discount for volume.

ottolwinner

thanks to all replies. Yes I think I’m being taken for a few tablets each month. The labels say 30. As per script but the box only has 28. I’ll check it out with local pharmacies and the other recomendaciones here. Thank you.

GAAcailin

HI, I don't think the pharmacist is being underhand; a standard month in pharmacy terms is 28 days; if you avail of the drugs under the DPS scheme (where your drug bill is capped at 80€ per month for a household) you are entitled to a 13th month.

Most pharmacies charge a dispensing fee per item; so say the drug costs €28 per box and you pay €35; that would be €7 dispensing fee. If the pharmacist was to put 2 extra tablets in the bad they could charge you €2 extra.

My daughter uses Singluar and I priced it with Healthwave pharmacies its - significantly cheaper than the local pharmacy; Healthwave price = Montelukast 5mg (Singulair) €28 for 3 months supply and €46 for 6 months supply this is based on a 28 tablet pack.

I queried this with my local pharmacy and she mentioned that she thinks Healthwave will be bust within a year - suits her to say that though!!

Gremlinertia

I too wouldn't put it down to pharmacies as much as manufacturers making standard 28 day blister packs, I take a variety of meds and some are loose into bottles but the blister packs are often a weird number though thankfully two of my meds are packaged by multiples of seven

Former Former Former

Just ask the pharmacy to give you 30 every month. It’s probably just an oversight.

If the pharmacist who gives you the 28 is from abroad, that might explain it; in many European countries, they would be horrified at breaking open a sealed pack and shoving two extra tablets into it.

L1011

https://www.boards.ie/discussion/comment/122648777#Comment_122648777

They've managed to not go bust for quite some time… decade or so now?

There's plenty of other local pharmacies matching their pricing at this stage too - you are then incredibly dependent on volume to get distributor discounts to make it work though.

head82

My wife is an Asthmatic and prescribed a Ventolin inhaler monthly. Of late though, when collecting her prescription the Ventolin inhaler has been replaced with a generic version.. Salamol. She wasn't aware of this replacement when collecting her prescription and wasn't informed by the pharmacist at the time. Not until she arrived home did she discover the 'swap'. Didn't think too much of it as if it did the same job.. well, fair enough!

It turns out though, this generic is essentially.. CRAP! Whether it's the contents of the cylinder is different or the design of the dispenser is the fault I don't know. It just doesn't work for her.

She returned to the pharmacy only to be told medicines could not be exchanged once they've left the premises. A note was made on her file that in future her prescription was to include Ventolin ONLY.

Next prescription, same thing happened. This time, my wife checked the contents of the package before leaving the shop and after a bit of a conflab the Salamol was exchanged for the Ventolin. The Ventolin was obviously in stock but the pharmacist still tried to fob her off with the cheaper generic.

Now perhaps it's my bad mind but as my wife has a medical card and her prescription specifically states 'Ventolin', I'm of the opinion the pharmacist is trying to pass off the cheaper generic version yet claiming for the more expensive version from the HSE.

grinder23

https://www.boards.ie/discussion/comment/122648983#Comment_122648983

Same thing was happening to us from a couple of different places we check everytime now but they know now anyway and haven't had it happen in ages, can't use the salamol it's useless

Former Former Former

https://www.boards.ie/discussion/comment/122648983#Comment_122648983

Once again, people are assuming dishonesty and underhanded tactics when the explanation is a lot more innocent.

Ventolin and Salamol have been determined by the HPRA to be 'interchangeable', i.e. absolutely equivalent. Reference below:

Interchangeable List Salbutamol IC0078-138-053 100 mcg Pressurised Inhalation Suspension Products on List: 3 Date Last Updated: Thursday, March 7, 2024 (hpra.ie)

It does not matter that your wife's prescription says 'Ventolin', the pharmacist will only get reimbursed from the HSE for the cheaper version (Salamol) unless the GP has written "DO NOT SUBSTITUTE" in his own hand-writing on it.

The pharmacy did exactly what they should have done and by giving you the more expensive Ventolin, the pharmacy took a (small) hit to keep the customer happy.

GAAcailin

Aren't pharmacists supposed to 'offer' a generic substitute where available.

Generic drugs are tested to within 98% of 'sameness' with the licensed drug but there is bound to be differences around packaging, pill coatings etc.

My mother is convinced that Panadol tablets work better than generic Paracetamol… twice the price too

Pauliedragon

https://www.boards.ie/discussion/comment/122648809#Comment_122648809

This. For my prescription it's always 28 days. The odd pharmacist gave me extra from an opened box but the head pharacist saw that one day and said the boxes should never be opened.

*I'll caveat that by saying my medication is free so it doesn't affect me money wise.

Gremlinertia

Ive moved this to consumer issues as it's definitely more suited to the subject, local charter applies

Grem

head82

https://www.boards.ie/discussion/comment/122649078#Comment_122649078

What's the "small hit" the pharmacy took in dispensing the correct medication as prescribed? Despite what the HPRA state, if the generic is ineffective on a particular patient then there's no point in dispensing it.

And it's not about keeping the "customer happy", it's about keeping them alive!

Former Former Former

https://www.boards.ie/discussion/comment/122649161#Comment_122649161

Again, you've decided there's a rip-off happening without actually reading my post.

The poster's wife is on a medical card. That means she does not pay for the medicine, the pharmacy dispenses it and the HSE pays the pharmacy at the end of the month.

The HSE will ONLY pay for the generic version. If the pharmacy dispenses the branded version and gets paid for the generic version, they are losing out on the difference.

Now, salbutamol inhalers are cheap so the difference is not big in this single instance, but if every patient demands the branded version, then that starts to add up.

Lots of people think the generic version isn't as good as the brand name. I think a lot of people would be surprised quite how much of the 'good' stuff comes from the same pharma plants in India.

I am not a pharmacist by the way, I was a long time ago but I have zero skin in this game, clarifying that because I can guarantee your next contribution will be a dig at me for being a crooked pharmacy owner.

head82

https://www.boards.ie/discussion/comment/122649193#Comment_122649193

I would never assume a posters direct involvement in a particular topic of discussion but it helps that you have stated you had at least had some experience in this particular field.

I was unaware "the HSE will ONLY pay for the generic version". But that is ultimately an issue for the pharmacists to resolve with the HSE and is of no benefit to those patients who are dispensed ineffective generics.

"Lots of people think the generic version isn't as good as the brand name. I think a lot of people would be surprised quite how much of the 'good' stuff comes from the same pharma plants in India."

I reiterate, it doesn't matter what the HPRA state about generics, it's not simply a mindset of the patient wanting only the most expensive version. There most certainly can be varying degrees of effectiveness amongst generics.

Former Former Former

https://www.boards.ie/discussion/comment/122649387#Comment_122649387

I reiterate, it doesn't matter what the HPRA state about generics, it's not simply a mindset of the patient wanting only the most expensive version. 

It absolutely does matter, because that's the law that the pharmacists have to operate to.

Again, the pharmacy in question by the letter of the law should have told the patient to like it or lump it, they didn't, they helped the patient out and still got hammered for it.

These rules were brought in to try to get public spending on medicines under control, that doesn't work if everyone decides that they only want the most expensive option at taxpayer expense based on nothing other than urban myths and pharmacies and GPs are free to indulge them.

GAAcailin

https://www.boards.ie/discussion/comment/122649668#Comment_122649668

Do you know how this affects patients who get their drugs under the DPS scheme e.g. if drugs for my household cost €250 per month for the licensed version OR €180 per month for the generic; can I as a consumer demand the licensed version? I only have to pay €80 - I am only asking out of interest; have no issue with the pharmacist dispensing the generic where there is € saving

L1011

https://www.boards.ie/discussion/comment/122650061#Comment_122650061

The legislation implies that only the cheapest substitute is reimbursable, so you'd have to pay for the entire product outside the €80 limit.

Any doctor can put Do Not Substitute against an item if they feel they need to, and a pharmacist can also decide that a different brand than the cheapest is suitable

head82

https://www.boards.ie/discussion/comment/122649668#Comment_122649668

I'm not entirely sure what you mean by 'urban myths'. There's anecdotal and personal first hand experience of the failure of certain generics meeting the desired requirements. I appreciate the pharmacist should not be expected to "take a hit" on a transaction but if we include the dispensing fees charged by pharmacists, I suspect the difference is compensated for in the majority of transactions.

And the "like it or lump it" attitude is one I hope does not become a staple of medical care when it comes to dispensing medication to vulnerable patients in todays modern society.

10-10-20

https://www.boards.ie/discussion/comment/122648983#Comment_122648983

In my opinion two things should happen here: your wife should contact her Doctor and explain that she feels that Salamol isn't having the same medical effect as Ventolin. The Doctor should then review what has been dispensed then review the application/use of the product to make an assessment as to whether it's a defect with the product packaging or the product itself, and maybe talk with the pharmacist about potential contraindications (interactions) with other drugs which may alter the effectiveness of the medicine. Most likely the Doctor will then provide the "do not substitute" flag on the prescription.

Secondly, you can at your perogative open a quality defect complaint via the HPRA website, and let the HPRA deal with it from there. The one complaint probably won't change much, but at least if others report the instance then it may have a cumulative effect.

https://www.hpra.ie/homepage/about-us/report-an-issue/suspected-medicinal-product-defect

Others whom are closer to the professions may have other opinions on this, I'd love to hear them.

dowhatyoulove

I’m a tech in a pharmacy and I deal with the claims/reimbursement process.
Honestly the whole thing a pain in the arse - most meds come packed in a 28 box and on most prescriptions say 28 tablets. you can get a regular 30/31 day supply but then you aren’t entitled to a ‘free’ month under the community schemes. It’s confusing for patients- really should be simpler.

To go the post at top - you should be getting the correct amount of tablets be it either 28/30. If what’s in it doesn’t match the outside label then that’s an issue (in terms of accuracy).

On the issue of ventolin - our dispensing software automatically always comes up with the cheaper generic option and we manually have to override it - every single time. that’s prob the issue you’ve encountered.

GAAcailin

https://www.boards.ie/discussion/comment/122661451#Comment_122661451

thanks for the clarification; was with the GP yesterday and got a script. He did specify ‘30 xyz’; these drugs come in boxes of 28 so will see what the pharmacist gives me…

Big Bag of Chips

I've been an asthmatic my entire life. I have had to tell the pharmacy to only give me Ventolin too. Salbutamol/Salamol has no effect for me. The pharmacy's contract with the HSE is irrelevant to the consumer. The pharmacy isn't doing anyone a "favour" by dispensing the medication they need.

Paying for a useless inhaler every month would be a complete waste of my money. I just wouldn't buy it. An asthmatic needs an inhaler that works. I have used generic brands of other medicines before with no issues. But I need an inhaler that works. Salamol is not the same as Ventolin.

GerardKeating

https://www.boards.ie/discussion/comment/122635326#Comment_122635326

All depends on what they are charging you for. I find most months, mine give me 30 (or 60 if taken twice a day). Once or twice a year, I might only get 28 for 2/3 items.

Arbie

Salamol and Ventolin are the same drug (salbutamol) in different packaging.

Evidence of equivalence has been around for years, e.g. Chang, et al. Is Salamol less effective than Ventolin? A randomised, blinded, crossover study in New Zealand. N Z Med J. 2007 Dec 14;120(1267):U2874. PMID: 18157200.

The only actual difference between the products is that Ventolin is more expensive and has a higher carbon footprint.

Former Former Former

https://www.boards.ie/discussion/comment/122662098#Comment_122662098

The pharmacy's contract with the HSE is irrelevant to the consumer. The pharmacy isn't doing anyone a "favour" by dispensing the medication they need.

It is very, very relevant.

In the scenario presented, the customer was getting her prescription on a medical card. That means the patient does not pay a penny. In order to get paid itself, the pharmacy has to conform to its contract with the HSE. The pharmacy did do that customer a favour, but people still insist on hammering them for good customer service and keeping her happy?

Salamol being "useless" is all in your head. Sorry to be blunt but it is. But so long as it's your money you're spending, knock yourself out.

Ezeoul

This has been enlightening. I too am asthmatic and I had noticed that my 'blue' inhalers have not been as affective lately and I needed it more frequently. I've been receiving the generic version of ventolin for the last few months, but as I assumed it was exactly the same, I never thought to make anything of it. I will be requesting the non-generic version at my next renewal.

i have also had an issue with 28 day sealed packets being given for a month, leaving me with a shortfall before renewal is due. My GP surgery sends all my prescriptions directly to the pharmacy, so I never see the number of pills on the script, but I will double check with them that it is 30 a month (as I suspect it is).

Ezeoul

In the scenario presented, the customer was getting her prescription on a medical card. That means the patient does not pay a penny.

As an aside, this is incorrect, medical card patients (under age 70) are charged €1.50 per item dispensed and €1 per item if over 70.

Former Former Former

https://www.boards.ie/discussion/comment/122667892#Comment_122667892

yes, correct, thank you.

But the point is the same - it's a flat fee, so the difference between the cost of the Ventolin and Salamol still has to be swallowed by the pharmacy

Big Bag of Chips

https://www.boards.ie/discussion/comment/122667792#Comment_122667792

My point is what the pharmacy and the HSE have agreed is irrelevant to me, the customer.

I need a specific medication and I am entitled to get that specific medication from a pharmacy that stocks it. What goes on with the pharmacy before or after my transaction is irrelevant to me. I first used Salamol many many years ago. I was too young to know the difference between what I usually get and generic brands etc. Salamol did not work for me as well as Ventolin does. I didn't get the same relief. I had to use more of it and still didn't get proper relief.

So "sorry to be blunt" but I think I know my reaction to medication better than a randomer on the internet. As I stated above I use generic brands of a lot of other medication without any issue. I cannot use anything other than Ventolin.

Arbie

https://www.boards.ie/discussion/comment/122668062#Comment_122668062

It's the same drug in different packaging - what explains the difference you are describing?

It's like saying you feel less hydrated when you drink Lidl bottled water instead of Ballygowan.

Former Former Former

https://www.boards.ie/discussion/comment/122668062#Comment_122668062

OK, you can't use anything other than Ventolin, whether that's all in your head (it is) or not is irrelevant so long as the cost differential is coming out of your pocket. Knock yourself out, a fool and his money etc etc.

The original question was about a medical card holder and why she was getting Salamol even though the prescription said Ventolin, with the accusation that the pharmacy was pulling a fast one. In that case, what the HSE imposes on pharmacies isn't only relevant, it's absolutely critical and it completely explains what has happened.

I've explained that multiple times, if you deactivate Karen mode you might get it.

looksee

https://www.boards.ie/discussion/comment/122671145#Comment_122671145

That is not entirely true, some drugs can have a slightly different make up while still qualifying as the same, between brands. My neice had her thyroid prescription changed from one brand to another and it took months to establish why she was having a fairly severe reaction to her medication. I am prescribed paracetamol (among other things) I get one of several generics. There is one generic (made in Ireland) though that is larger than others and has no coating, and I choke on them. I have finally established with the pharmacy - who are helpful at all times - that I will not be dispensed this particular tablet.

The 30/28 day thing is very confusing in relation to the DPS, I have had to juggle the date of the prescription being dispensed in order to be sure I have a prescription dated each month as required by DPS, and not have a month with no prescription. It does seem to be a very clutzy arrangement if you are claiming for more than drugs, I think I have finally sussed it but its a bit confusing. I have no idea how they can make a 13 month thing work, they seem to have problems with 12 months.

10-10-20

Both products list the same in terms of the active ingredient and the propellant, except Salamol also contains ethanol as an excipient. Not specifically saying that the ethanol is a factor, but my comment earlier is that the mechanical method of creating the aerosol during administration is going to be different for each of the products and this should be reviewed with a doctor in case there is a mechanical defect with the administration device. On the HPRA site both products contain an instruction to clean the mouthpiece once a week, and that could be a significant factor if the device is failing to sufficiently atomise the dose, meaning it never reaches into the deeper sections of the lungs.

Salamol:

https://www.hpra.ie/img/uploaded/swedocuments/2169728.PPA1328_040_001.9a05b173-04e7-411f-9d76-9739b0b2f597.000001SALAMOL%20PIL.151125.pdf

Ventolin:

https://www.hpra.ie/img/uploaded/swedocuments/Licence_PA1077-049-010_27022024104344.pdf

(no medical advice being issued, these are the guidelines as provided)

GAAcailin

https://www.boards.ie/discussion/comment/122671231#Comment_122671231

Same applies to Warfin; few family members use it and there are a number of generics available but patients have to stick to one generic and cannot deviate. The way the body processes warfin varies and patients cannot chop and change between different generic brands

Former Former Former

https://www.boards.ie/discussion/comment/122671348#Comment_122671348

this is an excellent example of the other end of the spectrum.

Warfarin is what is called a “narrow therapeutic index drug” where minor differences can have a clinical impact. Thyroid medication (levothyroxine) is another.

For exactly that reason, it isn’t deemed “interchangeable” by HPRA so your pharmacy should always dispense the same brand as prescribed by the doctor.

Salbutamol is not one of these drugs and can be safely substituted.

GAAcailin

I got my meds in Healthwave in Dundrum this week; the Doctor had written 30 tabs (repeat by 6) but the fresh unopened boxes contain 28 tablets - therefore I have 12 less than what the Doctor prescribed for 2 different drugs

€59 for six months supply V €174 in local pharmacy; bit more of a pain going out there but I am not at the point where I want the Doctor to send the script directly to Healthwave; I get a hard copy of it.

Local pharmacy had been annoying me recently, few mistakes etc. Really is some difference in price

mk7r

https://www.boards.ie/discussion/comment/122668062#Comment_122668062

Technically the pharmacy doesn't have to dispense any medication to you at all, its not a right and they can refuse.

You are perfectly entitled to ask for the name brand medication but you have to pay for it out of pocket as the HSE will only pay for the generic if using a medical card. You are not being denied the brand name medication but the HSE doesn't offer/cover it.