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Prescriptions for Trade - dispensed Generic

  • 14-11-2009 6:08pm
    #1
    GER12
    Closed Accounts Posts: 145 ✭✭


    Does anybody know what the hard and fast rule is for reimbursing under GMS or the people in the HSE who one could contact to find out if for instance a patient has a script for a trade medication but is dispensed a generic medication? In other words, when pharmacists claim under the GMS or DPS - do they submit the scripts and secondly would the generic not need to be written and prescribed on the script in order that the pharmacist is not incorrectly reimbursed for the more expensive trade named medication?


Comments

  • #2
    locum-motion
    Registered Users, Registered Users 2 Posts: 5,143 ✭✭✭locum-motion


    Moved from 'Health Sciences Education' to Health Sciences'


  • #3
    locum-motion
    Registered Users, Registered Users 2 Posts: 5,143 ✭✭✭locum-motion


    See here ( http://www.boards.ie/vbulletin/showpost.php?p=61249034&postcount=70 ) for my previous post in another thread which explains the difference between what happens legally and what happens in practice, using Prozac (R) and its various generic equivalents as an example. Effectively, the pharmacy usually has an informal general permission from the local GPs to generically substitute where appropriate. Pharmacies don't ring the GP to get permission on every occasion, as this would (rightly!) pi55 the GPs off bigtime.

    While on the subject of generic substitution: there is no reason from a clinical perspective why a pharmacist shouldn't substitute a generic for a propriatary brand. S/he will only do it or offer to do it in a case where it is appropriate to do so. There are certain cases where it is inappropriate to do so, and (with respect to the prescribers on this site) the pharmacist knows which cases these are better than the presriber does.

    Regarding what the pharmacy is claiming payment for: the pharmacy's computer system generates the claim file for transmission to the Primary Care Reimbursement Service from the data held on the patients' records. Therefore, and continuing the fluoxetine example since you didn't specify a drug in your post, if the pharmacist's label says 'Prozit', then that's what is recorded in your file as having been dispensed, and therefore that's also what is on the pharmacist's claim file as transmitted to the PCRS.

    There isn't really any cause for you to be concerned or to suspect that there's any fiddling going on unless what's on the label and what's in the box don't match up. And even then, it may be a genuine error, in which case you should bring it to the pharmacist's attention.

    Do you mind if I ask have you a specific concern in this area, or is it just a general query?


  • #4
    GER12
    Closed Accounts Posts: 145 ✭✭GER12


    locum-motion wrote: »
    See here ( http://www.boards.ie/vbulletin/showpost.php?p=61249034&postcount=70 ) for my previous post in another thread which explains the difference between what happens legally and what happens in practice, using Prozac (R) and its various generic equivalents as an example. Effectively, the pharmacy usually has an informal general permission from the local GPs to generically substitute where appropriate. Pharmacies don't ring the GP to get permission on every occasion, as this would (rightly!) pi55 the GPs off bigtime.

    While on the subject of generic substitution: there is no reason from a clinical perspective why a pharmacist shouldn't substitute a generic for a propriatary brand. S/he will only do it or offer to do it in a case where it is appropriate to do so. There are certain cases where it is inappropriate to do so, and (with respect to the prescribers on this site) the pharmacist knows which cases these are better than the presriber does.

    Regarding what the pharmacy is claiming payment for: the pharmacy's computer system generates the claim file for transmission to the Primary Care Reimbursement Service from the data held on the patients' records. Therefore, and continuing the fluoxetine example since you didn't specify a drug in your post, if the pharmacist's label says 'Prozit', then that's what is recorded in your file as having been dispensed, and therefore that's also what is on the pharmacist's claim file as transmitted to the PCRS.

    There isn't really any cause for you to be concerned or to suspect that there's any fiddling going on unless what's on the label and what's in the box don't match up. And even then, it may be a genuine error, in which case you should bring it to the pharmacist's attention.

    Do you mind if I ask have you a specific concern in this area, or is it just a general query?

    Thanks so much - it was just a general enquiry on reimbursement to see what the procedure was for reimbursement and then copped that they have dispensing receipts with correct meds on it. From a policy perspective I was also interested in light of the recent industrial dispute involving the HSE regarding administering the GMS and DPS systems and the issue of reducing overheads by dispensing generics as opposed to the trade named med.

    However, the generic meds are in their right boxes but have trade labels which are crossed out with the correct Rx. I was prescribed stilnoct and it was substited for zolon - which funnily enough was better in affect but had one hell of a hang-over (without alcohol) the morning after. The other was movox instead of mobic. But no probs - all is sorted.... Thanks.


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