Local Pharmacies withdrawing from HSE dispensing Schemes

tbh

I've written to the Irish Pharmacists Union to ask for clarification on their upcoming action starting Aug 1.

Hi xxx,

I'm writing to you as the moderator of the Long Term Illness forum on Boards.ie, Ireland most popular website.

It would be very helpful for us if you would be able to clarify what services are being withdrawn by pharmacies on August 1st. From what I can gather from your website, it would seem that medical card and community drug schemes are affected, but I'm not sure if the Long Term Illness scheme is affected as well, for things like Insulin.

As you can imagine, our posters are upset about this and some clarification, one way or the other, would be very much appreciated.

If you'd like to post directly on the forum, I'd be delighted to help you with that, but any information at all would be appreciated.

thanks,
xxx



I'll let you know as soon as I get an answer.

mike65

Was about the start a thread on this

I have a suspicion this threat will amount to a short-lived hill of beans (a fart?) and I'll be re-stocking before the deadline anyway. Someone on Liveline sounded in a tiz as she wondered about insulin, there followed a rather tedious argument between a pharmacist and AN Other (missed his ID) and I ended up tuning out.

CathyMoran

I am worried about it too, not just for my insulin but also my husband's crohns medication...it would helpful if we knew the situation.

Good idea tbh - thanks.

wicklowgal

Hi All, I'm not a member of the IPU but work in the pharmacy sector myself. Basically as of 6 this evening, over 1100 pharmacies all over the country have sent letters to the HSE saying that they wish to terminate their contracts with them as from the 1st of August 2009. This means that people will not be able to avail of any free prescription medication in any of these pharmacies from the 1st of August 2009, patients will have to pay for their meds in full. It is expected that the very most majority of pharmacies will pull out of their contract with the HSE, resulting basically in utter chaos.

This does not only apply to the LTI patients but all patients who avail of ANY community pharmacy schemes (GMS - medical card holders, DPS - Drugs Payment Scheme etc.)

As drastic as this all may sound, it is hoped that the HSE will seriously reconsider the cut backs they introduced as and from yesterday (1st July) which will basically kill many pharmacies and result in a huge amount of job losses all over the country within the pharmacy sector. Many pharmacies can simply not survive on such drastic cut backs.

I am speaking on this matter, not only from inside the pharmacy sector, but also as an LTI patient myself. It is hugely worrying for all involved.

I advise all concerned LTI patients to read up on the issue via the media and act! Act in whatever way you feel necessary.

ElBarco

The government may well be at fault - I don't want to debate the rights and wrongs of the whole situation.

But the pharmacists may all go and f*ck themselves if they think that taking this out on the patients is a good way to go. Seriously, the government may be proposing to reduce your income but everyones income is being reduced.

I will be going to stock up before the pharmacists imposed deadline. I'll also be giving the pharmacist my opinion and writing to my TD telling them that I wont be impressed if they back down to stupid bully boy tactics by the IPU.

Seriously, I don't want to be your football in this. Go and lobby the government if you feel you are being unfairly treated.

Is there any list of what pharmacists are or aren't involved? If there is I'll be ensuring my business goes to one who respects their customers.

wicklowgal

ElBarco wrote: »

The government may well be at fault - I don't want to debate the rights and wrongs of the whole situation.

But the pharmacists may all go and f*ck themselves if they think that taking this out on the patients is a good way to go. Seriously, the government may be proposing to reduce your income but everyones income is being reduced.

I will be going to stock up before the pharmacists imposed deadline. I'll also be giving the pharmacist my opinion and writing to my TD telling them that I wont be impressed if they back down to stupid bully boy tactics by the IPU.

Seriously, I don't want to be your football in this. Go and lobby the government if you feel you are being unfairly treated.

Is there any list of what pharmacists are or aren't involved? If there is I'll be ensuring my business goes to one who respects their customers.

Well whether or not your pharmacist will let you stock up or not is another story! I had thought the same myself but it's up to the individual pharmacist at this stage.

I had all my meds priced today and the amount it came to for 1 month - I wouldn't earn that much in the month!!

Hopefully it'll all be resolved before any real action has to be taken. I think the list of pharmacies involved or not, is private at the moment and only open to members of the IPU.

It's all very scary.

wicklowgal

Just found the link of the pharmacies that are intending to terminate their contracts with the HSE. These are the pharmacies that will NOT be providing LTI free of charge as and from the 1st of August 2009, this is unless things change between now and then.

http://www.ipu.ie/images/stories/pharmacies_who_have_given_notice_2_july_2009_-_6pm_2.pdf

CathyMoran

Thanks a millioin for that link - just found out that our local pharmacist is on the list

wicklowgal

Yeah unfortunately the majority of pharmacies will be on the list at some stage, if not now.

My advice; if this is to go ahead on August 1st, take your script out of your local pharmacy and find a pharmacy that will provide you with your meds FOC as we, LTI patients, are entitled to them!!

ElBarco

Thanks for that wicklowgal. My pharmacy is on the list too.

Time to select a different pharmacy methinks. I wouldn't want to be a burden on my current pharmacy by getting their payments reduced. Eliminated altogether will be much more straight forward for them.

ElBarco

tbh wrote: »

Just to say - I think that the fact that the IPU are willing to use patients as pawns in a game of brinkmanship is absolutely disgusting. I would urge anyone from the IPU who may be reading to contribute here, because I'll tell you this - as and from tomorrow, I'm never getting my scrip filled ANYWHERE but Boots (who are not on the list) - no matter what way this turns out. I feel like we have been stabbed in the back, and I won't forget this quickly.

Up to this I would have said we should do all we can to support locally owned businesses. After this they can shag off

Carsinian Thau

tbh wrote: »

Just to say - I think that the fact that the IPU are willing to use patients as pawns in a game of brinkmanship is absolutely disgusting. I would urge anyone from the IPU who may be reading to contribute here, because I'll tell you this - as and from tomorrow, I'm never getting my scrip filled ANYWHERE but Boots (who are not on the list) - no matter what way this turns out. I feel like we have been stabbed in the back, and I won't forget this quickly.

ElBarco wrote: »

Up to this I would have said we should do all we can to support locally owned businesses. After this they can shag off

I agree. And I think that every patient group should advise their patients to do the same. If not Boots, then at least some pharmacy that doesn't appear on that list.

This is an utter disgrace and I think they need to pay.

holly1

My daughters boyfriend drugs for a month come to 1000e he pays 100e,there is no way on this god foresaken planet he can fork out that much a month.

holly1

The four pharmacys in our town are on the list,where do you go!!!

Carsinian Thau

holly1 wrote: »

The four pharmacys in our town are on the list,where do you go!!!

Looks like you'll have to go out of town. I'm sorry.

These selfish pricks will get a fight though. What was between them and the government now involves the patients. And the pharmacists have thrown the first punch against the patients.

I think that they were foolish to threaten us.

The_Conductor

Our local pharmacy very helpfully the last time round said- 'Ah sure- you'll have no problem paying for them- then its just up to you to reclaim the money from the HSE at the end of every quarter........' Yeah, right...... Our joint net income is down 800 a month already this year- between the increases in PRSI, Pension Levy and abolition of mortgage interest relief. If our wonderful little pharmacist imagines we can magic up another 1500-1600 a month- she is seriously deluded.......

I can't find a pharmacy within 10 miles of here (and I'm in Dublin) thats not on the list. Perhaps if someone is kind enough- they might like to try to put together a list of pharmacies who are *not* taking part in the action.

Offhand- I think Boots are going to do a flying trade out of this.......

DrIndy

I think we need to watch the tone of this thread.

Remember that the fees to a pharmacy are not the salary of the pharmacist. There are significant overheads, staff, accountants, rent, electricity to consider too.

The increasingly desperate HSE are targetting front line services as they are the easiest ones to target rather than doing a root and branch review of the situation. Look at the behaviour towards doctors overtime - where doctors work MANDATORY overtime and get paid for this was spun instead as "greedy doctors". The Labour Relations Court has implemented EWTD as a settlement and now the chaos emerges that it is impossible to implement without reducing the health service to emergency only, cut all outpatient clinics and stop all elective surgery and procedures. It simply can't be implemented.

This unfortunately has become a critical effort of brinkmanship by the HSE. Pharmacy costs are high because wholesale supply prices are high. Do pharmacists make a profit as it is - yes. Should they reduce in line with the rest of the workforce - yes. Should they be singled out tyranically with swinging cuts of 33% - NO!

The original plan with doctors too was simply to refuse to pay any overtime past 60 hours - this would also result in the same level of cuts - if I am taking a pay cut, I should see my hours reduce too so that I can have some sort of semblance of contact with my friends and family.

This sucks for patients, really badly - but what other options are there to face down the government? They hold a monopoly on the service and abuse it. The only way forward is to use patients to pressure the government. If all the petrol companies got together into a cabal and decided to unilaterally hike the price of petrol by 33% "because of increased expenses" there would be riots on the street. However, the pharmacists are being spun as greedy buggers by the HSE so its ok.

There are always 2 sides to a story and the HSE is very good at spin and very bad at dealing with an issue in a co-ordinated or even fair way. They do not measure patient outcome as a marker for success and fund accordingly - its all about random bits of cash and administration. Throughout all of this - how many civil servants have been reorganised? How many supernumerary former health board employees have been redeployed or given early retirement? How many job duplication employees in DoH and HSE have been given new rolls or retired?

They are untouchable because no-one really knows what they do and so cannot really say they are not needed only that collectively, the productivity is low and cost is high. However, on the front line - slash and dash. Remember too that in the end, the only people who will be affected by a cut in frontline services will be you - the patient. The long term plan anyway in the HSE is to force everyone into privatised health care anyway.

BC

Thankfully neither of the chemists I go to in Dublin are on the list. I will check with them to be sure. I asked my consultant about it yesterday and he reckoned it will be called off. Fingers crossed. If they do then I like others will be switching to boots and never switching back.

I don't really care who's fault it is, the pharmacists have no right to play with peoples lives like this. Some people just will not be able to afford to buy insulin.

The_Conductor

I agree DrIndy-

Its just that patients are being held hostage by the Pharmacists in this regard.

I've had months where I've not gotten my medication- because I couldn't afford the DPS payment (not recently thankfully).

I don't see the issue with using generic drugs- and I do agree that the wholesale price of drugs is a major issue- but surely this should have been dealt with by the HSE and IPU without the brinkmanship where patients are being held hostage.

On the previous occasion- where the IPU pushed for the use of generics at all costs- and persuaded the HSE to remove a list of what were considered overpriced products from the DPS scheme (enteric coated prednisolone for example)- many patients with Crohn's Disease were actively advised by IPU members to travel to Belfast or to Britain to purchase supplies. Certainly many people could do just as well with generics as with the originals- but there are groups of people out there for whom the alternate is not appropriate. It took a fairly arduous letter writing campaign- along with a serious chat with the Minister in her constituency office to get some of the restricted medications reinstated. I don't have the time or energy to go down that road- and with a few very notable exceptions- I don't see patient advocate groups doing very much along these lines.

The HSE has a shocking amount of administrative staff- whose functions in many cases is purely as a result of red tape. There are even a significant number of nursing staff purely engaged on administrative duties- leaving actual patient interactions in many cases to contract nursing assistants. This is crazy.

I understand fully where you are coming from concerning overtime. It was appalling that Ireland and the UK were given an opt out from the Working Time Directive specifically for Junior Doctors. It really is ridiculous that the Irish Government actively encouraged the media to portray the junior doctors as greedy- I'm good friends with several docs- and my sis is a junior doc in the Mater- so I'm fully aware of the situation.

The HSE is looking for a sacrificial lamb- but the IPU are using patients as scape goats.

Its simply not the case that many people can afford to pay for their medications upfront and then reclaim the cost on a quarterly basis.

In my own case- I'm subject to the same levies as you are- which has reduced my net pay significantly- along with reduction in staff numbers, and abolition of mortgage interest relief. I am not dissimilar to many people using the DPS scheme. We are down EUR800 a month on our net disposable income (as a couple). Between us we get through over EUR900 worth of diabetic medication and almost EUR600 of Crohn's related medication on a monthly basis. We cannot afford to pay for this- we simply can't. The response from IPU members to patients is simply ridiculous.

Patients are being used as pawns- its as simple as that.

ElBarco

DrIndy wrote: »

This sucks for patients, really badly - but what other options are there to face down the government? They hold a monopoly on the service and abuse it. The only way forward is to use patients to pressure the government. .

I understand that the pharmacists may have a valid issue with the HSE. I don't think that it's fair to use patients to pressure the government. We are not there to be used as political pawns.

The only fair way forward is to engage with the HSE.

Carsinian Thau

DrIndy wrote: »

This sucks for patients, really badly - but what other options are there to face down the government? They hold a monopoly on the service and abuse it. The only way forward is to use patients to pressure the government. If all the petrol companies got together into a cabal and decided to unilaterally hike the price of petrol by 33% "because of increased expenses" there would be riots on the street. However, the pharmacists are being spun as greedy buggers by the HSE so its ok.

I still don't think it fair to use patients as pawns. But I can understand why they're doing it.

If everyone knows about the ridiculous state of affairs with regard to the number of HSE administrative staff, shouldn't it be possible to change it?

holly1

Im fully behind the the pharmacists even though it will make life very difficult for my family.

KiLLeR CoUCh

This is the first I've heard of this... And I only have about three or four days of my tablets left... What am I supposed to do? There's not I hope I could even pay for a handfull of tablets to keep me going for a couple of weeks.

The_Conductor

Don't worry- its not supposed to happen until the 1st of August.

wicklowgal

I KNOW the pharmacy I go to won't survive a 36% cut back. I spoke with my pharmacist and he's insisting that they are very open to negotiation with the HSE and were also open to accepting the 8% cut back (this % is in line with G.P's etc.) However, in case people have forgotten (or didn't know) Hickey's pharmacy won a court case against the HSE last year regarding breaking their contract (they tried to introduce heavy cutbacks on the pharmacies last year which the court ruled would be breaking their contracts with the pharmacies) and now the HSE have come down twice as heavy on the pharmacies this time round!

KiLLeR CoUCh

smccarrick wrote: »

Don't worry- its not supposed to happen until the 1st of August.

Ah, I'll relax in that case. Gives me enough to track down a new pharmacist =/

angeldelight

I understand patients' stress and worry about the situation but I would urge each of you to go and talk to your local pharmacist about the situation and why they are doing it.

Mary Harney has announced HUGE cuts to the sector - not only will pharmacists now be reimbursed less than the cost price of the medicines they are buying to provide to their patients, they will also have reductions in the mark up of the medicines. Also there are reductions in things like phased dispensing, Controlled Drug dispensing and a raft of other measures. It is simply not viable for pharmacists to continue to dispense medicines under these community drug schemes should these cuts be implemented. For many pharmacists it was a difficult decision not entered in to lightly as they have spent years building up a business and earning the trust and respect of their patients but what options do they have? Pharmacists can't be expected to trade at a loss, no more than any other service provider can. The IPU has made repeated attempts to engage the DoHC in discussion about ways to (a) save the country millions and (b) make greater use of pharmacists as is done in many other countries including our neighbours in the UK.

Pharmacists as a whole don't want to compromise patient safety but at the end of the day many of them have hundreds of thousands of loans, some into the millions due to the high capital required to start up a company. What other option do they have? Mary Harney will not negotiate. Not only that, pharmacists weren't even told about these cuts - the only way they know about them is from a press release issued by the DoH to the media. Pharmacists aren't doing this because they think "aha if I say I won't give this many patients their insulin she'll have to listen" - they're doing it because they simply cannot run their businesses should these cuts be implemented. Added to this is the fact that due to the new Pharmacy Act 2007 once a pharmacist declares themselves bankrupt they are removed from the register and therefore are never allowed to work as a pharmacist again.

I understand you are all worried about where to get your medicines but I implore you to read more about this issue, inform yourselves fully and then see whether your beef should really lie with your pharmacist or does the minister have some explaining to do.

I'd just like to say for completeness I am not a pharmacist who has resigned my contract - I'm a pre-registration pharmacist finishing up my intern year before going on the register, and the pharmacy where I am working will continue to dispense from August 1st much to my disgust as I believe pharmacists need to stand together to stop this one-sided bullying from the HSE.

angeldelight

smccarrick wrote: »

I agree DrIndy-

Its just that patients are being held hostage by the Pharmacists in this regard.

I don't see the issue with using generic drugs- and I do agree that the wholesale price of drugs is a major issue- but surely this should have been dealt with by the HSE and IPU without the brinkmanship where patients are being held hostage.

Patients are being used as pawns- its as simple as that.

What would you suggest pharmacists do instead?

No pharmacists see the issue with using generic drugs... the IPU has over and over again tried to convince the Minister of the potential savings to be made by both patients and the exchequer were generic substitution permitted but all she will say is that that is a matter for doctors.

The wholesale price of drugs is set by the manufacturers in part (ex-factory cost price is set by the manufacturer in line with the IPHA agreement signed in 2000) and the wholesalers - there is nothing, absolutely nothing the IPU can do about this. When Price Waterhouse Cooper were comissioned to do a study on the community pharmacy sector they said one of the most beneficial ways to save money would be by negotiation with the wholesalers and the HSE. However the wholesalers sought legal advice and the HSE cannot legally reduce the amounts paid to the wholesalers. Therefore the HSE went for the next step down in the ladder - the pharmacists.

Once again there is NOTHING the IPU can do to change wholesale prices - this is nothing to do with pharmacists and anger about this should be directed towards Uniphar/United Drug etc

I ask again... what should pharmacists do, given the position they are now in, if not resign from these loss-making schemes? And keep in mind that trading recklessly i.e. knowing you are trading at a loss, is in violation of company law.

Sloop John B

There is a 60% reduction mark-up on the LTI scheme. No adviser in the Dept of Health worth his salt would have allowed such a cut to go through without advising about its foolhardiness


Indeed patients are being used as pawns, but there are 2 people playing chess. Mary Harney and the pharmacists.


Mary Harney will not speak to us. She sends orders by diktat. Her message to pharmacists is simple - "Do you think you can beat me in a court case and get away with it."



Talk to your pharmacist. I'm busy tyring to organise for every patient to have supples to get them through to at least mid August. I'm more than willing to play my fair share in the current financial crises but these cuts appear designed to goad a response.

A reduction in drug cost of 10% would give over half the savings Mary Harney says she needs from pharmacists. I would be more than willing to fairly take on the other half.


There's 2 sides to this.

LegacyUser

Just to clarify a few issues for people on the current dispute:
- This issue started approx 2 years ago. For the 1st year, the HSE said that they could/would not sit with IPU due to EU law. They used this excuse for over a year until EU pointed out that they were incorrect. They have since then simply refused to sit with pharmacists. The gov will sit with the IRA but not pharmacist union.
- There was no discussion prior to these cuts. They were simply issued via press release. Not one meeting.
- Recent legislation required all health professionals to take 8% cut. The imposed cuts on pharmacists varies between 35-42%. This has been independently confirmed.

Under proposed fee regime, for any GMS patient (80% of customers), a pharamcist will get only betwen €3.50 and €4 for the entire transaction. Nothing more. Not one cent. For this they are expected to rent and fit out a shop, train and pay staff, stock the shop (apporx 200k worth - paid in advance of any sale), pay rates and insurance (plus the new annual gov set fee introduced last year of 2500 per shop every year), etc etc. A busy pharmacy may have 200 customers a day. That would require 5-6 staff and they are ow expecetd run on income of 800 euro to cover everything.

So in accordance with requirements, they have given the HSE a months notice. Under the requirements of business, you cannot as an owner trade recklessly so they cannot run revised HSE schemes that will bankrupt nearly 400+ shops with most others laying off staff and introducing major cut backs (no more free deliveries, less stock on shelves, no more MDS packing etc) to stay alive


It is very easy for people to attack pharmacists on this (and I can understand their upset re: a sensitive issue) but:
- HSE refuses to sit and discuss cuts proposed by IPU at all- not one meeting
- Introduces their own cuts via press release with new weeks notice

What would you have them do? Trade for a few weeks in august and go bankrupt. The hse have ignored them for 2 years. You think any other group in country wouldn't have to take this action of last resort.

PS
Just to clarify on the "eternal" issue of Irish drug prices vs spanish drug prices - Pharmacists have no involvement in setting prices. No 1% involvement. The HSE set them with the manufacturers.

Sorry for the length of the email but unless both sides of an argument are highlighted, you get slanted rants and not debate.

locum-motion

Hi, all. I'm new to boards.ie. I came over because I was pointed in the direction of this thread from another forum. I am a pharmacist. I do not own a pharmacy.

Can I just please point out that the issue of payments to pharmacies is much more complex than most people realise. It is a subject upon which I have written much on another site, askaboutmoney.com. I am not going to re-write it all here, but can I ask you to take a few minutes to have a look at people's questions over there, and at the answers that I and others have given. The link is:
http://www.askaboutmoney.com/showthread.php?t=115450

As regards the current dispute; no pharmacist wants to use any patient as a pawn in any fight. The fact of the matter is that under the Financial Emergency Measures in the Public Interest (FEMPI) Act, Section 9, the only options open to us are 1. accept the cuts or 2. give 30-days notice of resigning the contract. Any other action would be illegal. Given that the cuts are extremely unfair, totally disproportionate when compared to the cuts imposed on other sectors, and prejudicial to the survival of the profession, many of my colleagues have been left with no option but to resign from their contracts. If I had my own shop, I would have resigned too. This step was not taken lightly by any one of them. Each one of us hopes that the Minister will come to her senses and sit down with our Union to negotiate a solution.

Please, read the thread that I've posted the link to above. Talk to your pharmacist. Ask them to show you some figures; how much medicines cost to buy into the pharmacies, how much the remuneration used to be, how much it will be in the future. Given that this is the LTI thread, I would hazard a guess that many of you have good relationships with your pharmacist, built up over many years. Do you really think we want to piss you off? Or do anything that would harm you? Of course we don't. Minister Harney and the HSE have left us with no choice. Please give your pharmacist the chance to explain that to you.

smccarrick wrote: »

On the previous occasion- where the IPU pushed for the use of generics at all costs- and persuaded the HSE to remove a list of what were considered overpriced products from the DPS scheme (enteric coated prednisolone for example)- many patients with Crohn's Disease were actively advised by IPU members to travel to Belfast or to Britain to purchase supplies.

Dear smccarrick,

I'm afraid I have to take issue with the above statement; The IPU has never (nor would it ever) push for the removal of "overpriced" medicines from any of the community drug schemes.

Yes, the IPU's policy is to promote the use of generic equivalents when appropriate (Which, by the way, will save patients and taxpayers money, and a portion of those savings will come from pharmacists' pockets).

I think that what may have happened is that you misunderstood the situation that occurred some time ago when Deltacortril (enteric coated prednisolone) were temporarily unavailable.

Prednisolone is a great medicine; effective, widely used, cheap, and safe for nearly everybody. For those that do suffer from its side-effects, though, the side-effects are reduced by providing it in an Enteric Coated (Deltacortril) tablet. It's still as effective, but much more expensive (I don't have figures in front of me, but I think 5 or 10 times the cost). For those patients that don't suffer side-effects, it makes more sense overall to provide the cheaper product. However, for those that do suffer the side-effects, then it has to be the more expensive product. Pharmacists and the IPU are committed to providing the cheaper, generic option, but only when it's appropriate to do so. The efficacy and safety of the medicine must always be considered before the cost.

Unfortunately, a situation arose a couple of years ago when the manufacturers/distributors of Deltacortril were unable to supply any stock; there was some kind of persistent problem in the factory. Those patients for whom it was appropriate (mostly, ones that didn't have peptic ulcer disease) were switched to the uncoated, generic form instead. Many pharmacies procured stock of coated prednisolone from outside the state, maded by other manufacturers (not the Deltacortril manufacturers). These stocks would have been ULMs (or UnLicenced Medicines) and would mostly have been procured from a company called Medisource, which 'does exactly what it says on the tin', so to speak.

It is a simple fact of the pharmacy business that when we have to source a ULM, it works out much more expensive, often more than ten times more expensive. Unfortunately, what happened on this particular occasion was that the PCRS (the part of the HSE that calculates and processes our payments) decided that they would not foot the bill for the more expensive product.

This is the reason why, for a while, enteric coated prednisolone could not be obtained on the LTI, DPS, GMS etc. It was nothing to do with the IPU at all.

Thanks for reading.