Charges for medical card drugs.

Duiske

I've just seen the following article on the RTE website regarding the charges for precriptions for those on medical cards. Link

The Minister for Health has said the Government is considering introducing a prescription charge for medical card holders.

Speaking on RTÉ's The Week in Politics, Mary Harney said that the charge could be 'something like' 50 cent per drug prescribed.

She said everything in the health service is being looked at ahead of the Budget and this is one of the options on the table.

The charge would raise money and also discourage the overuse of medication, the Minister said.

She said that one in six medical card holders are prescribed 10 or more drugs and that 'is not good for patient safety'.

Ms Harney also said that those lending money to the country at the moment will stop doing so unless tough decisions are taken in the Budget.

The two main Opposition parties have said they would be opposed to the possible introdution of a prescription charge for medical card holders in next month's Budget.

Now I fully realise the dire state of the public finances, and understand that every means of cutting costs should be looked at, but a couple of the reasons Mary Harney gives for introducing these charges just beggers belief.

1.The charge would raise money and also discourage the overuse of medication, the Minister said.

2. "one in six medical card holders are prescribed 10 or more drugs and that 'is not good for patient safety'."

Firstly, if she thinks that medication is being "overused", is this not an issue she should take up with the person who actually writes the prescription ? Does she think that doctors working under the medical card scheme actually don't know what they are doing, and are endangering patients by over prescribing drugs ?

Secondly, the point about 10 or more prescribed drugs being a risk to patient safety is just ludicrous, and again shows a lack of faith in those working in the medical profession.
My own dad (who is 83) is on 13 different drugs per day, of which 8 are making whatever time he has left more comfortable, and 5 are actually keeping him alive.
There no doubt in my mind that any doctor would not prescribe medication in that quantity unless he/she thought it absolutely vital.

Sorry for the rant guys, but this woman is really starting to sicken me. I have no problem per say with the charges but wish she would call it what it is, a cost cutting exercise, and not try to wrap it up as some kind of patient welfare program.

Victor

Duiske wrote: »

There no doubt in my mind that any doctor would prescribe medication in that quantity unless he/she thought it absolutely vital.

Don't you mean the other way around?

Wasn't there a doctor reprimanded last week for handing out drugs willy-nilly?

Duiske

Victor wrote: »

Don't you mean the other way around?

Wasn't there a doctor reprimanded last week for handing out drugs willy-nilly?

Didnt she do so under duress ? Irish Times

She accepted some of the prescriptions she issued were for large amounts and, while she gave some reducing dosages, there were others who would not accept this and she continued to prescribe what they were asking for as she was fearful. Dr Kulczyk said the people who came to her were very aggressive and she was assaulted three times, including once when a patient threatened to burn down her surgery.

“He said if don’t give him the prescription, he will fire up the surgery – I was even attacked physically.”

It was only after a visit from Det Sgt Jason Lynch of the Cork City Divisional Drugs Squad that she began to feel more secure as he told her the drugs could be sold on the streets.

He explained to her how to refuse drugs to patients coming to her for prescriptions.

gamblor1975

A small 50cent charge on prescriptions does not seem outragous considering the drugs themselves will be free of charge in most cases. I know of at least two people who still collect medicines that they no longer need just because they are free and they feel entitled to them.

I also believe that there should be a small (say 5 euro) charge to visit the GP for people on medical card which would have the same effect of disuading people who do not actually need to see the doctor but go anyway because its free and "sure I was passing by anyway". This would free up the doctors surgeries and also reduce the bill the state pays for unused drugs. Win/Win.

Seth Brundle

Victor wrote: »

Don't you mean the other way around?

Wasn't there a doctor reprimanded last week for handing out drugs willy-nilly?

One swallow doesn't make a summer!

danman

I pay the drugs payment scheme maximum, 100euro/month each month for a chronic illness. I've paid this for the past 11 years, granted it was less at the start.

That works out at 4.166% of my take home pay.

50cent is only 0.006% of the monthly take home benefit (808euro) of people on social welfare, therefor the people being asked to pay this.

People seem to want social equality, as long as it only swings one way.

irish_bob

gamblor1975 wrote: »

A small 50cent charge on prescriptions does not seem outragous considering the drugs themselves will be free of charge in most cases. I know of at least two people who still collect medicines that they no longer need just because they are free and they feel entitled to them.

I also believe that there should be a small (say 5 euro) charge to visit the GP for people on medical card which would have the same effect of disuading people who do not actually need to see the doctor but go anyway because its free and "sure I was passing by anyway". This would free up the doctors surgeries and also reduce the bill the state pays for unused drugs. Win/Win.

+1
thier is no doubt that those on medical cards tend to go to thier GP more often and anyone who has ever attended ER will know the kind of people who are always there in droves

Victor

irish_bob wrote: »

thier is no doubt that those on medical cards tend to go to thier GP more often

Perhaps because they need to?

and anyone who has ever attended ER will know the kind of people who are always there in droves

You get all sorts of whingers in every walk of life.

old boy

it is not the charge that rankles me, it the given reason, no wonder jesus wept,
if doctors are over prescribeing medication why not use the proper channels, why use a poxy excuse, how does she think this will end the so called over prescribeing if there is such a thing, doctors have taken an oath to save lives not to endanger life.

Duiske

danman wrote: »

I pay the drugs payment scheme maximum, 100euro/month each month for a chronic illness. I've paid this for the past 11 years, granted it was less at the start.

That works out at 4.166% of my take home pay.

50cent is only 0.006% of the monthly take home benefit (808euro) of people on social welfare, therefor the people being asked to pay this.

People seem to want social equality, as long as it only swings one way.

Thats a fair point and well made. But its not actually the 50c that concerns me. Its peanuts compared to the actual cost of the drugs, and should be higher.

Taking your case as an example of what could happen. The health dept are saying that they hope one of the outcomes of this is that doctors will prescribe less medication to medical card holders.
You say you have a chronic illness, and you are working, so its fair to assume that whatever medication your doctior is prescribing is working for you. What happens in your case if you happen to become unemployed and need to apply for a medical card ? Would you think its fair that your doctor chose the amount of drugs to give you, not based on your medical need, but on the basis of your financial situation ?
Thats the dilemma that the health dept are forcing on doctors. If the Government want to cut costs then thats fine, but they should not be interfering with the clinical decisions of arguably the most intensively trained professionals in the country.

astaines

There is a major prescribing problem in Ireland, we have the dearest drugs in Europe, and miserable rates of generic prescribing. Fixing this would require taking on FF's friends in the drug industry, and possibly my own profession too.

We know what these charges will do, as there's a lot of research on this very topic - 50c an item doesn't sound much, but it will hit the sick poor especially hard. Some of them will stop taking their meds, and some of those will end up in hospital or dead, as a result. It's still more reasonable, if you are an FF'er, than tackling powerful interest groups.

It's exactly the same with the banks. AIB has just told Brian Lenihan to run away and play, and he's doing as he's told, while they appoint one of their own to the top job. FF are incapable of standing up to the powerful, so the poor, the sick and the old get shafted.

Anthony

tippspur

50c next year 1euro the year after 2 euro the next year and it will just go up and up,that's what always happens.

lmimmfn

i think this is a great idea, should be a euro or 1.50 though.

sk1shot

I am on the medical card and would have no problem paying the medication fee if it saved the amount which is predicted. and I can't see anybody effectively commiting suicide over 50 cent.

keane2097

gamblor1975 wrote: »

A small 50cent charge on prescriptions does not seem outragous considering the drugs themselves will be free of charge in most cases. I know of at least two people who still collect medicines that they no longer need just because they are free and they feel entitled to them.

I also believe that there should be a small (say 5 euro) charge to visit the GP for people on medical card which would have the same effect of disuading people who do not actually need to see the doctor but go anyway because its free and "sure I was passing by anyway". This would free up the doctors surgeries and also reduce the bill the state pays for unused drugs. Win/Win.

+1

I really think these types of measures are an easy way to help - great ideas...

heyjude

Lets clarify one thing for starters, the purpose of this proposal has nothing to do with patient welfare and everything to do with raising money.

I think some posters should look carefully at what is being proposed, its not 50c per prescription, its 50c per drug prescribed(i.e. per item), that makes a huge difference for many people, as few older people would have a prescription with just one item on it. Just looking back over my late Dads' daily medication list from a few years ago, at one stage his monthly prescription consisted of 22 items, so under Mary Harneys' proposal that would have cost him €11 per prescription, as compared to just 50c if the charge was prescription. In the UK, they have a prescription charge, but AFAIK its per prescription not per item, though it is much more than 50c.

Don't have a medical card myself so won't affect me, but as others have said, it won't stay at 50c per item for long, if they manage to bring it in. I'd say within 5 years it will have risen to 1 or 2 Euro per item(if not more).

Will this charge also apply to drugs prescribed by hospital pharmacies to in-patients with medical cards too ?

MaceFace

Interesting - maybe make it €3 per prescription.

What annoyed me recently was when I went to the out of hours doctor and paid €70 to be told that I should not have come in and they should have told me that over the phone, there was a lady who came in with her child.
Now this lady had a medical card so paid nowt. However, when I looked at the kid - he was eating Hunky Dorys and wearning Nike runners.

My point is that if this person can afford to feed her kid 80c bags of crisps and wear top brand clothing, surely she could afford to feel some pain in the purse the same way I had to.

keane2097

The concerns about certain people with extensive prescriptions paying large amounts could easily be overcome by putting an upper limit on the charge, something in the region of e5 seems reasonable...

danman

heyjude wrote: »

Lets clarify one thing for starters, the purpose of this proposal has nothing to do with patient welfare and everything to do with raising money.

I think some posters should look carefully at what is being proposed, its not 50c per prescription, its 50c per drug prescribed(i.e. per item), that makes a huge difference for many people, as few older people would have a prescription with just one item on it. Just looking back over my late Dads' daily medication list from a few years ago, at one stage his monthly prescription consisted of 22 items, so under Mary Harneys' proposal that would have cost him €11 per prescription, as compared to just 50c if the charge was prescription......

11 euro per month is still only 1.361% of monthly income and that would be an extreme case, not the average for medical card holders.

The prescription charge in the UK applies to everyone, it's their equivalent to our drugs payment scheme upper limit.

RichieO

Yes, this has to be the best way to get the country back on it's feet... Let's get a bigger stick to beat the cr*p out of the less well off, after all, it's all it's their fault the country is in the state it's in, taking all the tax payers money in welfare payments...

Spare a thought for those who have to make these new cuts, it must be breaking their hearts, if they have one, knowing whatever cuts they make won't affect them in the slightest, as they laugh up their sleeves....

This has nothing to do with people, it's only about numbers...

nesf

danman wrote: »

I pay the drugs payment scheme maximum, 100euro/month each month for a chronic illness. I've paid this for the past 11 years, granted it was less at the start.

That works out at 4.166% of my take home pay.

50cent is only 0.006% of the monthly take home benefit (808euro) of people on social welfare, therefor the people being asked to pay this.

People seem to want social equality, as long as it only swings one way.

Similar position here, except last 5 years with no end in sight. 50 euro a time for the GP too. I'm finding it very hard to have sympathy for a nominal charge being introduced for either prescription meds or GP visits.

ZYX

danman wrote: »

The prescription charge in the UK applies to everyone, it's their equivalent to our drugs payment scheme upper limit.

The prescription charge in the UK does not apply to everyone. Mary Harney says it does but then it just shows how little she knows. Large numbers, do not pay prescription charges. Anyone over 60, under 18 in full time education, on social welfare and many other groups pay no prescription charges.

I think (although I am open to correction) there are no prescription charges at all in Scotland or Wales

ZYX

nesf wrote: »

Similar position here, except last 5 years with no end in sight. 50 euro a time for the GP too. I'm finding it very hard to have sympathy for a nominal charge being introduced for either prescription meds or GP visits.

The problem is it is pointless. It is typical Mary Harney. Why save a billion when she can do this and save a couple of million. A far more sensible way would be to only cover the generic price of the medication. If a person (Private or GMS) wanted a branded alternative they would have to pay the difference. Then the charge becomes optional and would save hundreds of millions a year.

nesf

ZYX wrote: »

I think (although I am open to correction) there are no prescription charges at all in Scotland or Wales

For Scotland anyway they plan on abolishing them but they haven't done it yet I think.

nesf

ZYX wrote: »

The problem is it is pointless. It is typical Mary Harney. Why save a billion when she can do this and save a couple of million. A far more sensible way would be to only cover the generic price of the medication. If a person (Private or GMS) wanted a branded alternative they would have to pay the difference. Then the charge becomes optional and would save hundreds of millions a year.

Um, because it's far simpler and cheaper to introduce a prescription charge than it is to change legislation to allow the substitution of generics? Allowing the substitution of generics would have to be full of exceptions (brand name if on script for mental illness, epilepsy etc) and this would require some kind of expert group of doctors and pharmacists assembled to agree on such exceptions.

It should be done but it won't be trivial to implement and it will cost money to assess such a change in system. Unless you believe that mental illness and epilepsy patients just to name two should be made pay for brand name drugs despite generic drugs not necessarily being a viable option for them.

ZYX

nesf wrote: »

Um, because it's far simpler and cheaper to introduce a prescription charge than it is to change legislation to allow the substitution of generics? Allowing the substitution of generics would have to be full of exceptions (brand name if on script for mental illness, epilepsy etc) and this would require some kind of expert group of doctors and pharmacists assembled to agree on such exceptions.

It should be done but it won't be trivial to implement and it will cost money to assess such a change in system. Unless you believe that mental illness and epilepsy patients just to name two should be made pay for brand name drugs despite generic drugs not necessarily being a viable option for them.

But it is already done in UK. Simply copying their system would not be that difficult. Pharmacies in UK certainly used to get paid in that way. There would only be about 20 or so exceptions which could easily be put in. The point is it would save hundreds of millions. Prescriptions charges only save a few million.

nesf

ZYX wrote: »

But it is already done in UK. Simply copying their system would not be that difficult. Pharmacies in UK certainly used to get paid in that way. There would only be about 20 or so exceptions which could easily be put in. The point is it would save hundreds of millions. Prescriptions charges only save a few million.

Honestly, do you think it's even a remotely a good idea for Politicians to simply copy what is done in another country with something as technical as generic vs brand name drugs on prescription? I mean the vast majority of them won't even grasp the reason for the exceptions and wouldn't notice if there was some flaw in this system that the British use.

As much as a farce as quangos can be, expert advice is very much needed on many topics like this one before any new policy is implemented.

ZYX

nesf wrote: »

Honestly, do you think it's even a remotely a good idea for Politicians to simply copy what is done in another country with something as technical as generic vs brand name drugs on prescription? I mean the vast majority of them won't even grasp the reason for the exceptions and wouldn't notice if there was some flaw in this system that the British use.

As much as a farce as quangos can be, expert advice is very much needed on many topics like this one before any new policy is implemented.

Well of course politicians wouldn't do it. The colleges eg College of Medicine, Surgery, General Practice etc would do it. They already exist. Work would be overseen by Irish Medicines Board which again already exists. No need for any new quangos. The only difficult part would be negotiating with Irish Pharmacy union or with individual pharmacies about how money is collected, recorded, rules for non-payment etc. All could easily be done in 12 months and would save more in its first week than this system will save in the intervening year.

Taxipete29

50c per item is not alot. It seems reasonable. However as mentioned above, what happens next year, €1 or € 1.50??. Thats when the problems start.

ZYX

How about another way to save far more money. At the moment hospitals have budgets for drugs. They strike deals with drug companies to get expensive drugs very cheaply. So they prescribe these very expensive drugs (because to hospital they are cheap). Patient then leaves hospital and now GMS or private patient has to pay the very expensive price.

Tomorrow Mary Harney could ban hospitals makind deals that were not available to general population and save the country millions. Again far more than this prescription charge would raise

nesf

ZYX wrote: »

All could easily be done in 12 months and would save more in its first week than this system will save in the intervening year.

Exactly! We need money now not in 12 months. We should initiate a system to bring in generics but it's not a short term measure to raise revenue and right now we need such measures as well as looking to medium term measures. Just because we should introduce generics doesn't mean we shouldn't introduce a prescription charge!