Charges for medical card drugs.

ZYX

nesf wrote: »

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!

But prescription charges will not raise money now. It will take time to set up. It hasn't even been officially announced yet. Rate has not been set. Who will collect money. How will money be paid. Do pharmacists get payment for extra admin, what about people who refuse to pay. What about hospitals when patient gets a few days drugs on discharge. What about getting drugs in A&E. Who collects it there. If this is announced in budget it will take at least 2 months to get up & running (and that is being conservative) if the HSE works faster than it has ever done before.

After 3 months of it actually getting up and running it will have raised less than 1 million. That will be in 6 months time. So in 6 months we have 1 million or in 1 year we have 4 million a week or so (exact amount is difficult to quantify). Which is worth spending the most effort on. Mary Harney is talking about prescription charges she isn't even talking about the other way.

On the point that we need the money now not in 12 months well obviously we need it now and far more in 12 months.

Max Power1

Great idea tbh
The medical card system as a whole needs to be evaluated as it is costing the state waaaaay too much. This is a good start. Now lets have more stringent conditions imposed and lessen the numbers on medical cards and maybe substitute them with GP visit cards

nesf

ZYX wrote: »

But prescription charges will not raise money now. It will take time to set up. It hasn't even been officially announced yet. Rate has not been set. Who will collect money. How will money be paid. Do pharmacists get payment for extra admin, what about people who refuse to pay. What about hospitals when patient gets a few days drugs on discharge. What about getting drugs in A&E. Who collects it there. If this is announced in budget it will take at least 2 months to get up & running (and that is being conservative) if the HSE works faster than it has ever done before.

After 3 months of it actually getting up and running it will have raised less than 1 million. That will be in 6 months time. So in 6 months we have 1 million or in 1 year we have 4 million a week or so (exact amount is difficult to quantify). Which is worth spending the most effort on. Mary Harney is talking about prescription charges she isn't even talking about the other way.

On the point that we need the money now not in 12 months well obviously we need it now and far more in 12 months.

You're only assigning value in terms of levy collected not behaviour changed. We won't know how much this will save us until after a year or so of operation but it is almost guaranteed to save us more than just the levy collected.

Duiske

nesf wrote: »

Similar position here, except last 5 years with no end in sight. 50 euro a time for the GP too.

Thats a problem that affects a lot of people without medical card's. I'd have no problem with the charge being raised to 1.50, provided there were conditions attached.

A. Any increase in the charge in subsequent years is in line with inflation.

B. 50% of the charge is for the benefit of the exchequer (as is being proposed now), and the other 50% be ringfenced into a fund and used to reduce costs for those with long term illness and not entitled to medical cards.

C. It should be left to GP's to decide what drugs a patient requires, and in what frequency. Mary Harney should have no say in this.

There are other issues which need to be looked at as well, the use of generic drugs and GP visit charges being a couple of examples. Its going to be tough to create a system thats fair to everyone, but fairness is whats needed.

danman

ZYX wrote: »

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

I posted, badly admittedly, that their charge is the same as our drug payment scheme. No-one pays more than around £10 per perscription, whereas here it's 100euro.

I still cannot see any problem with paying 50cent for a perscription. If there is one person in this country that cannot afford 50cent out of 808euro per month, they may need some help with maths.

pow wow

heyjude wrote: »

In the UK, they have a prescription charge, but AFAIK its per prescription not per item, though it is much more than 50c.

In Northern Ireland the charge is £3 per item rather than per prescription. There are various exemptions to the charges as one of the other posters said. Those on a lot of medication also have the option of buying a 'prepayment certificate' for either £25 for 12 months or £9 for 4 months which effectively gives the holder unlimited prescription items for 'free'.

I think at face value the 50c charge is fair, granted if you think of the possibilities once some kind of charging system is in place then the propensity for increase after increase is immense, but on the face of it it would seem a low enough charge not to be of detriment to those with medical cards as the predicted income is based on volume.

Duiske

danman wrote: »

I still cannot see any problem with paying 50cent for a perscription. If there is one person in this country that cannot afford 50cent out of 808euro per month, they may need some help with maths.

Its not 50c per prescription thats being considered, its 50c per item on the prescription.

danman

Duiske wrote: »

B. 50% of the charge is for the benefit of the exchequer (as is being proposed now), and the other 50% be ringfenced into a fund and used to reduce costs for those with long term illness and not entitled to medical cards.

The long term illness scheme is something that should be looked at in the future, when the economy recovers.
There is a list of illnesses that is very small, I think there are only up to 10 illnesses on this list.

I've had my illness for over 20 years, it has no cure, just meds to try to slow down the symptoms. I have constant medication and various visits to the hospital and surgerys.

Yet, according to the Long term Illness scheme, my illness doesn't qualify as long term.

To be honest, I have been able to pay over the past few years, but now it's getting harder.

Like I've said on previous posts, I don't know why I have to suffer such financial hardships, when others can get their antibiotics, or whatever, for free.

In the past 12 months, I paid out over 2,500euro in prescriptions and hospital visits.

50cent isn't too much to pay to make a contribution to your healthcare, especially if the person isn't contributing anything else towards healthcare.

My illness

danman

Duiske wrote: »

Its not 50c per prescription thats being considered, its 50c per item on the prescription.

I still can't see how it can be regarded as a high charge. 10 items on a perscription wouold still only work out at 5euro, that still leaves 803euro left over.

10 Items would be a very unusual perscription. how many medical card holders would be in the group that needs 10 different meds per month?
Very few.

Taxipete29

danman wrote: »

I still can't see how it can be regarded as a high charge. 10 items on a perscription wouold still only work out at 5euro, that still leaves 803euro left over.

10 Items would be a very unusual perscription. how many medical card holders would be in the group that needs 10 different meds per month?
Very few.

17% I think is the figure. I would imagine that most of these would be pensioners. 10 items is not that unusual if you have a long term illness.

nesf

Taxipete29 wrote: »

17% I think is the figure. I would imagine that most of these would be pensioners. 10 items is not that unusual if you have a long term illness.

10 separate drugs not being unusual? I beg to differ to be honest with you. I'm on 14 pills a day for bipolar but this only translates into 4 separate items on my prescription! Many pills does not automatically equate many separate items on a script!

seclachi

I think its a more than fair price, especially considering how good we have it here with medical cards and the drugs payment scheme. I have a long term condition, its nothing massively serious, but it is a quality of life thing to have it treated with drugs.

I have looked up the drugs I am on and I have found that I would be paying roughly in the region of 600-800 euro a month in prescriptions. When I wasnt working I had a medical card for it, and now that I am working I qualify for the drug payments scheme. Im grateful I only have to pay the 100 euro, and Id pay more if needed. I really cant see how people could complain about such a small amount of money (The 50c levy), especially if it helps cut down on the waste of expensive drugs.

Maybe something excluding over 70s or somebody on a large number of items would be a good idea.

Taxipete29

nesf wrote: »

10 separate drugs not being unusual? I beg to differ to be honest with you. I'm on 14 pills a day for bipolar but this only translates into 4 separate items on my prescription! Many pills does not automatically equate many separate items on a script!

Well you can disagree all you want but 17% is hardly a rarity now is it??

From my own experience, Mam has 11 items to get. GFs mother is about the same if not more. My late father had about 8. These are just personal experiences but they certainly arent rare cases. They all have or had standard enough conditions.

rasper

personally I don't agree with anything to be given for "free" as it encourages waste and takes from people who really need it, a small donation is ok in my eyes especially considering the amount of people who can't afford the €50 to see the doctor

ZYX

nesf wrote: »

You're only assigning value in terms of levy collected not behaviour changed. We won't know how much this will save us until after a year or so of operation but it is almost guaranteed to save us more than just the levy collected.

Again I disagree with you that it is "almost guarenteed to save more than just the levy" Let me give you a few examples
1 I am a GP. If someone comes to me with say backpain. I examine them and decide they need 5 days painkillers. If they need painkillers beyond that they phone up fo a repest prescription. With a charge that patients will be less inclined to do that so GPs will end up giving much higher amounts of painkillers.
2 same with antibiotics. Most infections require 5 days antibiotics. Sometimes you are going to need 7. With a charge more and more patients will want the 7 days supply just in case. GP will get worn down and give in. If average antibiotic script changed from 5 to seven days the cost implications would be huge but also the risk of an increase in infections such as MRSA increases with indirect costs.
3. There are many combination medicines out there ie 2 medicines in 1 tablet. Generally speaking they are not a great idea. However when patients are charged per item they will want more combination items. A down side of them is if you want to stop one med you effectively have to stop both and start a new tablet with a single drug again with waste.
4 People may delay getting meds until say their dole or pension comes through. In most cases this doesn't matter but for someone on say warfarin. 2 days delay there could put their control totally off meaning they have to attend clinics more often and have more blood tests done. Again at a large cost. This is assuming they don't actually suffer a blood clot or bleed.
5. If one person delays treatment enough to cause hospitilisation for 1 night that would cost the equivalent of about 1,000 prescription charges
6 Unless A&E charges for scripts also it will lead to more attendance at A&E.
7 We have no idea of the costs involved in collecting the money.
8. HSE are assuming people are hoarding meds because they get them for free. In my experience this is not that big a problem. It happens a lot with inhalers as usually an inhaler lasts 50 days and scripts are given out monthly. To be honest that is the GPs fault and should always check to see if it is needed.

danman

Taxipete29 wrote: »

17% I think is the figure. I would imagine that most of these would be pensioners. 10 items is not that unusual if you have a long term illness.

I have a long term chronic illness.
Over the past 25 years, I've been on up to 30 meds per day. But that would break down to 5 items, immunosuppressants, anti-inflammatories, steroids and 2 different antibiotics.

Like I've said, I've ended up taking up to and over 30 per day.

10 separate items would be very unusual. Where did the figure of 17% come from, it seems extremely high if it relates to persons being on 10 different items of medication.

Even my 5 separate items would work out at 2.50euro, it's hardly a large amount out of 808euro.

aspasp1

I think this is a great idea without outting individuals under too much pressure, i have medical card. Last week hospital prescribed some difene for my wife and before i go to pharmacy i always check if i had them. and i do find more than half of the times the same medicine in my drawer. if they are not expired i will use them and never take another from pharmacy just because they are free, but i know my nutcase friend who wont bother and just keep collecting them cos they are free and obviously at the end he is not going to use and they will end up in the bin. So imo medical card holders must pay atleast some percentage of the medicines. A good move by charging 50 c imo.

Lemondrop kid

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.

All true

nesf wrote: »

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!

And therein lies the crux of the matter. This is a knee jerk simplistic soultion rather than a much needed genuine overhaul of the system of dispensing, generic drug use etc etc.

Didn't know this topic had been brought up before i started my thread, but good to see it being debated.:)

Lemondrop kid

ZYX wrote: »

Again I disagree with you that it is "almost guarenteed to save more than just the levy" Let me give you a few examples
1 I am a GP. If someone comes to me with say backpain. I examine them and decide they need 5 days painkillers. If they need painkillers beyond that they phone up fo a repest prescription. With a charge that patients will be less inclined to do that so GPs will end up giving much higher amounts of painkillers.
2 same with antibiotics. Most infections require 5 days antibiotics. Sometimes you are going to need 7. With a charge more and more patients will want the 7 days supply just in case. GP will get worn down and give in. If average antibiotic script changed from 5 to seven days the cost implications would be huge but also the risk of an increase in infections such as MRSA increases with indirect costs.
3. There are many combination medicines out there ie 2 medicines in 1 tablet. Generally speaking they are not a great idea. However when patients are charged per item they will want more combination items. A down side of them is if you want to stop one med you effectively have to stop both and start a new tablet with a single drug again with waste.
4 People may delay getting meds until say their dole or pension comes through. In most cases this doesn't matter but for someone on say warfarin. 2 days delay there could put their control totally off meaning they have to attend clinics more often and have more blood tests done. Again at a large cost. This is assuming they don't actually suffer a blood clot or bleed.
5. If one person delays treatment enough to cause hospitilisation for 1 night that would cost the equivalent of about 1,000 prescription charges
6 Unless A&E charges for scripts also it will lead to more attendance at A&E.
7 We have no idea of the costs involved in collecting the money.
8. HSE are assuming people are hoarding meds because they get them for free. In my experience this is not that big a problem. It happens a lot with inhalers as usually an inhaler lasts 50 days and scripts are given out monthly. To be honest that is the GPs fault and should always check to see if it is needed.

Stunning post. On the money! Esp the points i put in bold