MASSIVE difference in cost of exact same prescription between pharmacies!!!

fisher8181

P. Breathnach wrote: »

I have a vague recollection of reading somewhere that where a prescription covers a number of drugs, it works a bit differently - perhaps something like Boots charging the dispensing fee for each separate drug, whereas the traditional pharmacy charges only one dispensing fee. If that's the case, it becomes something of a "swings and roundabouts" situation.

Can anybody elucidate? Is my vague recollection correct?

yes, boots are not all they are cracked up to be!

Example:
I was getting 6 months supply of eltroxin 100mcg from them.
One box was costing me €7.64
Six months at one time was costing me €45.84

Went to Tesco pharmacy last month.
One month was €5.47 and 6 months was €15.31!!!

So Tesco charges only one dispensing fee as they only dispensed it once whereas boots charges 6 dispensing fees for 6 months supply dispite only dispensing it once!!!
Absolute rip-off!!

P. Breathnach

fisher8181 wrote: »

yes, boots are not all they are cracked up to be!

Example:
I was getting 6 months supply of eltroxin 100mcg from them.
One box was costing me €7.64
Six months at one time was costing me €45.84

Went to Tesco pharmacy last month.
One month was €5.47 and 6 months was €15.31!!!

So Tesco charges only one dispensing fee as they only dispensed it once whereas boots charges 6 dispensing fees for 6 months supply dispite only dispensing it once!!!
Absolute rip-off!!

Thanks for the response.

I'm also interested in what happens if a person has a prescription for, say, 5 different medications.

Kurtosis

P. Breathnach wrote: »

Thanks for the response.

I'm also interested in what happens if a person has a prescription for, say, 5 different medications.

As far as I'm aware, all pharmacies generally apply a fee to each item on a prescription. An exception may be where two strengths of a medicine are required e.g. Eltroxin, if someone takes 50 strength every day but takes an extra 25 two days a week, a fee may not apply to the few 25 strength tablets.

Jane5

http://www.irishtimes.com/news/health/drugs-charges-a-bitter-pill-to-swallow-for-southern-patients-1.1352841/drugs-charges-a-bitter-pill-to-swallow-for-southern-patients-1.1352841

The above article is well timed-a relative of ours is now picking him up a couple of months worth of his meds in Spain for a fraction of the cost of one month here. All they needed was a copy of the prescription and the doctor's medical council reg number. In future we will likely do this or else travel North. I don't like not giving Ireland the business, but it's just not affordable here.

nino1

Jane5 wrote: »

In future we will likely do this or else travel North. I don't like not giving Ireland the business, but it's just not affordable here.

you'd be better off going to boots or tesco than travelling north.
You only get it on the nhs if you are resident there. You will be charged a private script rate which will likely be no cheaper + cost of fuel!

rubadub

Jane5 wrote: »

Additionally, not everyone can read a doctors script accurately, I can, but due to the annotation on scripts, many people start describing them and the pharmacist says "I'd have to see that myself". I've heard them say that.

You could scan it in and email them. But this will of course cause delays, and you are not going to hold off buying stuff you need right away.

It would be great if one pharmacy came out with a price match guarantee like "if you see this cheaper elsewhere we double the difference" type scheme that other shops do. So you could confidently buy from them & email your script around to double check.

Jane5

nino1 wrote: »

you'd be better off going to boots or tesco than travelling north.
You only get it on the nhs if you are resident there. You will be charged a private script rate which will likely be no cheaper + cost of fuel!

That's not actually true, if you read the linked article. I'm not saying you would get it on the NHS, but what I am saying is that the private script rate is HUGELY cheaper than here. The mark-up here is actually that big.

If you do read the linked article, you can buy several months worth of your script up North if you arrange it with the pharmacist in advance and bring all relevant documentation with you, and the savings are considerable. We are only a couple hours away from the border as we're in Dublin. If we were to fill six months worth up there, even with fuel, we'd save a fortune.

nino1

Jane5 wrote: »

That's not actually true, if you read the linked article. I'm not saying you would get it on the NHS, but what I am saying is that the private script rate is HUGELY cheaper than here. The mark-up here is actually that big.

Don't believe everything you read in the papers Jane. Two weeks ago the papers reported on a survey by the NCA where they quoted prices of drugs and they quoted pharmacist selling drugs at what turned out to be less than the cost price. The NCA admitted they made a mistake but the papers still published the story.

Besides, where does it quote the mark up in the north?
It also says that the northern pharmacist will not dispense a generic if a brand is written. Southern chemists do.
They don't have a mark up of less than 20% like Tesco do or for the very expensive drugs boots will charge you €107 for a cost price of €100 which is a 7% markup!
Do the northern chemists charge less than 7% for drugs of this price?
You can also buy 6 months supply down south which will save you more money too (except in boots)

Northern chemists DO result in savings compared to independent pharmacies here but I suppose you should never let the full facts get in the way of a good story!

rubadub

Jane5 wrote: »

The mark-up here is actually that big.

This markup might be the manufacturers markup rather than the pharmacy.

They published known wholesale prices on other items before, e.g. pampers, and the NI wholesale price was a fraction of the what retailers here pay.

I expect the same could well go on for drugs.

I know you have to pay more regardless, but might be shooting the messenger (the pharmacist).

talla

I work for a company that produces software for pharmacies. There are a couple of misconceptions in this thread. The pricing algorithms on private scripts and DPS scripts are extremely complicated.

Currently there is no generic or reference pricing is Ireland for pharmacies. The legislation to introduce this will be implemented in the coming months. It will also take a number of years post introduction for prices to filter into the real world. The IMB and HSE will focus on the drugs that currently the state pays the most for e.g. atorvastatin. While prices should come down for these drugs, if patients reject generic substitutions it will actually become more expensive.

All pharmacies in Ireland charge a dispensing fee per item, not per script.
All pharmacies in Ireland have a right to charge what they want for a private prescription or DPS prescription. A prescription dispensed under the DPS scheme is treated as private script until the family threshold has been exceeded (currently €144).

Boots have the following pricing scheme per item on a prescription for DPS and Private scripts:
Trade Price of drug + Flat Dispensing fee + 0% Markup

Tesco have the following per item on a script:
Trade Price of Drug + dispensing fee + 20% Markup

Independents / Irish owned Pharmacy Chains typically charge per item:
Trade price of drug + dispensing fee + 50%.
Some of the independents / Irish chains will configure certain certain drugs to have a smaller markup and / or smaller dispensing fee.

With regards to reimbursement by the state to pharmacies, it gets extremely complicated.
The general payment rule the state uses for DPS is:
Reimbursement Price + dispensing fee + 20% markup on the total drug spend for a family within a calendar month that exceed the Family limit.

The Reimbursement price is typically the trade price less 8%.
Dispensing Fee ranges from €3.50 to €5.00 depending on how may items the pharmacy has dispensed in a month(first 1667 items are paid at a €5 fee, next €887 items paid at €4.50 with all other items paid at €3.50 dispensing fee).

Depending on the pricing used in a pharmacy, there are scenarios where once a family exceed the monthly limit does not necessarily mean the state pays anything for a drug e.g.
If a pharmacy is charging 50% markup for a drug on a DPS script, prescriptions fall into what has been termed a grey area.
Lets say a drug has a trade price of €100, 50% markup adds another €50 with a €5.00 dispensing fee so the total private cost of the prescription is €155.
If the patient was signed up the DPS scheme, they would pay €144.
However the government does not pay the pharmacy the difference. The government prices the same item as
€92(trade price less 8%) + €18.40( 20% Markup) + €5.00 = €115.4

As the patient has already paid €144 to the pharmacy, the pharmacy gets no payment from the government.

talla

One final point, you might wonder why pharmacies are paying more for a drug than what the state will reimburse them?

They don't. The pharmacy do not pay the listed trade price. Pharmacies have deals where they get a general discount off a supplier, get additional discounts for ordering specific drugs, get bonus stock for ordering in certain multiples etc.
I have seen scenarios where pharmacies are getting a 90% discount of the trade price price of a drug.

MBSnr

talla wrote: »

.
.
Lets say a drug has a trade price of €100, 50% markup adds another €50 with a €5.00 dispensing fee so the total private cost of the prescription is €155.
If the patient was signed up the DPS scheme, they would pay €144.
However the government does not pay the pharmacy the difference. The government prices the same item as
€92(trade price less 8%) + €18.40( 20% Markup) + €5.00 = €115.4

As the patient has already paid €144 to the pharmacy, the pharmacy gets no payment from the government.

Thanks for this. It explains what I suspected and mentioned in an earlier post. The pharmacy will not dispense 2x the item in one month (even though the prescription has it listed), as it would be above the €144 limit and they'd lose out on their lovely 50% markup from me that goes in their pocket!.... Unreal.

nino1

MBSnr wrote: »

Thanks for this. It explains what I suspected and mentioned in an earlier post. The pharmacy will not dispense 2x the item in one month (even though the prescription has it listed), as it would be above the €144 limit and they'd lose out on their lovely 50% markup from me that goes in their pocket!.... Unreal.

How does that explain what you suspected?
The pharmacy will not dispense 2x the item because the HSE will only pay them for one months supply.
If that was the case sure why not get 6 months supply for €144?!!

MBSnr

nino1 wrote: »

How does that explain what you suspected?
The pharmacy will not dispense 2x the item because the HSE will only pay them for one months supply.
If that was the case sure why not get 6 months supply for €144?!!

OK this is the way I figure it.

1. I think you're missing out the fact that there is more than one item. The drug in my case is €85 to buy.

This is my maths. I know the trade price of the drug is €50.

50-8% (46) + 20% (9.20) + Dispensing fee (5) = €60.20 is the price they'd get from the Gov.

€85 is what they get from me.

You see I cannot pay €144 for two otherwise the pharmacy loses out....
I'd assume they'd get €85 for the 1st item and €60.20 for the 2nd if it was on the DPS. They'd prefer the nice €24.80 extra for no hassle.... see you next month sir.

2. The prescription wasn't for 6 months so how can they dispense that?

nino1

MBSnr wrote: »

OK this is the way I figure it.

1. I think you're missing out the fact that there is more than one item. The drug in my case is €85 to buy.

This is my maths. I know the trade price of the drug is €50.

50-8% (46) + 20% (9.20) + Dispensing fee (5) = €60.20 is the price they'd get from the Gov.

€85 is what they get from me.

You see I cannot pay €144 for two otherwise the pharmacy loses out....
I'd assume they'd get €85 for the 1st item and €60.20 for the 2nd if it was on the DPS. They'd prefer the nice €24.80 extra for no hassle.... see you next month sir.

2. The prescription wasn't for 6 months so how can they dispense that?

That's not how it works!!
First of all the government only pays for the amount over ITS CALCULATION of a €144 monthly script so your figures are all wrong.
Secondly the doctor can prescribe you 3 or 4 lots for one month but the HSE will only pay the pharmacy for one and that's why you only get one for €144. You can get another as prescribed if you like but you will have to pay on top of the €144. You are asking the pharmacist to give you one for free where he will recieve no payment from you or the HSE.
Thirdly, why do you think the cost price is €50? That's highly unlikely if they are charging you €85 and if it is the case then you should find another pharmacy that charges less than the 60% mark up you claim!

MBSnr

nino1 wrote: »

That's not how it works!!
First of all the government only pays for the amount over ITS CALCULATION of a €144 monthly script so your figures are all wrong.
Secondly the doctor can prescribe you 3 or 4 lots for one month but the HSE will only pay the pharmacy for one and that's why you only get one for €144. You can get another as prescribed if you like but you will have to pay on top of the €144. You are asking the pharmacist to give you one for free where he will recieve no payment from you or the HSE.
Thirdly, why do you think the cost price is €50? That's highly unlikely if they are charging you €85 and if it is the case then you should find another pharmacy that charges less than the 60% mark up you claim!

OK you're saying that if I get 2 off the same item, the Gov only pays the pharmacy for one. But if I get two differing items the Gov will pay for both. Wow really? Fair enough, that explains it, but that's crazy.

Why do you question the cost price though? I can guarantee you the price is €50 as I have independently asked a pharmacist. I don't claim - this is FACT. I bet as well that the pharmacy doesn't actually pay that €50 but gets it cheaper. Why then does the Gov on the DPS only pay cost-8%? Probably due to the fact that the pharmacy is getting it MUCH less than cost in the 1st place!

I live in a rural location. My DPS is with one pharmacy. All the other pharmacies in the surrounding area charge the same price. Yes the markup is 60%. Yes I am being ripped off. No, I cannot find another pharmacy that sells it for less within easy travelling distance. Seems to me it's a cartel. Amazing how there's always more than a few pharmacies in every town - all seemingly doing well? No surprise with the 50-60% markup....

kdowling

MBSnr wrote: »

OK you're saying that if I get 2 off the same item, the Gov only pays the pharmacy for one. But if I get two differing items the Gov will pay for both. Wow really? Fair enough, that explains it, but that's crazy.

usually yes, but depends on the item. if the item is two inhalers for example you can get two of them. What is the item you are talking about?

MBSnr wrote: »

Why do you question the cost price though? I can guarantee you the price is €50 as I have independently asked a pharmacist. I don't claim - this is FACT.

Highly unlikely to be FACT as you put it!
I am a locum pharmacist and have worked in hundreds of pharmacies and never came across a pharmacy that charges more than 50% of trade price. Maybe the pharmacist made a mistake on the price he told you.

MBSnr wrote: »

I bet as well that the pharmacy doesn't actually pay that €50 but gets it cheaper. Why then does the Gov on the DPS only pay cost-8%? Probably due to the fact that the pharmacy is getting it MUCH less than cost in the 1st place!

They do get it cheaper, around 8%!! its no secret!

MBSnr wrote: »

I live in a rural location. My DPS is with one pharmacy. All the other pharmacies in the surrounding area charge the same price. Yes the markup is 60%. Yes I am being ripped off. No, I cannot find another pharmacy that sells it for less within easy travelling distance. Seems to me it's a cartel. Amazing how there's always more than a few pharmacies in every town - all seemingly doing well? No surprise with the 50-60% markup....

Get a presrciption repeated for 6 months from your doctor, then order 6 months supply from Tesco pharmacy. Then you only have to make one trip (or if its too far you may have a relative or friend that could collect and send them to you in the post) then on top of getting it at a 20% mark-up you save €17.50 for every item on your script for buying 6 months at a time!
(i.e. you have 6 drugs you save a futher €105.

Cianos

Hi folks, stumbled across this thread and it got me wondering whether there'd be any use in me building a website that works as a price comparison for different pharmacies?

It may not be of much use since there seems to be 3 clear brackets; Tesco, Boots and independents.

It would also need a lot of input from users to provide enough useful information, since there are so many drugs and so many pharmacies.

Anyway, just some thoughts. A site that would be similar is pumps.ie for petrol pricing.

vincentdunne

Cianos wrote: »

Hi folks, stumbled across this thread and it got me wondering whether there'd be any use in me building a website that works as a price comparison for different pharmacies?

It may not be of much use since there seems to be 3 clear brackets; Tesco, Boots and independents.

It would also need a lot of input from users to provide enough useful information, since there are so many drugs and so many pharmacies.

Anyway, just some thoughts. A site that would be similar is pumps.ie for petrol pricing.

I'd use it.

nino1

Cianos wrote: »

Hi folks, stumbled across this thread and it got me wondering whether there'd be any use in me building a website that works as a price comparison for different pharmacies?

It may not be of much use since there seems to be 3 clear brackets; Tesco, Boots and independents.

It would also need a lot of input from users to provide enough useful information, since there are so many drugs and so many pharmacies.

Anyway, just some thoughts. A site that would be similar is pumps.ie for petrol pricing.

why would pharmacists want to give you their pricing structure for your website that would potentially lead to lower prices due to there being more transperance?

Cianos

nino1 wrote: »

why would pharmacists want to give you their pricing structure for your website that would potentially lead to lower prices due to there being more transperance?

The prices would have to be contributed by the users. So if you get a prescription for X from pharmacy Y, you submit the info to the site so that other users know whether to go to or avoid that same pharmacy.

nino1

Cianos wrote: »

The prices would have to be contributed by the users. So if you get a prescription for X from pharmacy Y, you submit the info to the site so that other users know whether to go to or avoid that same pharmacy.

just playing devils advocate here.
I think it would be very difficult given the confusion most people have regarding brands and generics.
Sure the NCA reported prices of drugs in different pharmacies recently and had to back down the next days as they got the prices all wrong.

Cianos

nino1 wrote: »

just playing devils advocate here.
I think it would be very difficult given the confusion most people have regarding brands and generics.
Sure the NCA reported prices of drugs in different pharmacies recently and had to back down the next days as they got the prices all wrong.

Yeah I think the massive amount of variables would make it quite difficult to do properly alright.

vincentdunne

Mmmm ... well, I've got a prescription here for 5 items which I get, more or less, every month. They cost approx. €130 in my local pharmacy. I am going to get a price in Boots (local) and Tesco (if I can) and I will publish the results here if anyone is interested. Not scientific, I admit, but if it is cheaper for me = result.

vincentdunne

Hi, Here, as promised, is the list. I must admit I was very surprised. All that glisters ...............

Boots Local chemist

1. Item 1 11.63 10.20
2. Item 2 18.22 18.87
3. Item 3 38.24 42.10
4. Item 4 10.61 9.14
5. Item 5 7.76 6.10
6. Item 6 17.61 18.42
7. 104.07 104.83

vincentdunne

Re: The above list: I am completely impartial in this. It was carried out today. Sorry about the formatting but you get the idea. Very little difference in items or total, even though Boots includes 2 generics.( Item 1 and 3). Items 1,3 and 4 are for 30 in Boots and 28 in the local chemists.

Due to the closeness of the local chemist and the lack of difference, I will not be changing to Boots.

L1011

Fungus wrote: »

Is there a simple solution to this opaque pricing?

Simply, make it mandatory for pharmacies to publish their prescription prices on their websites.

Would that work? Do we need to to canvas the NCA on this?

There are ~25000 prescribable items on the pharmacy union product file. Most pharmacies don't have a website. Its completely impractical.

rubadub wrote: »

It would be great if one pharmacy came out with a price match guarantee like "if you see this cheaper elsewhere we double the difference" type scheme that other shops do. So you could confidently buy from them & email your script around to double check.

There are a number of independent pharmacies that do this. None of the chains do as far as I know, but also none have anywhere near countrywide coverage for it to make a major impact.

nino1

vincentdunne wrote: »

So Items 1,3 and 4 are for 30 in Boots and 28 in the local chemists.
.

Why would you not compare like with like? Some 28, some 30, some brands some generics!
I have amended your list to at least compare 28 days supply!

If you compare both for 28's you get

Boots. Independent

Item 1 10.85 10.20
Item 2 18.22 18.87
Item 3 35.69 42.10
Item 4 10.61 9.14
Item 5 7.24. 6.10
Item 6 17.61 18.42
100.22 104.83

The pricing structures have already been discussed earlier in the thread.
Boots are only cheaper if you are buying a single expensive item not if the total cost is expensive such as in your medication.
Your independent pharmacy looks very expensive. Their mark up is over 50% if your prices are correct. (Boots price minus €7 = cost price)

Tesco do 20% mark up for everything so you would save around €40 (very rough top of head estimate based on boots prices you quote)

vincentdunne

If you have an e address for a Tesco quote, I will try them next, but a drive to Balbriggan or Naas for a prescription is hardly on. Otherwise my 'research' stands as is.

palmcut

nino1 wrote: »

Why would you not compare like with like? Some 28, some 30, some brands some generics!
I have amended your list to at least compare 28 days supply!

If you compare both for 28's you get

Boots. Independent

Item 1 10.85 10.20
Item 2 18.22 18.87
Item 3 35.69 42.10
Item 4 10.61 9.14
Item 5 7.24. 6.10
Item 6 17.61 18.42
100.22 104.83

The pricing structures have already been discussed earlier in the thread.
Boots are only cheaper if you are buying a single expensive item not if the total cost is expensive such as in your medication.
Your independent pharmacy looks very expensive. Their mark up is over 50% if your prices are correct. (Boots price minus €7 = cost price)

Tesco do 20% mark up for everything so you would save around €40 (very rough top of head estimate based on boots prices you quote)

I think Tesco may be 20% mark up + €5 fee.
Then the list would be;
item 1...9.62
item 2...18.46.
item 3...39.43
item 4...9.33
item 5...5.29
item 6...24.07.

total...106.20