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DPS isn't capped at €134 it seems...

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  • 02-01-2019 2:20pm
    #1
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭


    Perhaps this has been covered before and my apologies if so. However I searched and couldn't find it.

    So, while we are lead to believe that the DPS has a monthly cap of €134 I recently discovered this isn't the case unless you use the same pharmacy.

    Back in Oct I picked up my regular monthly prescription ( into my 5th year of €134 payments now ) on a Friday. In an unrelated medical incident I ended up at Westdoc on the bank holiday Monday and subsequently ended up in the pharmacy close by. My usual pharmacy is close to my work & 40 miles away. I had to pay for my prescription on the day & when I explained my circumstances the pharmacist gave me a form, told me to send off the receipt & I could claim the cost of the prescription since it was within the same month & I had already paid my €134 three days earlier.

    Filled out the form, posted it off with the receipt & a few weeks later received a cheque from the HSE to the tune of 68% of the cost. I called them to ask why I hadn't received the full amount since I had already maxed my monthly payment & was told that it was the "pharmacists mark-up" & that was all I was entitled to. I made the point that if for example I ended up at 3 different pharmacies in a month for whatever reason then I would be exceeding the payment cap with no way to claim it back & I was told that is correct. So..

    Has anyone else experience of this scenario ?

    I spoke to my own pharmacist as I know him quite well and he said that he could not see why, and did not know of any reason or rule that states I was not entitled to be fully reimbursed. He said that the 'pharmacist mark-up ' in this scenario and for the particular drug I required wasn't applicable.

    My own pharmacist also informed that he has a card scanner which he was issued with approx 15 years ago by the HSE when a universal system was to be put in place so that all the pharmacies were linked & everyone had a DPS card that could be scanned.. which makes total sense. Machine arrived... project shelved. He informed me that every pharmacy in the country at the time got one of the card reader machines. Typical Ireland.. money down the drain after someone got themselves a nice contract of providing the readers.
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    #2
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    ...
    My own pharmacist also informed that he has a card scanner which he was issued with approx 15 years ago by the HSE when a universal system was to be put in place so that all the pharmacies were linked & everyone had a DPS card that could be scanned.. which makes total sense. Machine arrived... project shelved. He informed me that every pharmacy in the country at the time got one of the card reader machines. Typical Ireland.. money down the drain after someone got themselves a nice contract of providing the readers.

    There certainly were plans to introduce such a scanning system when the DPS was introduced (and it was more like 20 years ago). But it never happened, and the scanners (despite what you've posted) were NEVER delivered.

    Each pharmacy WAS sent an Oki Microline 280 dot-matrix printer in order to allow them to print the blue forms. I'd be absolutely shocked if any of them are still on the go - every pharmacy I know replaced them (at their own expense) with more robust models like the Oki 3320 about 10 or even more years ago.


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    #3
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    Back to the original question - can anyone shed any light on the €134 cap as mentioned in my OP ?


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    #4
    apache
    Registered Users Posts: 2,419 ✭✭✭apache


    You have to go to the same pharmacy in a month to avail of the DPS cap.


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    #5
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    well if that is the case then why was I refunded any of the 2nd prescription then ?


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    #6
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    ...

    Filled out the form, posted it off with the receipt & a few weeks later received a cheque from the HSE to the tune of 68% of the cost. I called them to ask why I hadn't received the full amount since I had already maxed my monthly payment & was told that it was the "pharmacists mark-up" & that was all I was entitled to. I made the point that if for example I ended up at 3 different pharmacies in a month for whatever reason then I would be exceeding the payment cap with no way to claim it back & I was told that is correct. So..

    Has anyone else experience of this scenario ?

    I spoke to my own pharmacist as I know him quite well and he said that he could not see why, and did not know of any reason or rule that states I was not entitled to be fully reimbursed. He said that the 'pharmacist mark-up ' in this scenario and for the particular drug I required wasn't applicable.
    ...

    Welcome to the reality of doing "business" with the HSE.

    The HSE is the biggest consumer of medication in the country, in that it pays either directly or indirectly for something like 80 or 90% of all the prescriptions in the country.

    As such, it enjoys a monopsony - a situation analagous to a monopoly but instead of a single supplier abusing its market dominance to push prices up it's a single customer abusing its market dominance to push prices down.

    Because of this, the price that the HSE pays for prescriptions is far below the actual market price. Effectively, the HSE forces pharmacies to give it a massive discount.

    The price that a pharmacy charges (for non-HSE customers) is the full actual market price ie; the price that the market will bear in a free market economy.

    If your regular pharmacist is NOT charging full actual market price for non-HSE business, he's very foolish.


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    #7
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    Back to the original question - can anyone shed any light on the €134 cap as mentioned in my OP ?

    Took a while for me to type my answer to that part (which I was leaving til second as it was the more important part), particularly since I got busy at work in the middle of it.


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    #8
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    Or to summarise:

    The DPS is capped at €134 per family per calendar month, when calculated at the pricing rate that the HSE decides for itself.


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    #9
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    Thanks Locum-motion but you're missing my point. I am a HSE customer...


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    #10
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    ... I am a HSE customer...


    You are a HSE customer if and when you present prescriptions for your family in a single pharmacy in a single calendar month that come to more than €134 when calculated according to the HSE's rates.

    If you present prescriptions that come to less than that amount, you are a private patient, and the price is the market rate.


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    #11
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    I am sorry but it is clear that the system is ridiculously flawed. Shall we all get sick at the same time of the month so we can avail of the cap. It is a joke.

    Your last comment still doesn't answer why I was reimbursed 68% of the prescription ?


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    #12
    Avatar MIA
    Closed Accounts Posts: 6,750 ✭✭✭Avatar MIA


    CtrlAltDelete wrote: »

    Your last comment still doesn't answer why I was reimbursed 68% of the prescription ?

    It does, they explained it very well.

    You bought a prescription outside of the HSE's purchasing power and the HSE repaid to you what it would have paid.


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    #13
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    OK. See below as stated on the HSE website. There is no mention of T&Cs ...

    Under the Drugs Payment Scheme (DPS) an individual or family will pay no more than €134 each calendar month for:

    approved prescribed drugs and medicines
    rental costs for a continuous positive airway pressure (CPAP) machine
    rental costs for oxygen
    If you don’t have a medical card and you pay more than €134 a month for any of these, you should apply.


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    #14
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    ...

    Under the Drugs Payment Scheme (DPS) ...


    That’s the important part right there.

    You bought meds OUTSIDE the DPS system. The HSE only reimburses you what it would have paid for your meds, if you had stayed within the DPS.


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    #15
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    Avatar MIA wrote: »
    It does, they explained it very well.

    You bought a prescription outside of the HSE's purchasing power and the HSE repaid to you what it would have paid.

    Avatar gets it.


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    #16
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    locum-motion wrote: »
    Avatar gets it.

    I'm not concerned if Avatar "gets" it or not. I "get" what you're saying. ... However the system is fundamentally flawed. You're clearly of the opinion that it is not.


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    #17
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    I'm not concerned if Avatar "gets" it or not. I "get" what you're saying. ... However the system is fundamentally flawed. You're clearly of the opinion that it is not.

    Oh, no, I'm fully aware of how flawed the system is, don't you worry!

    Even a well designed system couldn't cope with the situation where someone has to step outside of that system (while still recognising that this would happen less often if the system was better in the first place).


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    #18
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    locum-motion wrote: »
    Oh, no, I'm fully aware of how flawed the system is, don't you worry!

    Even a well designed system couldn't cope with the situation where someone has to step outside of that system (while still recognising that this would happen less often if the system was better in the first place).

    It shouldn't happen at all with a "well designed system".. that's the fundamentals of design. This should be really straightforward to implement. It's hardly rocket science.


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    #19
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    It shouldn't happen at all with a "well designed system".. that's the fundamentals of design. This should be really straightforward to implement. It's hardly rocket science.

    Ah, but this is the HSE you’re dealing with!!

    The section of the HSE that processes payments to Dr’s, Pharmacies etc used to be called the General Medical Services Payments Board (GMSPB).

    The HSE decided to change the name. It’s now...

    (Wait for it...)

    Health Service Executive Shared Services Primary Care Reimbursement Service.

    A body that can (in the name of efficiency) take a 5-word name and replace it with a 9-word name (with, don’t forget, the same word repeated three times therein) can not be trusted to organise the proverbial piss up in a brewery.

    One shouldn’t expect them to be capable of organising the DPS!!!


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    #20
    huskerdu
    Registered Users Posts: 1,931 ✭✭✭huskerdu


    CtrlAltDelete wrote: »
    I am sorry but it is clear that the system is ridiculously flawed. Shall we all get sick at the same time of the month so we can avail of the cap. It is a joke.

    Your last comment still doesn't answer why I was reimbursed 68% of the prescription ?

    The system is flawed but the HSE are correct not to pay any amount that any pharmacy wishes to charge

    If a DSP price for a drug is €30, that is what a pharmacy will get re-embursed.

    Pharmacies are private businesses who can try to charge their customers anything that they can get away with.

    In this case, the pharmacy charged you more than the DPS price and you didnt get reembursed for the price the pharmacy charged you.

    It's a harsh lesson to learn, but the pharmacy screwed you.

    I understand your frustration and I understand that its hard to price compare when you or a member of your family is sick and you are under pressure to get medication, but thats what happened.

    We would all be up in arms if the HSE paid pharmacies any price the pharmacy set.


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    #21
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    huskerdu wrote: »
    The system is flawed but the HSE are correct not to pay any amount that any pharmacy wishes to charge

    If a DSP price for a drug is €30, that is what a pharmacy will get re-embursed.

    Pharmacies are private businesses who can try to charge their customers anything that they can get away with.

    In this case, the pharmacy charged you more than the DPS price and you didnt get reembursed for the price the pharmacy charged you.

    It's a harsh lesson to learn, but the pharmacy screwed you.

    I understand your frustration and I understand that its hard to price compare when you or a member of your family is sick and you are under pressure to get medication, but thats what happened.

    We would all be up in arms if the HSE paid pharmacies any price the pharmacy set.

    It's not even the price, it's the flawed / misleading system that is the issue. No mention of all the "ifs and buts" on budget day.....

    I get the fact it's an expensive medication I receive and it is good to have it subsidised.. don't get me wrong. But, we, as a nation claim to be something we are not. I've researched it and the same medication is available for far less to ordinary everyday citizens in other "developed" countries.

    Lesson learned by me.. many more will and I'm sure are falling foul of this shady stipulation.


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    #22
    Avatar MIA
    Closed Accounts Posts: 6,750 ✭✭✭Avatar MIA


    CtrlAltDelete wrote: »
    It's not even the price, it's the flawed / misleading system that is the issue. No mention of all the "ifs and buts" on budget day.....

    I get the fact it's an expensive medication I receive and it is good to have it subsidised.. don't get me wrong. But, we, as a nation claim to be something we are not. I've researched it and the same medication is available for far less to ordinary everyday citizens in other "developed" countries.

    Lesson learned by me.. many more will and I'm sure are falling foul of this shady stipulation.

    On the actual form you filled out. Colouring is my edit.


    How to use the scheme
    [FONT=Arial,Arial][FONT=Arial,Arial]Once we have processed your application form, we will send you a card for each member of your family. You
    must present your card each time you attend the pharmacy before a prescription can be dispensed. We
    advise you to use the same pharmacy in a particular month if you wish to avoid paying more than the monthly [FONT=Arial,Arial][FONT=Arial,Arial]threshold amount.[/FONT][/FONT]
    [/FONT]    [/FONT]


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    #23
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    Avatar MIA wrote: »
    On the actual form you filled out. Colouring is my edit.


    How to use the scheme
    [FONT=Arial,Arial][FONT=Arial,Arial]Once we have processed your application form, we will send you a card for each member of your family. You
    must present your card each time you attend the pharmacy before a prescription can be dispensed. We
    advise you to use the same pharmacy in a particular month if you wish to avoid paying more than the monthly [FONT=Arial,Arial][FONT=Arial,Arial]threshold amount.[/FONT][/FONT]
    [/FONT]    [/FONT]

    I understand that...

    My point is.. why should a person have to ?? It's not always possible for people living in the countryside....

    System is flawed.


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    #24
    Avatar MIA
    Closed Accounts Posts: 6,750 ✭✭✭Avatar MIA


    CtrlAltDelete wrote: »
    I understand that...

    My point is.. why should a person have to ?? It's not always possible for people living in the countryside....

    System is flawed.

    Your original point was that you were wrongly overcharged. At least that's now corrected. And now you know why the HSE negotiate prices, if you don't you get ripped off.

    You've now moved on to claiming that rural society is not as well served as urban areas. I imagine that's true of all countries, but open to correction.

    But, you can write 'system is flawed' all you like, it's your prerogative in this country.


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    #25
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    huskerdu wrote: »
    ...
    It's a harsh lesson to learn, but the pharmacy screwed you...

    The pharmacy charged what the market would bear. That's how a free market economy works.

    The fact that the HSE would pay less is irrelevant. When the HSE is paying, it's NOT a free market.

    Does this mean that patients who pay for their own prescriptions are effectively subsidising those who don't?

    Yes, absolutely.

    But the blame for this lies with the HSE's distortion of the market in their own favour, not with the pharmacy.


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    #26
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    locum-motion wrote: »
    The pharmacy charged what the market would bear. That's how a free market economy works.

    The fact that the HSE would pay less is irrelevant. When the HSE is paying, it's NOT a free market.

    Does this mean that patients who pay for their own prescriptions are effectively subsidising those who don't?

    Yes, absolutely.

    But the blame for this lies with the HSE's distortion of the market in their own favour, not with the pharmacy.

    Who blamed the pharmacy ?!


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    #27
    locum-motion
    Registered Users Posts: 5,143 ✭✭✭locum-motion


    CtrlAltDelete wrote: »
    Who blamed the pharmacy ?!

    Huskerdu did. S/he said "the pharmacy screwed you."

    (BTW, my post clearly indicated not only that I was responding to Huskerdu, but also precisely which part of the post.)


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    #28
    [Deleted User]
    Posts: 0 ✭ [Deleted User]


    Ok. Haven't read the whole thread but got medication in several pharmacies about a year ago totalling over €134 in one month. Was informed that for the cap to be in effect at time of purchase everything had to be from the one pharmacy. Was directed to HSE refund form. Filled it in and posted it to Drug Refund Section - yes, a bit of an inconvenience but I survived. They refunded me a few weeks later for the excess over €134 that month.

    And thereafter the issue didn't arise as I stayed with the one pharmacy.


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    #29
    gctest50
    Registered Users Posts: 9,605 ✭✭✭gctest50


    CtrlAltDelete wrote: »
    I understand that...

    My point is.. why should a person have to ??


    It's not always possible for people living in the countryside....

    System is flawed.



    How is it "not always possible for people living in the countryside " to go to the one pharmacy ?


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    #30
    Graces7
    Registered Users Posts: 32,634 ✭✭✭✭Graces7


    gctest50 wrote: »
    How is it "not always possible for people living in the countryside " to go to the one pharmacy ?

    Because of the distances and other obligations. Driving an extra 60 miles so you can get to the same pharmacy? Especially if you are unwell...


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    #31
    CtrlAltDelete
    Registered Users Posts: 422 ✭✭CtrlAltDelete


    Graces7 wrote: »
    Because of the distances and other obligations. Driving an extra 60 miles so you can get to the same pharmacy? Especially if you are unwell...

    Exactly. Generally speaking those living in an urban environment are in closer proximity to everything. I'd have thought that was quite obvious...


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