Drugs Payment Scheme

doc22

I'm wondering if anyone knows if are prescriptions cheaper if using a DPS card? I know about the limit of 80. But under the scheme there seems to HSE reference prices and dispensing fees under the scheme which I presume make drugs cheaper then purely private transaction even if below the 80 threshold?

Luker

No they are no cheaper. Big difference between some pharmacies though

paddy19

Pharmacies won't normally sell you prescription medicine under DPS under €80 per family per month.

They will mark your receipt "Private Script" which allows them to charge whatever they like.

It gets dodgy for the pharmacy when you start to get near the €80 limit.

Over €80 HSE gets involved they will only pay the reference price https://www.sspcrs.ie/druglist/pub

plus a max dispensing fee of €5. This leads to the interesting gap between the €80 you pay and when the pharmacist can claim from the HSE. Effectively he has to eat into the profit sub €80 until he has provided the drugs at the HSE rate.

FrankTupelo

I am interested in understanding how the medicines are charged by pharmacies under the DPS scheme when the amount is below the €80 threshold.

First example
My wife went to buy one box of tablets for a recurring prescription and asked to get it under the DPS card.
The pharmacist told her that he could sell two boxes to her for a cheaper cost without using the DPS card…
I do not remember the actual costs but it was something like this:
one box ~€35 with DPS card
two boxes ~€50 without DPS card

Is this because pharmacies are adding a mark up + dispensing fee to the cost that you would pay without DPS (so buying as "Private Script")?

Second example
I paid €80 for 4 medicines with the DPS card.
In the same calendar month we had other medical expenses which were entitled to be refunded under the DPS scheme.
So I submitted the claim directly to HSE and also requested the breakdown of their refund.
On the HSE breakdown the total amount of the 4 medicines is €59.61…

Does this mean that I would have paid €59.61 to the pharmacy if I had not used the DPS card?

paddy19

ne box ~€35 with DPS card
two boxes ~€50 without DPS card

This shows the peculiarities of the DPS system. One explanation is you maybe getting close to the €80 monthly limit for the family. It can make sense for a pharmacist to offer extra low cost generic than loose money over €80. (see explanation below.)

Does this mean that I would have paid €59.61 to the pharmacy if I had not used the DPS card?

The short answer is possible but unlikely. Pharmacists can charge what they like up to €80. Most pharmacist do not offer the same deal to paying customers as they have with the HSE. Notable exceptions are Chemist Warehouse and Healthwave.

One reason the pharmacist may want you private is that she knows the HSE will only give her a max of €5 dispensing fee on DPS.

Another possible reason is that she may be getting a special discount deal from the wholesaler.

Without knowing the drug code is hard to see how this case works.

The good news you can see what the max price the pharmacist is paying for the drug.

"On the HSE breakdown the total amount of the 4 medicines is €59.61…"

Although everyone talks about the €80 a month maximum limit from the customers point of view that is not how it works.

You need to look at it from the Pharmacist's point of view to understand the system.

THE HSE allowable €80 is not the same as the customer paid €80.

THE HSE pays the pharmacist the reimbursable price plus a max dispensing fee of €5.00 per item (it can be as low as €3.50).

The Pharmacist can charge any dispensing fee they like up to a total charge to the customer of €80 because customers have been told they shouldn't pay more than €80.

If you look at your white HSE Prescription Claim Form receipt you will see a a drug code for each item.

Plug this code into the HSE/PCRS database https://www.sspcrs.ie/druglist/pub

add €5 per item and you have the price the Pharmacist can charge the HSE.

Take an example:

Take 9 different customers. First customer has 1 item, second customer has 2 items…….

Product cost is €5 and the max HSE dispensing fee of €5 per item.

Take the same €5 product cost for the Pharmacist (not true but ok for this purpose) but she charges a €15 fee per item.

Everything is grand for the pharmacist up to our fourth customer with 4 items and €80 charge (4 items x €5 + 4 fees x €15 ). Happy days!

Things get awkward for the Pharmacist above 4 items. On the 5th customer she can't charge €100 because he won't pay the extra €20 because it's over the €80 limit.

So the pharmacist is stuck between a customer who won't pay more than €80 and the HSE who will pay a max fee of €5 not the €15 fee the pharmacist has been charging.

Sad times! She has to forgo the €20 extra that she would like to charge.

So her effective fee has dropped to €11 per item. It gets progressively worse until she gets to the 8th customer where her fee of €5 is the same as the HSE fee.

The important column to watch is HSE allowable > €80.

Obviously this just one example and with higher product costs it means that the Pharmacist hits the €80 faster.

Simple!

Some Pharmacists will offer you special deals if you buy multiple of a months supply.

I got quotes ranging from €151 to €299 for the same 6 months supply!

It effectively takes you out of the DPS system which is all based one months supply.

In my very limited sample, Lloyds did offer a discount but their prices were way off.

Some won't offer a volume discount notably Boots, Pure and Chemist Warehouse.

The local independents were pretty flexible and offered some good deals.

Best bet is send an email with your list to a selection of pharmacies requesting a quote for 28, 84 and 168 tablets. Only pharma could define a month as 28 days!

The critical question to ask is why won't Pharmacists charge customers the same €5 max dispensing fee they charge the HSE.

Exactly the same product, exactly the same service. In fact since you're a cash customer you'd expect a lower fee.

No dealing the HSE, no paperwork, no waiting up to a month to get paid.

The only answer I've ever got is because they can charge what they like. I've been charged a €19 fee.

So much for looking after the community!

L1011

This is why you need to shop around, if your needs are simple enough that changing around doesn't have an impact - my pharmacy charges close to or the actual DPS price at all times; my monthly medications cost a grand total of €11 quid and looking at the reimbursement for the specific brands the costs are €1.81 for one and €2 for a full box of another, I get 3/4 of a box.

In the old days before generic substitution and patent expiry, both those drugs were €30-40 a month reimbursement cost, and lots of pharmacies charged a 50% markup and a dispensing fee of up to €7 per item for private scripts. Can't remember the old DPS rules at this stage, been over a decade since I stopped needing to know (worked in an equipment supplier to pharmacies)

paddy19

I think your lucky. Lots of older people are getting ripped off.

The present secret price system allows pharmacists to charge different customers different prices for exactly the same product.

With e-prescriptions and verified online pharmacies the prices of all prescription drugs need to be on each pharmacies web site.

It's ridiculous that every other item in a pharmacy and online has a price displayed but the prescribed medicine prices are locked away in the pharmacist's computer only to be revealed when the pharmacist is forced to open up by the customer.

Pharmacists are in powerful position and lots of customers will simply be afraid to ask.

L1011

What we have since COVID for electronic prescriptions transfer is far from a real e prescription system. It's pdfs of scripts being sent through an access controlled office 365 tenant

paddy19

Wow that's interesting, sounds like a glorified Fax system.

FrankTupelo

Thanks a lot for your information and suggestions!

In my case the pharmacy was Boots and the receipt was marked as DPS, I went there and got the price of each medicine.
So we can compare both the HSE refund amounts (confirmed on their official letter) with the "private" prices:

As previously mentioned using the DPS card I was actually charged €80 by the same pharmacy so there are two key points to note here:

a) using the DPS card the pharmacy charged me even more than "private"
b) I lost ~€9 with the pharmacy using the DPS card and €20 with HSE when I submitted the claim for prescription + other medical expenses (for the €80 amount spent, the total reimbursable price for HSE is €59.61)

This real life example is simply reiterating what paddy19 mentioned

• Pharmacists can charge what they like up to €80.
• The Pharmacist can charge any dispensing fee they like up to a total charge to the customer of €80 because customers have been told they shouldn't pay more than €80.

So from my customer point of view the Drugs Payment Scheme in practice is mainly working when the cost is beyond €80..

I had checked the HSE/PCRS database but the online prices were updated 10 days ago and I cannot use them as reference for my purchase which happened a couple of months ago.

Some Pharmacists will offer you special deals if you buy multiple of a months supply.

Good to know, I found out this option only a few months ago when it was mentioned to my wife (first example in my initial post, different pharmacy..).

Best bet is send an email with your list to a selection of pharmacies requesting a quote for 28, 84 and 168 tablets.

Will keep in mind, thank you!

The only answer I've ever got is because they can charge what they like. I've been charged a €19 fee.

Yeah.. €19 is definitely too much!

Blueeyedlass24

The DPS system is simply not functioning as it should. The pharmacists seem to be charging at their own discretion, resulting in the HSE paying out significantly less for the medication than what the customer is being charged. This is a serious issue that needs immediate attention.

One example that I have from someone else’s prescription is as follows-

HSE refund price: Medication X= €6.87 (60 capsules).

Cost to the consumer: €12.85 (30 capsules).

When I received my receipt, my medication came to €80. There is never a breakdown of what each drug costs. I am now dealing with pharmacy number three or four at this stage, and any time I have questioned this, it ends up in a heated discussion with the pharmacist, which makes me suspicious about price transparency and the DPS system.

I contacted the PSI –The Pharmacy Regulator, about this, and they have advised me that they have nothing to do with price transparency and that any queries should be dealt with by speaking with the Supervising Pharmacist, who is in overall control of the management of the pharmacy. Although the PSI has stated on its webpage the following information-
What type of complaints will the PSI consider?

Failure to comply with certain provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.

The DPS refund system is not fit for purpose. The fact that it is paper/post-based in this day and age is terrible. But it is designed like this for a reason- to not pay out.

They request paper copies of receipts from the pharmacist, tend not to include them in the calculation costs, and/or say they never received them. When you ask them for a breakdown of the decision, they rarely come back with an explanation. When you attempt to appeal the decision and request the receipts back, you are declined. It is the worst system that I have ever witnessed. I have lodged several complaints to the DPS and all I have received is a 'copy and paste' from the HSE webpage of what the DPS is and to speak to the Ombudsman.

In 2016 there was a good example of where their errors were found and highlighted-

Drugs Payment Scheme- Page 24 of 48 of this document-https://www.ombudsman.ie/publications/ombudsmans-casebook/casebook-summer-2016.pdf

paddy19

"There is never a breakdown of what each drug costs. "

In the PSI transparency/not transparency page it does call for itemised receipts:

"Following the dispensing of medicine(s), pharmacists should provide the patient/their representative with a receipt which itemises the price charged i.e. sets out the price per item dispensed."

https://www.thepsi.ie/gns/Pharmacy_Practice/PracticeUpdates/PricingTransparency.aspx

This has no basis in law, it's purely aspirational but it does make it more awkward for the pharmacist to say you can't have itemised billing.

From a practical point it's a choice on the print menu in Pharmacy software, so they can do it if they want to.