Is my pharmacy just being underhanded in med dispensing?

Is the prescription that the doctor provided for multiple months or just one month at a time?

If it is for multiple months then call other pharmacies, ask do they do multiple months at once and what the price is for one, two and three months.

Reason is that you are going travelling.

If the docket says 30, then they should be dispensing 30. Or dispensing 28, charging you for 28 and adding the missed 2 to a future collection.

If you find another place close by that's cheaper then just have your prescription moved there.

Fee per item is the default, there's very few places that don't charge it. Some charge a markup instead, which can make cheaper drugs even cheaper but makes dearer stuff dearer.

In the old days, it was often a 50% markup and a fee per item; there are still pharmacies that charge a markup and a fee.

That model dying off plus the state getting much better buying deals has slashed the price of the most common medicines and we're starting to be one of the cheaper places in Europe for medicines - although the countries most people compare us to for obvious reasons, UK because we have a border with them and Spain because so many people go on holiday there - continue to be exceptionally cheap.

HI, I don't think the pharmacist is being underhand; a standard month in pharmacy terms is 28 days; if you avail of the drugs under the DPS scheme (where your drug bill is capped at 80€ per month for a household) you are entitled to a 13th month.

Most pharmacies charge a dispensing fee per item; so say the drug costs €28 per box and you pay €35; that would be €7 dispensing fee. If the pharmacist was to put 2 extra tablets in the bad they could charge you €2 extra.

My daughter uses Singluar and I priced it with Healthwave pharmacies its - significantly cheaper than the local pharmacy; Healthwave price = Montelukast 5mg (Singulair) €28 for 3 months supply and €46 for 6 months supply this is based on a 28 tablet pack.

I queried this with my local pharmacy and she mentioned that she thinks Healthwave will be bust within a year - suits her to say that though!!

Just ask the pharmacy to give you 30 every month. It’s probably just an oversight.

If the pharmacist who gives you the 28 is from abroad, that might explain it; in many European countries, they would be horrified at breaking open a sealed pack and shoving two extra tablets into it.

My wife is an Asthmatic and prescribed a Ventolin inhaler monthly. Of late though, when collecting her prescription the Ventolin inhaler has been replaced with a generic version.. Salamol. She wasn't aware of this replacement when collecting her prescription and wasn't informed by the pharmacist at the time. Not until she arrived home did she discover the 'swap'. Didn't think too much of it as if it did the same job.. well, fair enough!

It turns out though, this generic is essentially.. CRAP! Whether it's the contents of the cylinder is different or the design of the dispenser is the fault I don't know. It just doesn't work for her.

She returned to the pharmacy only to be told medicines could not be exchanged once they've left the premises. A note was made on her file that in future her prescription was to include Ventolin ONLY.

Next prescription, same thing happened. This time, my wife checked the contents of the package before leaving the shop and after a bit of a conflab the Salamol was exchanged for the Ventolin. The Ventolin was obviously in stock but the pharmacist still tried to fob her off with the cheaper generic.

Now perhaps it's my bad mind but as my wife has a medical card and her prescription specifically states 'Ventolin', I'm of the opinion the pharmacist is trying to pass off the cheaper generic version yet claiming for the more expensive version from the HSE.

Once again, people are assuming dishonesty and underhanded tactics when the explanation is a lot more innocent.

Ventolin and Salamol have been determined by the HPRA to be 'interchangeable', i.e. absolutely equivalent. Reference below:

Interchangeable List Salbutamol IC0078-138-053 100 mcg Pressurised Inhalation Suspension Products on List: 3 Date Last Updated: Thursday, March 7, 2024 (hpra.ie)

It does not matter that your wife's prescription says 'Ventolin', the pharmacist will only get reimbursed from the HSE for the cheaper version (Salamol) unless the GP has written "DO NOT SUBSTITUTE" in his own hand-writing on it.

The pharmacy did exactly what they should have done and by giving you the more expensive Ventolin, the pharmacy took a (small) hit to keep the customer happy.

This. For my prescription it's always 28 days. The odd pharmacist gave me extra from an opened box but the head pharacist saw that one day and said the boxes should never be opened.

*I'll caveat that by saying my medication is free so it doesn't affect me money wise.

What's the "small hit" the pharmacy took in dispensing the correct medication as prescribed? Despite what the HPRA state, if the generic is ineffective on a particular patient then there's no point in dispensing it.

And it's not about keeping the "customer happy", it's about keeping them alive!

I would never assume a posters direct involvement in a particular topic of discussion but it helps that you have stated you had at least had some experience in this particular field.

I was unaware "the HSE will ONLY pay for the generic version". But that is ultimately an issue for the pharmacists to resolve with the HSE and is of no benefit to those patients who are dispensed ineffective generics.

"Lots of people think the generic version isn't as good as the brand name. I think a lot of people would be surprised quite how much of the 'good' stuff comes from the same pharma plants in India."

I reiterate, it doesn't matter what the HPRA state about generics, it's not simply a mindset of the patient wanting only the most expensive version. There most certainly can be varying degrees of effectiveness amongst generics.

Do you know how this affects patients who get their drugs under the DPS scheme e.g. if drugs for my household cost €250 per month for the licensed version OR €180 per month for the generic; can I as a consumer demand the licensed version? I only have to pay €80 - I am only asking out of interest; have no issue with the pharmacist dispensing the generic where there is € saving

I'm not entirely sure what you mean by 'urban myths'. There's anecdotal and personal first hand experience of the failure of certain generics meeting the desired requirements. I appreciate the pharmacist should not be expected to "take a hit" on a transaction but if we include the dispensing fees charged by pharmacists, I suspect the difference is compensated for in the majority of transactions.

And the "like it or lump it" attitude is one I hope does not become a staple of medical care when it comes to dispensing medication to vulnerable patients in todays modern society.

Salamol and Ventolin are the same drug (salbutamol) in different packaging.

Evidence of equivalence has been around for years, e.g. Chang, et al. Is Salamol less effective than Ventolin? A randomised, blinded, crossover study in New Zealand. N Z Med J. 2007 Dec 14;120(1267):U2874. PMID: 18157200.

The only actual difference between the products is that Ventolin is more expensive and has a higher carbon footprint.

This has been enlightening. I too am asthmatic and I had noticed that my 'blue' inhalers have not been as affective lately and I needed it more frequently. I've been receiving the generic version of ventolin for the last few months, but as I assumed it was exactly the same, I never thought to make anything of it. I will be requesting the non-generic version at my next renewal.

i have also had an issue with 28 day sealed packets being given for a month, leaving me with a shortfall before renewal is due. My GP surgery sends all my prescriptions directly to the pharmacy, so I never see the number of pills on the script, but I will double check with them that it is 30 a month (as I suspect it is).

yes, correct, thank you.

But the point is the same - it's a flat fee, so the difference between the cost of the Ventolin and Salamol still has to be swallowed by the pharmacy

It's the same drug in different packaging - what explains the difference you are describing?

It's like saying you feel less hydrated when you drink Lidl bottled water instead of Ballygowan.

That is not entirely true, some drugs can have a slightly different make up while still qualifying as the same, between brands. My neice had her thyroid prescription changed from one brand to another and it took months to establish why she was having a fairly severe reaction to her medication. I am prescribed paracetamol (among other things) I get one of several generics. There is one generic (made in Ireland) though that is larger than others and has no coating, and I choke on them. I have finally established with the pharmacy - who are helpful at all times - that I will not be dispensed this particular tablet.

The 30/28 day thing is very confusing in relation to the DPS, I have had to juggle the date of the prescription being dispensed in order to be sure I have a prescription dated each month as required by DPS, and not have a month with no prescription. It does seem to be a very clutzy arrangement if you are claiming for more than drugs, I think I have finally sussed it but its a bit confusing. I have no idea how they can make a 13 month thing work, they seem to have problems with 12 months.

Same applies to Warfin; few family members use it and there are a number of generics available but patients have to stick to one generic and cannot deviate. The way the body processes warfin varies and patients cannot chop and change between different generic brands

I got my meds in Healthwave in Dundrum this week; the Doctor had written 30 tabs (repeat by 6) but the fresh unopened boxes contain 28 tablets - therefore I have 12 less than what the Doctor prescribed for 2 different drugs

€59 for six months supply V €174 in local pharmacy; bit more of a pain going out there but I am not at the point where I want the Doctor to send the script directly to Healthwave; I get a hard copy of it.

Local pharmacy had been annoying me recently, few mistakes etc. Really is some difference in price