PRESCRIPTIONS
Prescription Charges and Pricing Medicines for Patients
he issue of free prescriptions and the value of medicines have recently, once again, hit the headlines across the UK. On the day the latest costs of prescriptions and annual reimbursement of medicines were printed, the Scottish Conservatives Health Spokesperson Jackson Carlow claimed, “The general prescribing of products which can easily be bought in any supermarket does not demonstrate good value for the NHS in Scotland.”
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The Scottish Conservatives have long maintained a desire to reintroduce a “modest prescription charge” for those able and willing and able to pay. This would follow moves in Northern Ireland to reintroduce prescription charges for the funding of a specialist drug fund.
Commenting on the increase in prescription charges in England to £8.20 per item recently, Health Secretary Shona Robison said: “Free prescriptions in Scotland mean that no one is forced to decide which prescribed medicine they can afford and which they will have to go without.
“This is the right thing to do, and unlike in England means that those living with a long term condition are not facing the on-going fi nancial penalty of prescription charges just because they are unwell.
“It remains our fi rm belief that healthcare should be free at the point of need – the founding principle of the NHS. Free prescriptions are consistent with our ambitions for a
22 - SCOTTISH PHARMACIST
socially just society for the people of Scotland, and we remain committed to this policy.”
Other suggestions have recently hit the headlines to support waste medicines reduction, Jeremy Hunt has announced in a speech to council leaders in England on personal responsibility that every medicine which is valued more than £20 will be marked as such and will also be labelled “funded by the UK taxpayer”
The recent proposal has caused concern from Pharmacy Bodies. English Pharmacy Board Chair of the Royal Pharmaceutical Society Sandra Gidley said, “We agree with the intent to make sure people use their medicines correctly and to reduce medicines waste.” However, she expressed concern that some patients might see themselves as a burden on the NHS and don’t collect their medicines resulting in hospital admissions due to non-compliance.
Pharmacy Voice commented that whilst the idea of marking prescription with values may be “superfi cially attractive” but as a body they were sceptical it would have the desired effect. The body also expressed concern at additional workload burdens on community pharmacy teams to deliver the expected requirements.
Scottish Pharmacist spoke with James Semple, Vice-Chair of Community Pharmacy Scotland on the recent headlines. James recalled when he gave evidence to the Health and Sport Committee advocating the retention
of prescription charges. Refl ecting upon his stand point at the time, James now believes he was wrong with this opinion.
He states that the access to medicines afforded by the zero charge has improved patient care and the evidence from Wales and Scotland on the issue means his original fears were unfounded.
On the topic of marking drugs greater than £20 value James says this idea is incredulous. “The vast majority of prescribed items are for cheap generics,” he said. “The average gross ingredient cost of 90% of all items dispensed in the NHS has crashed over recent years- which is good for everyone.”
James also expressed a view that reason for the increasing drug bill are now small volume, niche products for cancers and other relatively obscure illnesses. These are the drugs which patient groups and MSPs regularly lobby the Government to ensure they have access to.
We also spoke with the Right Medicine’s Jonathan Burton. He expressed a view that he would not be in favour of reintroducing the prescription charge in Scotland, He believes it is a tax on health which is not in line with the core principles of the NHS in Scotland i.e. patients have care which is free at the point of access. He also felt that prescription charges would reintroduce unnecessary & troublesome workfl ow for busy community pharmacists and their teams, not to mention counter fraud services.
He did however say “I understand the fi nite nature of public funds for NHS services though and support efforts to streamline services and make cost effective savings. Within community pharmacy I would, for example, support widening patient access to the minor ailments service but in tandem introduce a far more limited, evidence based formulary.”
The Scottish Pharmacist also asked Jonathan his view on the proposals put forward by Jeremy Hunt. Jonathan stated “Marking prescription labels with the price of medicines if they are
over £20, in my view is unwise for two main reasons: fi rstly it introduces further text and numerals onto dispensing labels, and that may be a patient safety risk in itself. The prime & only purpose of a dispensing label should be to aid patient safety & identifi cation of a medicine. Secondly the proposal is not evidence based, i.e. we do not even know if the measure would lead to less medicines waste. It may even be counter-productive in some patients care, for example how do we know that vulnerable patients may not cease to order and collect medicine due to feelings of guilt about being a burden to the health system?”
It is clear in the current climate of fi nite resources we need to ensure medicines are used effectively. We perhaps need more innovative solutions to waste medicines. As a fi rst port of call perhaps consideration should be given to ensuring maximum lengths of repeat prescriptions of 56 days or less need to be compulsorily introduced. This week the writer dispensed a prescription of Apidra Solstar and Lantus Solstar worth over £300 this is likely to last over four months on previous history. What happens if the patient loses the medicine, what happens if their fridge breaksdown? Also what happens if during a review changes are made to the patient’s therapy?
Increased, use of repeat dispensing via the Chronic Medication Service should be used to minimise the supply of medicines in treatment cycles of greater than fi fty six days. This could also support compliance monitoring of inhalers such as 60 dose inhalers with fi xed dosage regimes where non-use can lead to exacerbation of symptoms of COPD or asthma ending in hospital admission.
It is clear politically that reintroducing prescription charges would be seen to unlikely in Scotland at the moment. There is also concern at the proposals being considered by the Department of Health are likely to have a detrimental effect on some patients. Whatever happens reduction in inappropriate use of medicines and waste medicines need to happen to ensure NHS costs are not further driven up in years to come. •
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