Mobidoctor scripts no longer accepted in pharmacies?

arbitron said:
In Ireland as it stands, you can either present a paper prescription from a prescriber from anywhere in the EU or you can get a prescription from a prescriber on HealthMail. Outside of the HealthMail system, normal email prescriptions are not valid in Ireland. This is not a contravention of any EU rules or regulations, in fact it is specifically permitted under EU law.
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Where exactly?

I couldn’t find such language in the Cross-Border Healthcare Directive.
 
Sarah Ryan said:
Thanks for this information I have been reading about that new scheme.

I think the main problem here is that if I present a paper prescription to a pharmacist, it's a prescription that I have printed out myself from my online account with the online doctor.

It has all of the relevant particulars name, address, medication type, dosage, validity of prescription, and electronic signature from the prescriber.

I'm just so confused at what point does everything become invalid because I'm printing out a prescription and bringing it to a chemist.
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That is probably technically a valid prescription.

However, you have a doctor from Romania, with an address in Malta, prescribing online, for a patient in Ireland who they have presumably never examined. It may also be for a drug with significant potential side effects.

The pharmacist is obliged to make sure this is a valid prescription before dispensing and I think they would be understandably wary of a script like that.

I think there are some pharmacists here on AAM - it would be good to hear their experience and they probably have up to date info on this.
 
arbitron said:
That is probably technically a valid prescription.

However, you have a doctor from Romania, with an address in Malta, prescribing online, for a patient in Ireland who they have presumably never examined. It may also be for a drug with significant potential side effects.

The pharmacist is obliged to make sure this is a valid prescription before dispensing and I think they would be understandably wary of a script like that.

I think there are some pharmacists here on AAM - it would be good to hear their experience and they probably have up to date info on this.
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Well that's the thing they have examined me, we do a detailed video consultation.

I have been on a particular medication since September 2022 which has been dispensed in this way along with other prescriptions for ear/sinus infections over the same time.

My pharmacist recommended that I use a different company in Ireland and the funny thing is I'm getting a script for a pretty serious medication without any face to face interaction whatsoever, they are just taking my word for it so I've gone from having a consultation and having medical interaction with somebody to just getting something online sent via a secure mail system.

So as a patient, in order for the pharmacist to satisfy one regulation, this is actually worse for me because I'm not being medically managed at all even though I'm well versed on what it is that I'm taking.

Makes no sense!!
 
arbitron said:
I don't know, I have seen it referenced HSE, PSI documents, etc. I will have a look and see if I can find any shared with me.
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@Dr Strangelove , had a quick check in emails and saw this quote:

The recognition of such prescriptions shall not affect national rules governing prescribing and dispensing, if those rules are compatible with Union law, including generic or other substitution. The recognition of prescriptions shall not affect the rules on reimbursement of medicinal products. Reimbursement of costs of medicinal products is covered by Chapter III of this Directive.

In particular, the recognition of prescriptions shall not affect a pharmacist’s right, by virtue of national rules, to refuse, for ethical reasons, to dispense a product that was prescribed in another Member State, where the pharmacist would have the right to refuse to dispense, had the prescription been issued in the Member State of affiliation.
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Looks like it comes from a 2011 directive but I can't find which one.

[Edit: seems to be "Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare"]

In the same email, the document for discussion quoted a paper saying:

Pharmacists may decline to dispense a medicinal product if they can demonstrate that doing so is “necessary or proportionate to safeguard human health” or if they have legitimate doubts about the authenticity, content or comprehensibility of the prescription.
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This is probably what they would point to in @Sarah Ryan case.

IANA(EU)L or a pharmacist so would be good to hear from them.
 
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arbitron said:
This is probably what they would point to in @Sarah Ryan case.

IANA(EU)L or a pharmacist so would be good to hear from them.
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So basically, after over a year and a half of prescribing a medication they can decide we don't like the format or the people that you are procuring this medication from, but if you'd like to use this service in Ireland we'll accept it from this service no problem.

Oh and by the way this service will not give you any guidance or follow-up information and we don't really care about your patient safety so long as it comes through the magic mailbox.

Right ok i got it lol. I just find it really difficult to resonate with silly decisions.
 
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@Sarah Ryan

I've taken what you had and re-drafted quite a bit for you to send to the European Commission. I'm basically trying to make very clear where the gap is between Irish law and practice and what EU law obliges. EU law is of course supreme and member states are supposed to implement it although frequently they don't. This is where the European Commission is supposed to investigate and take action up to the EU courts which can impose fines on a member state

Anyway if I was of a conspiratorial frame of mind I would imagine Irish doctors love nothing more than a prescription system that can't be accessed by doctors who aren't registered in Ireland:)

Back to the text below, I've made it quite neutral and specific. They get a lot of people with legitimate complaints but who leave out key details and put in irrelevant personal stuff so I've tried to keep it very dry.

Dear Ms XXX

I am an EU citizen resident in Ireland. For several years until 2024 my local pharmacy in Ireland was able to accept a printed prescription provided to me by a company called Mobidoctor. To my knowledge Mobidoctor is based outside Ireland but within the EEA and provides telemedicine services and prescriptions to Irish residents from medical professionals registered elsewhere in the EEA. Since early 2024 my pharmacy in Ireland has refused to accept printed prescriptions from Mobidoctor on the grounds that it could no longer do so due to new legislation in force in Ireland.

This legislation is S.I. No. 98/2020 - Medicinal Products (Prescription and Control of Supply) (Amendment) Regulations 2020. It states that Irish pharmacies may only accept prescriptions which are either in:

(i) nk and be signed by the person issuing it with his or her usual signature and be dated by him or her, or

(ii) electronic form, transmitted by the national electronic prescription transfer system and clearly indicate the date of issuance and, without prejudice to subparagraph (c)(ii), the professional registration number of the person issuing it, and must be traceable electronically back to him or her;”,

The Irish national electronic prescription system is known as Healthmail and is run by the Health Service Executive (HSE), the Irish health administration authority. The Healthmail https://www.healthmail.ie/registration.cfm (website)states that "Healthmail accounts are available only to healthcare professionals who are registered with the Irish Medical Council".

This appears to be in conflict with the obligation on member states to ensure that prescriptions issued in another EEA member state can be dispensed on their territory. I refer to Article 11 of the Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare (the "Cross Border Health Directive") which states:

1. If a medicinal product is authorised to be marketed on their territory, in accordance with Directive 2001/83/EC or Regulation (EC) No 726/2004, Member States shall ensure that prescriptions issued for such a product in another Member State for a named patient can be dispensed on their territory in compliance with their national legislation in force, and that any restrictions on recognition of individual prescriptions are prohibited unless such restrictions are:

(a)limited to what is necessary and proportionate to safeguard human health, and non-discriminatory; or

(b) based on legitimate and justified doubts about the authenticity, content or comprehensibility of an individual prescription.

The medicines prescribed by Mobidoctor are all legal to be dispensed in Ireland. The above restriction to medical professionals registered with the Irish Medical Council is not consistent with what is necessary or proportionate to safeguard human health. It is discriminatory. The above restriction is also disproportionate as a general measure with regard to concerns about the authenticity, content, or comprehensibility of a prescription.

I believe my rights as an EU citizen to benefit from prescriptions written by medical professionals elsewhere in the EEA are being grossly infringed. I urge the European Commission to investigate this issue with the Irish authorities and to take action up to and including infringement procedures against Ireland. I am ready to provide documentary evidence of prescriptions which have been refused by pharmacists based in Ireland.

Sincerely

Sarah Ryan
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I will send you the addressee by PM.

It's no harm as well to send it for information to the MEP candidates in the constituency where you live. This is the kind of thing where MEPs might take an interest as it means lower prices for Irish consumers via EU policy. National politicians are much more likely to be influenced by lobbyists for Irish medical professionals.
 
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arbitron said:
Some prescription requirements are common across the EU (e.g. patient demographic details, prescriber name, drug dose, etc.) but they are not universal and there can be significant variation. Differences can include the types of drugs available (e.g. generic substitution is not allowed everywhere), the types of prescriptions required (e.g. high-tech drugs), the duration a prescription is valid for, etc.
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That's a really useful insight from the inside. I'm a layman and it's always surprised me how much drugs and prescription defaults differ so much from country to country and I've never really understood the medical rationale given that human bodies do not vary that much!

I'm sympathetic to pharmacists who have to deal on a daily basis with fraud and abuse and need a minimum level of assurance that the prescription in front of them (electronic or paper) is valid. But at the same time the net effect of Healthmail has been to freeze out hundreds of thousands of medical professionals from prescribing drugs to Irish patients. This is despite these same medical professionals prescribing drugs on a daily basis to hundreds of millions of other Europeans without question!

I know there is a patient safety angle but it's hard to think there aren't medical professionals who don't like competition and this is a way to keep it out.
 
Dr Strangelove said:
That's a really useful insight from the inside. I'm a layman and it's always surprised me how much drugs and prescription defaults differ so much from country to country and I've never really understood the medical rationale given that human bodies do not vary that much!
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We are lucky in Ireland as the standard of care and service from pharmacists is remarkably high. There is a lot of variation across Europe, within and between countries, in both the quality of care delivered and the systems of delivery.

Unfortunately human bodies vary a lot... which is what keeps me in a job!

Dr Strangelove said:
I'm sympathetic to pharmacists who have to deal on a daily basis with fraud and abuse and need a minimum level of assurance that the prescription in front of them (electronic or paper) is valid.
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One hospital I worked in the catchment area had a high rate of prescription fraud. We would often get calls querying if a script was really from Nurse X or Dr. Y because there was some small detail off. Pharmacists are really good at picking these things up but with random emailed scripts from anywhere in the EU it would be very difficult. HealthMail helps with this and I suspect it benefits far more patients than it would disadvantage.

I was recently in another European country and needed a prescription medication that I had forgotten but knew it was over the counter there. No safety questions at all, they just sold me 8 months supply, as if I was buying Mars bars. That is not a good approach to drugs that can kill you. I would rather wait an hour and pay a bit more.

Dr Strangelove said:
I know there is a patient safety angle but it's hard to think there aren't medical professionals who don't like competition and this is a way to keep it out.
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Patient safety is a pharmacist's main job and they are good at it. That's why they ask really annoying questions and give a Paddington stare when you ask for codeine. I have no doubt that the industry as a whole wants to minimise competition but individual pharmacists care about their professional registration and not harming anyone.

I am personally anti-protectionist and think competition is healthy but in this area you have to be very cautious. The 3 worst patient safety cases I was ever asked to review all involved irresponsible treatment abroad in the EU: 1 related to surgery and 2 to prescribed items. I can't go into details but I can tell you the surgical one was horrific, with a near death for the patient and a cost to the HSE of at least 7 figures in aftercare (so far). The other 2 each cost the HSE low 6 figures to treat, not to mention the life-long side effects for the patients. None of these incidents could have happened in Ireland, which is why these people ended up going elsewhere in Europe, sadly with disastrous consequences. We have enough problems and costs in the HSE without adding to them.

The aim in healthcare is for it to be affordable, accessible, and safe. It is extremely difficult to achieve all 3, so you always have to consider if a doctor/pharmacy is accessible and cheap, are they providing high quality care? Maybe, but I would tread very carefully.
 
arbitron said:
The aim in healthcare is for it to be affordable, accessible, and safe. It is extremely difficult to achieve all 3, so you always have to consider if a doctor/pharmacy is accessible and cheap, are they providing high quality care? Maybe, but I would tread very carefully.
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I can hand on heart say that the level of care I have gotten from Mobidoctor is on par with what I have gotten from my own GP the very odd time I have had to physically go and see him.

Anytime I have done a video consultation for sinus / ear infections they go through all symptoms in detail and also ask very specific questions which I gather are doing checks for infection / potential sepsis issues. Very thorough.

Accessible, affordable and quality are possible with this service and I can say that from experience. I guess it's one of those things it needs to be seen to be believed.

Also extremely handy when you are travelling around Europe as well no trying to find a doctor or hospital.
 
I assume you can print out several and present it to other chemists.

I remember ringing a local chemist for an urgent script for my mother and they gave me both the healthmail address and the ordinary email.
 
beautfan said:
I assume you can print out several and present it to other chemists.

I remember ringing a local chemist for an urgent script for my mother and they gave me both the healthmail address and the ordinary email.
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No quite the opposite there is a code on each script that you can check has it been filled already.
The pharmacist needs to mark the script as filled on the website - if the pharmacist doesn't complete the process should the end user have to suffer?
 
Sarah Ryan said:
No quite the opposite there is a code on each script that you can check has it been filled already.
The pharmacist needs to mark the script as filled on the website - if the pharmacist doesn't complete the process should the end user have to suffer?
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Oh I see, I thought it was like the old paper script that was stamped.
 
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