# Medical card - Pharmacies



## gotsomenow (1 Jul 2009)

Hello,

I was wondering if anyone could shed any light on this.  I get medicine every month and it would come under the Long Term Illness Scheme.  Does anyone know if this will be effected by the cuts?

Thank you.


----------



## Fatphrog (1 Jul 2009)

Ask your pharmacist what he's doing on August 1st.


----------



## annet (2 Jul 2009)

Mary Harney is planning to reduce the payments made to the pharmacists under these schemes.  Essentially, notice of withdrawal on the minister has been served - withdrawal date being August 1.  The affected schemes are the GMS (medical card), long term illness book and the drugs payment scheme.


----------



## gotsomenow (2 Jul 2009)

Well rang my pharmacy and thankfully I have such a great pharmacist because she is ordering me two months supply for July.  After that I don't  know what will happen, but I will more than likely end up costing the government more by being admitted to hospital.  I could no way ever afford the meds, they cost nearly 4 times the amount of my mortgage.


----------



## Mpsox (2 Jul 2009)

at the minute not all pharmacists are withdrawing from the scheme, according to todays papers two thirds have writen to the HSE withdrawing


----------



## locum-motion (2 Jul 2009)

I am a pharmacist.

Very much simplified version of situation/issues:

1. Under the Health Acts, Govt is obliged to provide your drugs for you if you're eligible.
2. Pharmacists were contracted to provide these for you on Govts behalf.
3. The Govt tried to reduce the payments for these services, was ruled by the court to have breached the contract.
4. Govt changed the law (Financial Emergency Measures in Public Interest Act, 2009, aka FEMPI) meaning that contract wasn't worth paper its written on. FEMPI states that Minister can reduce payments despite any contract that says otherwise.
5. Govt announced sweeping cuts in the payments at only 13 days notice, amounting to approximately 34-35% of the profits that pharmacies made for providing the services. Essentially, cuts are on a "take it or leave it" basis. (FEMPI says health professionals can give 30 days notice if they don't want to accept the cuts)
6. Many pharmacists (approx 1100 out of 1500-1600, as of 2/7/09) give the Govt notice of non-acceptance of the cuts, effective from 1st August.
7. Govt still obliged to supply or make arrangements to supply your drugs.

For a details discussion of how much pharmacies are paid, including explanations of why medicines are much cheaper in Spain etc., please visit the following thread:
http://www.askaboutmoney.com/showthread.php?t=115450
Please read it. You may be surprised. Pharmacies are not the rip-off merchants that many seem to believe.

Pharmacists recognise the need to save money on the drugs budget, and have been attempting for years through our Union to negotiate such matters with the Govt. The Govt has consistently refused to negotiate. When last year's attempt at cuts nearly led to a withdrawal, there were 11th-hour promises made by the Govt/HSE to engage in meaningful negotiations with the Union. These promises were reneged upon.

What pharmacists want: the right to have cuts negotiated with our Union; for any cuts to be reasonable and proportionate to that being asked of other professions/sectors of society; meaningful engagement with our Union about how to reduce the overall drugs bill in a sustainable manner.

What happens in August: The Govt's obligation to supply meds to those eligible still exists. Similarly, for those with "partial eligibility" are still entitled to get refunds and/or partial refunds. If the Govt doesn't engage with the Union, they will have to make alternative arrangements for you. Please ask the HSE what those alternative arrangements are.

We are not being unreasonable. The HSE and the Govt in the form of Mary Harney are being unreasonable.

Please, talk to your local pharmacist. We are an approachable bunch of people, and you don't need an appointment! Ask us how much it costs us to buy stock. Ask us how much we used to get paid to supply them. Ask us how much we will get paid in the future.

And then, make up your mind.

Thanks for reading.


----------



## markowitzman (3 Jul 2009)

best of luck in your campaign.
HSE as usual will try and cut at front line when the dogs on the street know the waste is in the pen pusher political appointees in the admin sections.
Joe Soap does not realise that the local pharmacy is doomed.
Joe Duffy was very biased against legitimate pharmicist's concerns today.
The populist view is to say rip off ireland and let the fat cats suffer.
Harney is feeding off this.
Public support will only happen once pharmacies close and then Joe Duffy will be bleating and it will be too late!!
Save your local pharmacy!


----------



## commentator (6 Jul 2009)

I have two quite separate questions about this mess:

1. Can someone with a medical card or a DPS card still go into their pharmacy and pay the full price for their prescription (obviously assuming they have the money to do so) and claim it back from the HSE?

2. It seems to me that the private and DPS business which pays very well for pharmacists subsidises the medical card business which is very poorly paid\(am I right?). Why have the HSE and the Pharmacists union never been able to sit down and negotiate a proper overall pay arrangement that is fair to both the pharmacists and the tax-payer who ultimately pays the bills? The whole payment system seems overly complicated and distorted to me between mark-ups and fees and discounts. Rather than tinkering with the existing pay structure why couldn't it all be restructured properly or am I being completely unrealistic and idealistic given that it's the HSE involved. I just don't understand why the dispute has escalated so quickly to this extent but then again I don't know the history here.


----------



## locum-motion (7 Jul 2009)

commentator said:


> I have two quite separate questions about this mess:
> 
> 1. Can someone with a medical card or a DPS card still go into their pharmacy and pay the full price for their prescription (obviously assuming they have the money to do so) and claim it back from the HSE?
> 
> 2. It seems to me that the private and DPS business which pays very well for pharmacists subsidises the medical card business which is very poorly paid\(am I right?). Why have the HSE and the Pharmacists union never been able to sit down and negotiate a proper overall pay arrangement that is fair to both the pharmacists and the tax-payer who ultimately pays the bills? The whole payment system seems overly complicated and distorted to me between mark-ups and fees and discounts. Rather than tinkering with the existing pay structure why couldn't it all be restructured properly or am I being completely unrealistic and idealistic given that it's the HSE involved. I just don't understand why the dispute has escalated so quickly to this extent but then again I don't know the history here.


 
1. Under the Health Act (and I'm paraphrasing here) the Govt is obliged to
a) provide meds to those entitled to it.
b) provide refunds or partial refunds (as laid out in the regulations) to those with partial entitlement, or to those who are entitled but chose not to use their entitlement to obtain their medicines directly. So, in other words, Yes. But don't be surprised if the HSE say No!

2.
a) (Yes).
b) IPU have been trying to negotiate for years. Unfortunately, it is impossible for only one party to negotiate!
c) You're absolutely right.
d) Yes, I'm afraid you are. As you say, it's the HSE that are involved!
e) It hasn't been that quick. Something like this has been brewing for a couple of years. Something similar nearly happened last year. At about 21:30-22:00 on the night before 986 pharmacies were pulling out, the HSE made various promises re negotiation etc. These promises were reneged upon. Since then, the High Court has ruled that the cuts then planned were in breach of contract. Then the Govt changed the law so that they could make cuts despite the contract. Then they made this new attempt to make cuts.


----------



## Fritz6 (7 Jul 2009)

Can't help but feel a bit sorry for both the Pharmacists and the Government. Like everthing else this should have been tackled during the good years when the govenment and pharmacy had the cash and the pharmacy market was growing at 14% p.a.

I think the essence of what the government is trying to do is ok(ish). The cost of distributing drugs in Ireland is too high. The system was set up so that the wholesaler would receive 15% margin (17.66 mark up - same thing) on drugs. So with a trade price of €10.00 for a drug the wholesaler should get €1.50 and the pharmacist a fee (€3.60 or whatever - I think the average is about €3.90 accross all schemes?) and in the case of private/DPS etc a 50% margin. However, the Pharmacist then began to play the main wholesalers off against each other to get more margin in the form of discount (average of 8%) - even on GMS (discount is for almost all purchases regardless of how they are finally dispensed!)

So in our example above the actual cost of the drug to the pharmacy is say avg €9.20, but they claim from the government as if the cost was €10.00.

This is what Mary Harney was after! Her point was that if the wholesalers can give away 1/2 their margin then it should be going back to the taxpayer (who pays the total bill) not to the pharmacy. That's why the HSE were saying last year that the reduction in reimbursement to 92% of trade price would not affect pharmacy margins - their opinion was that this money was not meant for the pharmacy in the original scheme when it was set up- it was wholesaler margin and if they don't need it the taxpayer will take it back thank you very much!

Only problem with the above is that there is no such thing as an average pharmacy - some will screw the wholesaler for discount and end up claiming from the government (as cost) more that the actual cost of the drug to them (in addition to fees, margins etc) and some will have discount levels less that 8% and end up only being able to claim less that the actual cost of the drug! This is the basis of the claim by some pharmacies that they will end up being reimbursed less than the cost of the drug - yes if they have less that 8% discount with wholesalers.

There is no doubt that the pharmacy market has been a gravy train for the last number of years (can't deny it - just look at the number of new pharmacies being opened - that signifies one thing - big salaries and profits.)

This new fee structure announced a few weeks ago, however, goes beyond just reclaiming the discount from the wholesaler and could put shops in serious risk of closing.

Which side are you on (if you can be on any side here)? Can't help feeling that the industry was a bit thick to treat the wholesaler discount (or discount from manufacturers on generics which can be huge) as permenant. Take it while its there obviously - that's capitalism at its best, but don't build your whole business model on the premise that it will always be there. Many pharmacies will have to restructure there business to survive here.

Read the Indecon Report on the sector - very interesting.


----------



## locum-motion (7 Jul 2009)

Well done, you show a much better grasp on the concepts than most: have you a connection to the pharmacy game? You certainly understand it much better that Harney does!

The problem is that without the little bit of percentage point profit that comes from the discounts (and also the fact that DPS/LTI effectively cross-subsidise it), the GMS scheme is financially unviable. Actual cost price plus a flat fee of a couple of quid was fine  when the scheme was set up in the 70's. But a month's supply of Zyprexa 10mg twice daily (to chose one example) is ~ €140! To get paid €143.60 for it would be unsustainable. And under the new model you'd get...wait for it...€135.90. If you get 3% or less discount from your supplier, you'd be _paying_ the government for doing your job. If you get 6%, you make a profit of €4.30 (margin of 3.1%)

OK, I know the Zyprexa example is an extreme one, but the point remains!


----------



## fobs (7 Jul 2009)

There does seem to be a very large number of pharmacies and maybe the market is saturated and some need to close. In my small town there are 5 pharmacies, 2 of which have opened in the last 2 years. This seems an overkill as no other business with such high number in the town bar pubs (there are 6 pubs) and there have been 3 pub closures in the last 3 years. Maybe if there was less pharmacies there would be more business to go around.


----------



## Darthvadar (7 Jul 2009)

Well, whatever the rights and wrongs of the whole issue, and I don't want to get into an argument about it all,  I want to say how much I and my mum appreciate the wonderful service we receive for our pharmacist...

I've multiple disabilities and medical conditions, and I'm caring for my mother who is is in End Stage Kidney Failure... Combine that with the fact that we are both wheelchair users, you can imagine just how important a good pharmacist is... 

Our medication needs come under three different schemes... GMS, Hardship Meds, and High Tech. Meds (Mum's Arenesp injections)... I dread to think of the paperwork involved!. The pharmacist is wonderful, and goes above and beyond the call of duty to help... Always available (I have her mobile number, and have been told to call day or night if need be!... I would never do it, but it's appreciated!). If there's an error, or mix-up in our prescriptions (frequently happens!), she just grins and says "Don't worry about it, leave it with me, I'll sort it out, and deliver this afternoon"... The time she spends on the phone sorting out things out for us doesn't bear thinking about... 

She also delivers our meds, and even puts them away for us... I don't know how we'd cope if we hadn't a good, very helpful pharmacist... Just to know we're being well taken care of is such a relief... 

I want to wish all good, caring pharmacists all the very best, and may I say a HUGE thank you for the lifeline you provide to those of us with serious illness, and or significant disability... You're certainly our fourth Emergency Service!...

May God bless and protect you all...

Darth...


----------



## GreenQueen (8 Jul 2009)

While I agree with the previous poster about the wonderful service that my local pharmacist and dispensary provide I have to say this action has me extremely troubled.

I dread to think how we (as in my family) are going to manage to pay for the large amount of medications that I'm prescribed if my chemist withdraws their GMS/DPS service.  If it is a situation where we will have to pay up front and subsequently get refunds from the HSE I will be in a difficult position where I will have to pick and choose what medication I can afford to pay for.  

I am definitely not the only person with this concern and I'm extremely worried.  I do have sympathy for the pharmacies for the position they find themselves in but the action will put a large number of families into financial hardship in the short term when many are struggling to survive as it is.


----------



## Darthvadar (8 Jul 2009)

GreenQueen...

Have a chat with your pharmacist about your concerns... I think you'll find that him or her sympathetic to your plight... 

Mine is arranging for us to have enough supplies for three months if need be (hoping the dispute won't stretch out that long, but wise to be making contingincy plans)... Like yourself, I certainly couldn't afford to pay up front for our neds...

Darth...


----------



## locum-motion (9 Jul 2009)

locum-motion said:


> Well done, you show a much better grasp on the concepts than most: have you a connection to the pharmacy game? You certainly understand it much better that Harney does!
> 
> The problem is that without the little bit of percentage point profit that comes from the discounts (and also the fact that DPS/LTI effectively cross-subsidise it), the GMS scheme is financially unviable. Actual cost price plus a flat fee of a couple of quid was fine when the scheme was set up in the 70's. But a month's supply of Zyprexa 10mg twice daily (to chose one example) is ~ €140! To get paid €143.60 for it would be unsustainable. And under the new model you'd get...wait for it...€135.90. If you get 3% or less discount from your supplier, you'd be _paying_ the government for doing your job. If you get 6%, you make a profit of €4.30 (margin of 3.1%)
> 
> OK, I know the Zyprexa example is an extreme one, but the point remains!


 
I checked today, and my example above is wrong. A month's supply of that particular drug costs €138.38 if you're on it once a day. It'd be €276.76 for twice daily.


----------



## annet (10 Jul 2009)

In today's Irish Times there is a report that Prof. Drumm has asked Local Health Service Managers in the HSE to each provide three alternative sites to dispense medicines to patients as a contingency plan in the advent of pharmacies withdrawing from the state community schemes.  Where exactly are these services going to be located... in clinics, hospitals, community halls?  Are we going to further entrench the two current tier health system - where those with the ability to pay will access local community pharmacies and those with long term illnesses, or eligibility under the DPS or GMS system will be faced with another endless queue and waiting list... this time on the street?  Are we back in the poor law?


----------



## gotsomenow (11 Jul 2009)

Holy God, that sounds mad.  My prescription comes under High Tech meds too.  I rang the HSE on the day I last posted here and surprisingly nobody could answer my questions (What would happen to me when the medication ran out), I was promised a call back.  I must have rang 50 times since, but I am still waiting on my call.

I have to say, I am getting very nervous.


----------

