Thoughts on Prescription Charges

Hidden away amongst the discussion of the Compton Review Edwin Poots again mentioned the prospect of reintroducing prescription charges. There is a certain irony in this in that although it was Michael McGimpsey who ended prescription charges the DUP repeatedly claimed this move as one of the successes of devolution and claimed much of the credit for that decision.

More recently, however, Poots has repeatedly proposed reintroducing the charges in order to pay for cancer drugs and the like. Part of the problem of ending prescription charges has been that it proved considerably more expensive than it was at first anticipated (£30 million rather than the expected £13 million). There have been reports of people getting things which seem frivolous on prescription such as sun cream which they should buy for themselves. As an aside there are a number of medical conditions where sun exposure is so dangerous that free sun block might be entirely reasonable such as albinism or lupus. Some drugs such as amiodarone can also make people extremely sun sensitive. However, for the majority of people we should clearly buy our own sun cream.

The concern has been that people have been getting things they previously would not have asked for and either were unnecessary or often would have bought for themselves (such as paracetamol). The current suggestions of a 50p charge seem fairly trivial but may earn some money (the BBC say millions but put no more details on it). They may reduce the trivial requests but the costs of administering a system with only a 50p charge may make the financial benefits negligible and very few over the counter medications cost less than 50p so the reduction in requests for drugs better bought by the patient themselves may be very limited.

There is, however, another possible method for charges.

It must be understood that the prescription charge of £7.40 in England is quite expensive. Sometimes the drugs it buys are vastly dearer: 56 Bosentan tablets – a 28 day supply for a condition called pulmonary hypertension costs £1510.21. On the other hand a 7 day course of amoxicillin (a standard antibiotic) costs £1.07 and a 28 day supply of bendroflumethiazide (for high blood pressure) 79p. Frequently therefore the £7.40 a patient pays is vastly more than the cost of the drugs s/he obtains and more even than could reasonably be considered an acceptable dispensing charge.

The other issue is the cost of prescriptions for long term aliments and who should and should not pay for their prescriptions. From personal experience I have had asthma for 30 years and as an adult always had to pay for my prescriptions (until the charge was abolished). It was noteworthy that pharmacists were sometimes surprised when I got out money to pay for the prescription as they were so used to most people having free prescriptions and “signing on the back”. Currently the DoH in England claim 90% of their prescriptions are free but equally £7.40 per item is so much that it would have to be free for many people: a middle aged man with a heart condition might well still be working and on 5 drugs and, hence, could be charged £37.00 per month (£444 per year). One can, however, obtain a monthly or yearly prepayment (£28.25 and £104 respectively).

Occasionally in the past pharmacists and GPs in England have apparently come to an agreement to help their patients: the GP has issued a private prescription for the medication if it is an inexpensive drug and the pharmacist has then dispensed it for cost price plus a modest dispensing fee. Such a system has required the cooperation of both GP and pharmacist and, I believe, was severely frowned upon by the NHS. It would, however, offer a mechanism for prescription charges which might be fair and equitable and also show patients the cost of their medications. There could be an agreed NHS dispensing charge with at least part of that paid by the patient (say £1.00 or £2.00) and the patient then, in addition, required to pay for the medication up to a maximum value of again £1.00 or £2.00. This would result in patients making a contribution to the cost of their treatment, would discourage obtaining prescriptions for trivial things, would more accurately reflect the true cost of some medications and obtain money for the NI NHS. The introduction of such a system with relatively fewer people qualifying for free prescriptions might offer a mechanism whereby patients could obtain their medications at an acceptable cost whilst saving considerable money for the NHS and possibly even achieve both of these with public acceptance.

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