Guest Post from Mr. Dispenser: The Back of It

Thank you, Mr. Dispenser for this great guest post! It’s about how prescriptions are paid for in England, geared towards the US audience. It’s quite enlightening and very interesting. I hope you guys enjoy it. If you get a minute, you should check out his blog. He’s a great writer that I always enjoy reading. My US counterpart can be found on his page.

—————————–

The Back of It

In England, the majority of people get free prescriptions if they qualify through 13 categories. Although, I really wish patients would stop asking me what they should tick on the back of their prescription!

 

 

The categories are:

A] Under 16 years of age

It makes me chuckle when people tick income support on their babies’ prescription. The parents fill in the prescription but writes down her exemption instead of the child’s.

B] 16, 17, 18 AND in full time education

If you leave school at 16 and get a job, then you pay. Students start university at 18 years of age and get quite upset when they hit 19 and realise that they have to pay. I have seen students blatantly lie about their age even though it is printed on the prescription.

C] Over 60

The people who use the most medicines get free drugs too. The pharmacy staff sometimes fill out the back of the prescription for people who are exempt by age, when we receive the prescription from the doctors. Sometimes, they tick over 60 when they patient is not. One day, I will get a slap when handing out a prescription for an insecure 55 year old lady

There is no requirement for someone over 60 to sign the back of their prescription if it is a printed prescription as it’s obvious from the date of birth that they will be exempt. Depending on how grumpy the person is, I do or do not make them sign.

Sometimes you may ask someone to pay and they say that they are over 60 and it’s confirmed by looking at the prescription properly. If you apologise and say that they look good for their age, then you will get brownie points.

D Maternity exemption

Once you get pregnant and up to the child’s first birthday, your prescriptions are free. Sometimes, ladies will ask me if I want to see their exemption card but I say that I can see their evidence. This is either a big bump or a baby.

Sometimes, this is ticked by a man with medical exemption by accident which causes much hilarity and embarrassment for the man.

 

E] Medical Exemption

People with certain conditions get free prescriptions. These include epilepsy, diabetes and under active thyroid. Recently cancer was added to the list which is excellent. However, my Auntie was over the moon when she got diabetes as she now has free prescriptions for life.

F] Pre-payment certificate

If you do pay for your prescription, then it can get costly. Each item costs £7.65. If you need more than 4 items in 3 months or 14 items in 12 months, then a three or twelve month pre-payment is a good option. They cost £29.10 and £104 respectively. Then you can get as many prescriptions as you want.

Unfortunately, some people don’t believe that it is a good offer. I once wasted 5mins of my life explaining the benefits of a pre-payment complete with calculations and my working out and they couldn’t be bothered. I’m more upset about having to do some calculations.

G] War pension

Former soldiers are also entitled to free prescriptions.

L] HC2

People on low incomes can apply for a HC2 certificate. This is normally but not exclusively used by students once they turn 19. It normally depends on how much savings they have, whether they work and how much their parents earn.

X] Free of charge contraceptives  

All women get free contraceptives on prescription. Some women who have another non-contraceptive item on the prescription, sometimes conveniently forget to pay for that item and just tick X. These women get chased after by overweight pharmacists.

H] Income support

This is the most common benefit that is ticked on the back of the prescription. This is also the default option when people don’t know what to tick. Some people who can’t speak English just say ‘H’ when asked what they tick. It is also normally ticked by people in expensive cars who have just come back from holidaying abroad

K] Jobseekers allowance

This is another benefit that is given to some people. It is normally ticked by people in McDonalds uniform and taxi drivers

 

M] Tax credits

Another benefit that is generally claimed by people who work part-time or have a partner that does. Some pharmacy staff claim this. There is sometimes the awkward situation when they don’t want to accept any more hours at work as it will affect their tax credits.

S] pension credit guarantee credit

I have never seen anybody tick this option

Prescription Charge

The prescription charge is a contribution to the NHS. It is not a payment to the pharmacist. It bears no relationship to the cost of the medication. It is currently £7.65.The quantity of each item is irrelevant.

There are some anomalies. A pair of hosiery stockings carry two prescription charges. If you are prescribed the same drugs in different strengths is only one charge. A drug prescribed in two different formulations is two charges.

False exemptions

There is a great opportunity for patients to tick anything on the prescription. At the end of the month, all the prescriptions get sent off to The National Health Service Business Services Authority for payment. Less than 1% of the exemptions are checked by them. So it is highly likely that you will not get caught unfortunately.

There is an ‘evidence not ticked box’ on the back of the prescription for the pharmacy to tick if the patient has not provided any evidence. Pharmacy contractors are in no way responsible for the accuracy of a patient’s declaration; this remains the responsibility of the patient. Patients found to have wrongly claimed help from the NHS with the cost of their NHS prescriptions will face a penalty charge and in some cases prosecution.

If the patient does not tick anything on the back of their prescription and it gets sent off, then £7.65 is taken off the pharmacy. It is in the pharmacies best interest to ensure that the back of the prescription gets filled in.

 

Mr Dispenser

My blog can be found here

Pictures Are Worth a Thousand Words

 

So, I realized something today. I realized how much I’ve become a part of some of my patients’ lives. I know that a pharmacist is a familiar face many people see; however, forming a bond with a patient is something special and doesn’t happen with just any patient and any pharmacist.

Today, I had a woman share pictures of her grandson’s graduation from college. She had them in a cute photo album and everything. I didn’t think anything of it until she told me she has been carrying it with her the past few times she came to the pharmacy, hoping it would be my day to work. I suddenly felt very prominent in this woman’s life and not just in a healthcare professional way. It made me smile to know that she has connected with me in such a way. It ultimately benefits her and will make the quality of healthcare she receives from me even better. I’m not saying I will treat her better than other patients, but that she will be more receptive to what I advise her to do. She will be more open to patient education that is important to share with her. And, that is a great thing.

After that, I realized that there are several other people who have made similar, more personal connections with me. I feel very privileged to be able to experience such wonderful things. Days like these  make me enjoy my job and profession even more than I already do. =)

So, what personal connections have you guys made with your patients? Patients, what personal connections have you made with your healthcare professionals? I would love to hear.

 

Image courtesy of http://i736.photobucket.com/albums/xx10/CindyGee13/photography1.jpg

Stole Our Hearts

 

Today’s story is a sad and difficult one.

One of our pharmacy’s favorite patients stopped by today. He’s a man in his nineties and loves to make us laugh. He didn’t have a prescription, but he said he had some other shopping to do. He stopped by and said hi to everyone. We all smiled and were glad to see him, as always.

Our smiles quickly faded, though, because we were informed by our store manager that she caught him stealing candy and a few other items. We didn’t want to believe it. We asked if it was just forgetfulness or senility, and we were told it wasn’t, as he had stuff shoved in his pants and jacket pockets and began walking out the doors without purchasing anything else. It made us wonder how many times he had done this before. =(

This is probably once of the most difficult things I have come across at this pharmacy. Luckily, I was not the one who had to approach him about it. Now, our trust in him as a patient and a person is gone. I wonder if he was stealing due to a lack of money, but still, none of the items he attempted to steal were necessities. Overall, it’s just so disheartening.

 

Image courtesy of http://i627.photobucket.com/albums/tt354/Klepto_Cam-_-/klepto.jpg

Puffy Eyes

 

So, I had an interesting phone call today. A woman who isn’t a patient of ours called to ask about her eyes. She told me they were red, puffy, and almost swollen shut. I asked if both side were equally swollen, and she told me they were. She also told me the few medications she was on, but stated that she had been on them for a while. At this point, I had come to the conclusion that is was either really bad seasonal allergies or that she had consume or used something that she was allergic to without knowing it.

I asked if she had eaten anything out of the ordinary or new recently and if she had switched soaps or detergents in her house. She answered no. I started telling her that she should take some diphenhydramine and call her doctor first thing in the morning. She interrupted me, asking if there were any interactions with that and her other medications. I told her no, and she replied back to me:  “Well, that’s good. I just wanted to make sure, since these medications are all sort of new to me.” Whoa. Back up. Rewind. Didn’t she just tell me she had been on them for a while? I asked her when she began taking the medications. She told me she started them a week ago. *facepalm*

So now, the tables have turned. Now, I’m leaning more towards a drug allergy being the cause of this. But, the question is, which one is causing the problem? She started each of them on the same day. I told her this and let her know the only way to know for sure which drug would be the cause is to discontinue all of them and restart each individually. Again, I told her to take the diphenhydramine and call the doctor first thing in the morning. I also told her if she experienced any throat tightening or trouble breathing to go to the emergency department of the nearest hospital. She agreed to do so if needed, thanked me, and hung up.

The take home point of this story is to always ask questions. Lots of questions. Ask the same thing in different ways. Use open-ended questions (when did you start these medications vs. have you been taking these medications for a while). It’s important for us to ask these questions and get to the root cause of why the patient is speaking with us. It’s how we screen them and determine what action needs to be taken next, whether it be self-treatment, a call to the doctor, or even a hospital visit. Never be afraid to ask the same thing again if you need to. When patients seek out your help and advice, they usually don’t mind the questions. Most times, they appreciate how much effort we put in to helping them. This is one of our duties to our patients. It falls under the “Do No Harm” portion of the Hippocratic and/or Pharmacist’s Oaths. And, it can make all the difference in a person’s life.

 

Image courtesy of http://i33.photobucket.com/albums/d76/xx_Emmeh_xx/eyeball.jpg