Minister Cowen announces improved changes in Community Drugs Schemes
The Minister for Health and Children, Mr Brian Cowen TD today (1 December, 1998) announced improved changes in the Community Drugs Schemes with effect from 1 March, 1999. These changes are:
- firstly, the existing Drugs Cost Subsidisation and Drug Refund Schemes will be merged into one new Drugs Payments Scheme with a threshold of £42 per month per family unit;
- secondly, a common drugs/medicines list for all schemes will be introduced. This list will essentially be the current list of items reimbursable under the General Medical Services Scheme, and
- thirdly, in tandem with these changes, the introduction of a common prescription form for all schemes.
The primary aim of the new Drugs Payment Scheme is to bring about important improvements and equity in the existing schemes.
“The new Scheme will effectively merge the best elements of the two existing schemes and is designed to significantly improve the cash flow situation for families incurring ongoing expenditure on medicines” Minister Cowen said.
The new family scheme will have significant advantages over the existing Drugs Refund Scheme. Under the Drugs Refund Scheme, families pay the full cost of their prescription medicines and may, at the end of the quarter, claim reimbursement from their health board of expenditure over £90 in that calender quarter. Many families have very heavy expenditure on drugs and medicines in a quarter and have to wait a further six weeks from the end of that quarter before they receive a refund. In effect, they may have to wait up to four and a half months and be incurring expenditure in the next quarter before they receive a refund. In 1997, more than 110,000 claims under the Drugs Refund Scheme were for claims in excess of £150 per quarter. Of these, approximately 33,000 were for claims of £300 or more per quarter or almost £80 per month. This can cause considerable cash flow problems for a significant number of families. This will not happen under the new Drug Payment Scheme. From 1st March next, no individual or family will have to pay more than £42 per month for prescribed medicines. It means that families will, for the first time, be able to budget for the cost of medicines. Families will know that, whatever the size of their drugs bill, whatever unexpected illness might befall them, they will not have to pay more than £42 per month. In addition there are families where, although one member may qualify for a Drug Cost Subsidisation Scheme card, combined expenditure on medicines by other members, which can be considerable, cannot be recouped until the end on the quarter. With the new Drugs Payment Scheme, no family will have to pay more than £42 in any month for prescribed medicines. The new scheme will be of significant benefit to such families.
The fact that the Drugs Payment Scheme will operate on a monthly basis has distinct advantages over the current Drugs Refund Scheme. Under the Refund Scheme, a family could, for example in one month have expenditure of say £80 but no expenditure in the other two months. They would not have been entitled to a refund. Under the new scheme, they will only have to pay £42 in that month.
“The new Drugs Payments Scheme is for everyone. To qualify under the old DCSS Scheme, patients had to be certified by their doctor as suffering from a condition requiring ongoing expenditure on medicines in excess of £32 per month. There are no qualifying criteria for the new scheme. In effect, where expenditure by a family exceeds £42 per month, the balance will be met by the State” said Minister Cowen.
With regard to the increase in the threshold, the Minister pointed out that there has been no increase in the threshold for the existing schemes since 1991. It must also be borne in mind that the new threshold refers to family expenditure as opposed to the existing threshold in the Drug Cost Subsidisation Scheme which relates to individual expenditure.
“The introduction of the common medicines list will ensure equity between the General Medical Services and the new Drugs Payment Scheme in relation to the range of medicines paid for by the State under both schemes. It will not remove any essential prescribed medicines from the schemes. The comprehensive range of the most modern therapies required to treat all conditions, which is available on the GMS, will continue to be paid for under the new scheme” Minister Cowen explained.
What is being removed is a range of over-the-counter preparations that do not need a prescription from a doctor and are available in many instances in supermarkets and other retail outlets. Examples of such products are some simple analgesics such as Panadol, Disprin, Solpadeine, Neurofen; vitamin supplements such as Rubex, vivioptal, seven seas, royal jelly; and products for the treatment of baldness such as Regaine. A range of analgesics are on the GMS and these will continue to be paid for under both schemes. “It is, in my view, seriously inequitable that the cost of these products is reimbursed to patients who may have significant means, whereas those with medical cards who constitute some of the least well-off in society, have to pay for them” concluded the Minster.