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Prescription reform

Liz Phelps
Citizens Advice
Key facts and figures
• £7.10 per item (£7.20 From April 09)
• £102.50 for 12 mth PPC (£104 from April 09)
• 796 million items dispensed in 2007
• Average of 15.6 prescriptions per person
• 89% of items delivered free BUT around 80% of
  patients aged 18-60 pay.
• Charges raise around £450 million (but admin
  costs around £50 million)



Prescription reform
Twofold problem
• Unfairness
  • Unequal load – some pay nothing , others over £100
  (if spread equally on per capita basis would cost less
  than 10p per person per year.)
  • Sick pay more – correlation between health and
  poverty
  • Current exemptions impossible to justify
  • Free in Wales, abolition planned in Scotland and N
  Ireland
• Affordability –


Prescription reform
Affordability - CAB perspective
• 2,000 enquiries a year about prescription charges
• Key issue – difficulty in affording charges/ going
  without/penalty charges(5x amount owed)
• 2001 CAB report Unhealthy Charges. MORI research
  updated 2008 - 800,000 going without all or some of
  their prescriptions because of cost
• People on low incomes AND with long term health
  problems worst affected
• Key recommendation – strong case for abolition BUT
  priority must be to tackle affordability by increasing
  income threshold for free prescriptions.



Prescription reform
Government response
• 2004 free prescriptions level raised to IS +1/2
  prescription charge (BUT have to claim under
  LIS)
• PPC purchase by direct debit to spread the cost
• No action in response to HSC 2006 report
  despite promised consultation until:
• Sept 08 Brown announcement - affordability
  agenda abandoned?



Prescription reform
CAB response to current review
• Concern that affordability ignored
• Extending LTC exemptions will
  • Be complex to administer
  • Be perceived as unfair
  • Fail to address affordability
• learn from Scottish experience – from LTC to
  abolition following consultation




Prescription reform
The case for abolition
• Free at the point of delivery
• Health and poverty links
• Fairness – sick pay most (cf funding via income tax)
• Cost effective? Health impact of not being able to afford
  to get prescriptions dispensed
• Once you take out the high users/payers (LTCs), is it
  economical to administer?
• Paid for by savings from move to generic prescribing
  (OFT 2007 market study identified £500 million potential
  savings from just some major drug categories)
• BUT if abolition not acceptable then priority must
  be:


Prescription reform
Extend exemption to main disability
benefits
• Use receipt of ICB/ESA and DLA as proxy for
  LTC
  • Simple to administer, easy to implement
  • Makes sense to patients
  • Focuses help on those with LTC who are likely to be
  on a low income because unable to work (IB/ESA)
  and/or have disability/ caring needs(DLA)
• AND



Prescription reform
Reform PPC

• To help those with LTC not claiming disability
  benefits:
  • Halve the cost of PPC
  • Improve patient awareness of PPC by embedding
  take-up in prescription issuing/dispensing process
  •    incentivise GPs/pharmacists to provide information and advice
  on claiming PPC
  •    Set DH targets on PPC take up




Prescription reform
Prescription reform

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Prescription Reform

  • 2. Key facts and figures • £7.10 per item (£7.20 From April 09) • £102.50 for 12 mth PPC (£104 from April 09) • 796 million items dispensed in 2007 • Average of 15.6 prescriptions per person • 89% of items delivered free BUT around 80% of patients aged 18-60 pay. • Charges raise around £450 million (but admin costs around £50 million) Prescription reform
  • 3. Twofold problem • Unfairness • Unequal load – some pay nothing , others over £100 (if spread equally on per capita basis would cost less than 10p per person per year.) • Sick pay more – correlation between health and poverty • Current exemptions impossible to justify • Free in Wales, abolition planned in Scotland and N Ireland • Affordability – Prescription reform
  • 4. Affordability - CAB perspective • 2,000 enquiries a year about prescription charges • Key issue – difficulty in affording charges/ going without/penalty charges(5x amount owed) • 2001 CAB report Unhealthy Charges. MORI research updated 2008 - 800,000 going without all or some of their prescriptions because of cost • People on low incomes AND with long term health problems worst affected • Key recommendation – strong case for abolition BUT priority must be to tackle affordability by increasing income threshold for free prescriptions. Prescription reform
  • 5. Government response • 2004 free prescriptions level raised to IS +1/2 prescription charge (BUT have to claim under LIS) • PPC purchase by direct debit to spread the cost • No action in response to HSC 2006 report despite promised consultation until: • Sept 08 Brown announcement - affordability agenda abandoned? Prescription reform
  • 6. CAB response to current review • Concern that affordability ignored • Extending LTC exemptions will • Be complex to administer • Be perceived as unfair • Fail to address affordability • learn from Scottish experience – from LTC to abolition following consultation Prescription reform
  • 7. The case for abolition • Free at the point of delivery • Health and poverty links • Fairness – sick pay most (cf funding via income tax) • Cost effective? Health impact of not being able to afford to get prescriptions dispensed • Once you take out the high users/payers (LTCs), is it economical to administer? • Paid for by savings from move to generic prescribing (OFT 2007 market study identified £500 million potential savings from just some major drug categories) • BUT if abolition not acceptable then priority must be: Prescription reform
  • 8. Extend exemption to main disability benefits • Use receipt of ICB/ESA and DLA as proxy for LTC • Simple to administer, easy to implement • Makes sense to patients • Focuses help on those with LTC who are likely to be on a low income because unable to work (IB/ESA) and/or have disability/ caring needs(DLA) • AND Prescription reform
  • 9. Reform PPC • To help those with LTC not claiming disability benefits: • Halve the cost of PPC • Improve patient awareness of PPC by embedding take-up in prescription issuing/dispensing process • incentivise GPs/pharmacists to provide information and advice on claiming PPC • Set DH targets on PPC take up Prescription reform