Drugs charges a bitter pill to swallow for Southern patients
Dramatic savings and generic alternatives driving more ’pharmacy tourists’ Northwards
Patients in need of regular medicines are being hit by a “double whammy” of prescriptions for branded drugs and higher Southern charges compared with Northern Ireland.
As a result, they are seeking repeat prescriptions from their GP for cheaper generic drugs and then buying them in the North.
Dispensing pharmacists in Border counties, and especially in Newry, are working hard to meet the surging demand as Southern patients discover they can save four-figure sums over the course of a year.
A range of pharmacists contacted by The Irish Times report that “a Southern mindset” among GPs is not attuned to cost-cutting, unlike their Northern equivalents who are ruthlessly monitored when it comes to their prescribing patterns.
Hospitals in Northern Ireland are banned from dispensing branded drugs for inpatients when there is a generic equivalent available.
Only in cases where a drug is still under patent can the branded version be prescribed – and even then the process is closely watched
The same applies to the clinics of family doctors who are routinely checked for evidence of unnecessary prescribing and their use of generic drugs.
The difference in prices is astounding.
One pharmacist in Downpatrick, Co Down – a full 30 miles from the Border – said he still receives prescriptions from Southern customers for branded medicines despite the availability of vastly cheaper equivalents.
“Neurontin [for epilepsy control] is listed for dispensing at roughly £55-£63 [€65-€74] per box,” says Sean Sealey, who works at Market Street pharmacy in the town.
“I could give them the generic Gabapentin which costs £6 and is exactly the same, but I can only dispense what is written on the prescription – it’s a legally-binding document and I can’t substitute.”
As a result, patients are asking their doctors for prescription for generics, then shopping around. That usually means a journey up the M1.
Sealey believes many GPs in the Republic are simply used to filling out prescriptions with branded drugs and no one is telling them not to – or at least not telling them loudly enough.
“They’ve always written scripts for the branded drugs and that’s what they’re used to prescribing,” he says.
In Newry, the top cross-Border shopping destination, competition is helping to drive prices down and eyebrows are constantly raised at the charges levied in the Republic, even for generic drugs.
Jacinta Curran, owner of the independent Medical Hall pharmacy in Newry’s Quays shopping centre, explains: “When a drug comes off patent, it will go generic and the generic houses then can go and manufacture it to the proper standard.
“Then there is proper competition between the drugs manufacturers and the price drops dramatically.
“That’s what happens here but for some reason in the South the generic products are not very much cheaper than the branded products and I don’t know why that happens.”
She has a growing Southern customer list as the thickening file of patient details shows.
That file grew by a further 52 in the fortnight before Easter alone, with one customer who travels from Munster saving an estimated €1,300 annually for four generic drugs.
Such customers are becoming better organised with many ordering in advance and others presenting multiple repeat prescriptions to make the best use of the trip up North. But there are limits.
“There are exceptions,” says Curran. “I would not [dispense] sleeping tablets or codeine-containing products for obvious reasons.
“But cholesterol tablets and those for blood pressure as well as stomach tablets, that’s where the really big savings are.
“It’s for people who are on tablets all the time and will not be changing.”
A short distance away Denise Kay dispenses at Gordon’s chemists – a large Northern chain of pharmacies.
She backs up the claims that Southern shoppers are becoming increasingly sophisticated with many phoning ahead or even contacting the company’s headquarters to inquire about the best arrangements.
“Some even email our head office and they will be referred here and we will see if there is something we can help them with. We try to ensure patients know what they need; how a prescription needs to be written in order for us to be able to dispense.”
The procedures are strict.
“Southern doctors must be registered with the Medical Council of Ireland and we will then check the register,” she says, but help is there to make sure all the boxes are ticked.
In common with the other two pharmacists contacted, she says she sticks by the Northern Ireland pricing structure, VAT rules, profit mark-up and dispensing fees. There is no naked profiteering.
“It works on a pricing scale, the more a patient has on prescription, the more expensive it is but then the mark-up gets less.
“That’s the way we tend to do it, it’s the same dispensing charge for everyone – if I had a private prescription from the North I would charge the same as one from the South.”