Co-payment for drugs

Discussion in 'ARCHIVE FORUM: Support discussions' started by Skye, May 14, 2007.

  1. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    #1 Skye, May 14, 2007
    Last edited: May 14, 2007
    I've just seen a report on the BBC News that NICE has recommended that cancer drugs can no longer be funded.

    What worried me is that, while people can pay for these drugs themselves (the cost is astronomical, £1000 a month was quoted), those who choose to do so then are regarded as private patients, and have to pay for hospital appointments, in-patient treatments, etc. Co-payment is not allowed.

    I just wondered what implications this has for people who pay for their own Alzheimer's drugs.

    http://news.bbc.co.uk/1/hi/health/6652183.stm
     
  2. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    #2 jenniferpa, May 14, 2007
    Last edited: May 14, 2007
    Having just looked at the BBC website, it seems the situation is more nuanced than that. Much depends on which PCT you are with as to whether paying for drugs makes you a private patient, with some trusts interpreting it one way, and others another. Scotland seems to be different still. If this becomes standard, it won't be just AD drugs that become an issue: what about people who need malaria prophylaxis for a vacation? Those drugs have to be paid for privately, so would that make those people private patients for everything else. I can imagine the howls of outrage from the chattering classes about that. And if you let people who need this sort of medication remain on the NHS books, then you can hardly turn around and say that AD patients need to come off them.
    http://news.bbc.co.uk/1/hi/health/6652183.stm

    Edited to add:

    From what I've read this also seems, at least in part, a pre-emptive strike to try to sway public opnion on the subject. All well and good as far as it goes, but I have serious doubts that public opinion means anything to the bean counters at NICE or any other quasi government body. Just because "the people" don't agree with a course of action, doesn't mean that it won't become policy. I'm sorry, I know that sounds defeatist, but when it comes to the NHS, I have real doubts that it will ever become a "world class" health system again.
     
  3. KenC

    KenC Registered User

    Mar 24, 2006
    913
    Co Durham
    Hi Hazel,

    I heard this programme this morning and it seems that we would be in the same position if we paid to get the treatment, we would be treated as private patients from then on unless something changes soon.
    We will just have to hope that things will change before much longer, because it is a pity when people have paid the Taxes and National insurance all there lives thinking that they would be safe, and then this happenes.

    Best Wishes

    Ken
     
  4. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    It's very worrying. First they say Ebixa can't be prescribed on the NH. So people opt to pay for private prescriptions.

    Then they hit people with this. If it's allowed to happen, it's iniquitous, just another step to dismantling the NHS, one of our proudest achievements.

    And I'm not political!:eek:
     
  5. Louise Lakey

    Louise Lakey Registered User

    Apr 19, 2007
    29
    Good afternoon,

    The official policy of the Department of Health is that allowing patients to contribute towards NHS care - known as co-payment - is against the principles and values of the NHS. However, different PCT's can take different approaches.

    Drugs for dementia can be purchased privately, which would also involve the cost of a private consultation. However, even if the drugs and consultation are purchased privately, an individual will still have other services funded by the NHS.

    The Society is against a two tier system and campaigns for people with dementia to have access to drugs on the NHS on the basis of clinical need.

    I hope this helps.

    Louise Lakey
    Policy officer
     
  6. I look forward with Gods help; that the National Council for Clinical Health and Excellence; will also loose its Funding; and the miserable gits all end up on the Dole; where they will be paid their total worth; supplementary benefit; at the reduced rate..Micky.
     
  7. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #7 Margarita, May 14, 2007
    Last edited: May 14, 2007
    Some, like Herceptin for breast cancer, have won NICE backing as being cost effective for the health service. Others like Tarceva, which can extend the life of lung cancer patients, have been turned down.




    I hope this does not sound cruel, but at lest they are offered some medication from NICE also chemotherapy,

    Where with AZ, need I say anymore?

    So if they cannot give that man medication to see his child first birthday, what hope is they that they give people with AZ medication for exbiza on NHS is ZERO
     
  8. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Thanks, Louise.

    I'm totally with you on the campaign for everyone to have access to NHS drugs at need.

    But what you say about other services being funded by NHS contradicts what was said in the news article. I know it's not set in stone yet, but once these changes are mooted, it doesn't usually take long for them to become established practice.

    My understanding of the article, transferred to a person with AD, would mean that if that person were paying for Ebixa, for example, and had to be admitted to hospital for any AD-related condition (for example, a fall), they would have to pay.

    Have I misunderstood?
     
  9. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    Hazel, I don't think you've misunderstood. What I do think is that this is speculation based on the perception that you cannot be an NHS patient and a private patient at the same time. While this is true as far as it goes, what has not been mentioned in most of this speculation is the phrase the the Department of Health use "during a single visit to an NHS organisation". In other words you can't go to the doctor for a broken leg and say "oh by the way, can you write me a prescription for Aricept". You would have to pay for a consultation separately for that. Now no one can say that this won't change tomorrow, but as it stands I think one has go by this statement from DOH "As always patients can opt for private treatment but this must be a separate or further treatment to the one they have received from the NHS." The reporting indicates that different PCT's have different rules, yet there seems no way of checking if this is actually policy, or based on anecdotal evidence.
     
  10. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Jennifer, this was directly contradicted by the BBC report. They showed a cancer patient receiving chemotherapy, and said that if that patient had opted for herceptin privately, they would have to pay for the chemo also. 'Top-up' treatment would be regarded as co-payment, and not allowed.

    I agree the situation is still very confused, and perhaps it will be clarified later. But I know there are members of the forum who pay for Ebixa, and I think it bears watching!
     
  11. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #11 Margarita, May 14, 2007
    Last edited: May 14, 2007
    So what they are saying is that if you can afford medication for cancer, you can’t get the rest of your care on the NHS if you go in to hospital or care or home needs ?


    But if you have AZ and can fund medication yourself while in hospital / care home or home but not fund the care home fees , care needs at home so is funded by NHS you can carrying on getting medication for AZ, as long as you fund medication yourself ?
     
  12. Louise Lakey

    Louise Lakey Registered User

    Apr 19, 2007
    29
    Hello,

    Sorry for any confusion - just to clarify the situation.

    The article is talking about people making payments to the NHS for the drugs necessary for their treatment. In this case, different PCTs will approach the situation in different ways - it seems that some may require the patient who wants to make a payment to the NHS to pay for all their treatment, but many will be much more flexible, effectively allowing patients to pay for drugs, while continuing to receive other NHS care.

    An individual could also choose to pay privately (ie go outside the NHS) for a consultation and prescription, in which case all other care would still be funded by the NHS.

    I was referring to the second option in the quote you picked out.

    Hope that helps.
    Louise
     
  13. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    I'm not saying it doesn't or hasn't happened and of course I didn't see the report. However, one patient's experience with one PCT doesn't make it a policy (anyone remember which PCT it was by the way?) Let's face, PCT's can make stupid judgement calls and have done. I suppose what makes me suspicious about this report in particular is that one would expect it to have been picked up by other news outlets and it hasn't been, at least not with any specifics. Early days of course, but one would (well I would) like a few more specifc examples. As to the example that was given in the BBC programme, I would also like to know how is was determined that had the patient opted for herceptin, they would have had to pay for the other chemo. I mean did someone from the PCT stand up and say this, was this what the patient said, or what?

    I probably sound argumentative but I don't intend to. I suppose I'm frustrated with a lack of specifics and a sensation that the story, at least as reported on the web, is exceptionally vague and smacks of propaganda. I'm not saying it's not true, but I do think it's a stretch to take one case and extrapolate from it. It just feels like someone, somewhere, has an axe to grind.

    Love

    Jennifer
     
  14. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,885
    Kent
    This is a totally different area, but might be of interest.

    Before Digital Hearing Aids were available on the NHS, I paid for one, through the Audiology Clinic of my local NHS Hospital.

    That was all I paid for. All hearing tests, adjustments and batteries were free, provided by the NHS.

    Not ideal, but a compromise. Now Digital Aids are available on the NHS, after years of campaigning.

    Pity the aid didn`t help, but that`s another story. :(
     
  15. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Thanks, Brenda. Wonder what, if anything, will be the NICE response.:confused:

    At least it should provide more ammunition for the campaign.
     
  16. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,438
    Call me a cynic, but I suspect that NICE will say the study is too small to count. Depressing, but par for their course. Does anyone know if NICE have ever reversed themselves on appeal?

    Jennifer
     
  17. Lonestray

    Lonestray Registered User

    Aug 3, 2006
    236
    Hereford
    A matter of intrest

    Hi everyone,
    I'm well aware there's nothing can help my wife now, but over the years she was never been offered any drug for Alzherimer's.

    The only drugs she was prescribed was first Prozac, then later, medication like morphine for bad pressures sores.

    Can anyone tell me if medication for AD was available about ten years ago?

    Five years ago when she lost all movement and speech, might it have been too late to offer AD drugs?

    I think it was last week I heard on Radio Five Live that NICE recommended that smokers be given paid time off work to help them quit the habit! Anyone else hear it?

    I use to find it stressful enough to be a carer, but the constant false hopes and smoke and mirror type answers to straight questions by people in power, only added to the stress. Now I'm at peace with my lot.

    You very special people, keep up the fight, wear them down before they do you.
    Padraig
     
  18. cris

    cris Registered User

    Aug 23, 2006
    326
    Chelmsford
    I have tried, in the past and again to find how NICE is funded. They themselves seem to say they are self funding. I do not understand. Can anyone enlighten me please ? How and who funded them to come to the conclussion that smokers should be given time off to quit. I did see that article myself. It reminds me of the issue that scientist (about 5 years ago) were given £500'000 to find out why cornflakes went soggy / lost their crispness. Money waisted. Again who funded NICE to evaluate the Alz drugs ?
    I'm very depressed today, and that maybe reflecting in my writing. Sorry.
    cris
     
  19. Nebiroth

    Nebiroth Registered User

    Aug 20, 2006
    3,511
    AFAIK the anticholinesterase type drugs have been around for about ten years, but were not approved by NICE as being "clinically and cost effective" until 2001, at which point it recommended that they should be available for prescription for persons in the mild and moderate stages. However it has recently reversed this decision and they are now only for peopl ein the moderate stage, and as far as I can see, that judgement has been made on "cost effectiveness" grounds. ie, they feel that treatment should be delayed until someone is bad enough that it costs the NHS more to look after them than it costs to give them the drug.

    If you look at NICE's document, you will see that nearly every argument such as the evidence provided by carers that quality of life is improved for patient AND carer, they just keep repeating "not cost effective".

    The fourth drug, Ebixa, is usually for people in the late stage, it was only licensed for use in the UK in 2002. But the most recent NICE ruling means that Ebixa is not available on the NHS at all.

    The only exceptions for these new rulings are persons who were already receiving the drugs, they will not cease to get them, even if they don't "qualify" under the new rules.
     

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