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JUNIOR FRESHMAN PHARMACY 2011-12

Medicine Supply SchemesJUNIOR FRESHMAN PHARMACY 2011-12

Medicine Supply SchemesMedicine Supply Schemes(“Community Drugs Schemes” / “Community Health Schemes”)

Medicine Supply Schemes(“Community Drugs Schemes” / “Community Health Schemes”)

Sheila RyderSheila Ryder

JF, Hilary term 2012 Medicine Supply Schemes

ObjectivesObjectivesOn completion of this component, you should be able to:

Critically discuss medicine supply schemes existing in Ireland:– General Medical Services (GMS) scheme

[also known as Primary Care Reimbursement Service (PCRS) h di l d h ]scheme, medical card scheme]

– Dental Treatment Services Scheme (DTSS)– Drugs Payment Scheme (DPS)– Long Term Illness (LTI) scheme– Health (Amendment) Act, 1996 scheme– High Tech Drugs (HTD) scheme– Methadone scheme– ‘Hardship’ scheme (‘essential non-GMS items’)

2JF, Hilary term 2012 Medicine Supply Schemes

Hardship scheme ( essential non GMS items )– Tax refunds– Supply to foreign visitors– Stock order forms

Identify relevant schemes when presented with a prescription, and provide advice to a patient or prescriber on how these schemes operate.

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Reference materialReference material

General Medical Services (Payments) Board, Information and Administrative Arrangements for PharmacistsApplication/claim forms for medication supply schemesLaboratory (dispensing and patient care) notesLaboratory (dispensing and patient care) notes

Lecture notes and supplementary reference material (available on WebCT)

Additional online resources:– European Health Insurance Card

www.ehic.ie


Contact email: [email protected]

– Health Service Executivewww.hse.ie

Associated material and evaluationAssociated material and evaluation

Associated materialAdditional lecture: Pharmacy legislation, ethics and code of conductLaboratory (dispensing and patient care) classesLaboratory (dispensing and patient care) classes

Practice of Pharmacy evaluation (Junior Freshman)End of year examination (80%)Dissertation (10%)Laboratory work and practical evaluation (10%)Coursework (satisfactory/unsatisfactory)


Knowledge of medicine supply schemes will also be required in lab classes throughout the degree, and will be evaluated in the dispensing and patient care practical examinations annually.

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Medicine supply schemes: EntitlementsMedicine supply schemes: Entitlements

Entitlements depend on:– whether Irish resident or visitor– income/social circumstances

nat re of disease– nature of disease– age

If ordinarily resident in Ireland, classed as category 1 or category 2– Category 1

medical card patientsmeans tested


means-tested>70 yrs old and means tested, lower threshold

– Category 2othersmay have GP visit card (means-tested)

General Medical Services (GMS) Scheme [also known as Primary Care Reimbursement Services (PCRS) scheme]General Medical Services (GMS) Scheme [also known as Primary Care Reimbursement Services (PCRS) scheme]

Medical card patientsRegistered with named doctorSpecial Rx forms Max 1 month (unless exceptional circumstances)Max 1 month (unless exceptional circumstances)Non-repeatable (except special repeat Rx sets)Prescribed medication, some appliances (syringes, ostomy products)Limited list (GMS 5-digit codes)Coding forms; uncoded symbol Pharmacist paid cost price + dispensing fee (no mark-up)


p p p g ( p)Patient contribution: 50c per item to max €10 per month (per family unit) from 1st October 2010Exemptions:- Children in HSE care- Methadone for opiate dependent patients- High tech products

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Payment structurePayment structure

Rx form signed by patient/representative to confirm receiptFee per item (now common to GMS, DTSS, DPS, LTI and HAA(1996) schemesSliding scale:Sliding scale:– €5.00 per item for each of the first 1,667 items dispensed in

a month;– €4.50 per item for each of the next 833 items dispensed in

that month;– €3.50 per item for each of the other items dispensed in that

month.I l l ti th ‘ t i ’ th ll f h l l


In calculating the ‘cost price’, the allowance for wholesalemarkup is now 8% of the manufacturer's price (formerly 17.66% of manufacturer's price)– Exceptions: fridge items (wholesale markup allowance 12%)

Zero pharmacy markup.

GMS prescription formGMS prescription form


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GMS repeat prescription formGMS repeat prescription form


Additional featuresAdditional features

Phased dispensingNon-dispensing (exercising professional judgement)Emergency GMS dispensing of hospital prescription


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Emergency GMS dispensing of hospital RxEmergency GMS dispensing of hospital Rx

1. Patient has been hospital in-patient or attended A&E.2. Impossible / very inconvenient to get Rx transcribed to GMS

form.3 Hospital R has:3. Hospital Rx has:

– generic name of drug(s)– name of prescriber in block capitals– patient's medical card number

4. Emergency supply made on day prescribed (or on following day in special cases).

5. No more than 7 days' supply dispensed (except inhalers etc.)


Payment claim:Submit photocopy of hospital Rx with claim form.Payment as for normal GMS Rx.50c levy per item paid by patients (to max. €10/mth)

Prescription claim formPrescription claim form


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Dental Treatment Services Scheme (DTSS)Dental Treatment Services Scheme (DTSS)

Participating dentists only

Patients > 16 yrs old

DTSS form

Eligible items (shorter list)

Rx form signed by patient/rep to confirm receipt

Cost price + dispensing fee (sliding scale, as for PCRSprescription from GP)

Patient contribution: 50c per item to max €10 per month (per family unit)


family unit)– same exemptions as for ordinary GMS Rxs

DTSS prescription formDTSS prescription form


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Drugs Payment Scheme (DPS)Drugs Payment Scheme (DPS)

Register with local HSE Area

DPS card– family ID number (head of household's PPS number)– eligible person's nameg p– code for position in family– PPS number– Expiry date

Max. €132 per calendar month for family unit in single pharmacyUniversal claim form (signed by patient/rep to confirm receipt)Procedure if multiple pharmacies


Eligible items and codingMax. 1 month (exceptions, e.g. erectile dysfunction)Payment = cost price (incorporates 8/12% wholesale markup as for PCRS)+ 20% pharmacy mark-up + dispensing fee (sliding scale: €3.50, €4.50, €5 as for PCRS)

Long Term Illness (LTI) SchemeLong Term Illness (LTI) Scheme16 medical conditions only– Diabetes mellitus – Cerebral palsy– Multiple sclerosis – Haemophilia– Hydrocephalus – Phenylketonuria

Diabetes insipidus Mental illness (<16 yrs only)– Diabetes insipidus – Mental illness (<16 yrs only)– Muscular dystrophies – Parkinsonism– Spina bifida – Cystic fibrosis– Epilepsy – Mental handicap– Conditions arising from – Acute leukaemia

thalidomide use

Treatment of specified condition


Universal claim formCost price + 20% pharmacy mark-up + dispensing fee (sliding scale)No 50c levy for items obtained on LTI- but if patient also has medical card, must pay 50c for each

item obtained on medical card- LTI book may be for “non-GMS items only”

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Health (Amendment) Act, 1996 SchemeHealth (Amendment) Act, 1996 Scheme

Hepatitis C from contaminated blood products/derivatives

Card valid indefinitely

Free prescribed drugs and medical / surgical appliances

Primary Care Reimbursement Service:Cost price + 20% pharmacy mark-up + dispensing fee (scaled €3.50-€5 as before)

Universal claim form

Also free:– GP services


– dental services– optometric/ophthalmic services

High Tech Drugs (HTD) SchemeHigh Tech Drugs (HTD) Scheme

Approved list of drugs, excluded from all other schemes

Registration– therapy details

nominated pharmacy– nominated pharmacy

Authorisation number

Wholesaler not paid by pharmacy

Monthly patient care fee (currently €62.03)

Payment system– GMS, LTI, HAA


, ,– DPS or other

Universal claim form

No attendance (max 3 mths), reason– half-fee (€31.02) if justified

Annual stock balance

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High Tech prescriptionHigh Tech prescription

JF, Hilary term 2012 24Medicine Supply Schemes

Methadone schemeMethadone scheme

Central treatment list

Drug treatment card (max. 1 year, renewable)

Specific Rx form

Prescription written in format for CD2 drug (3rd year lectures)

Rx form signed by patient/rep to confirm receipt

Records maintained by Department of Health and Children

Cost price (wholesale markup, but zero pharmacy markup) + €3.60 dispensing fee + €5.60 methadone fee

Also monthly patient care fee depending on level of supervision:


Also monthly patient care fee, depending on level of supervision:

– < 12 times per month €52.07

– > 12 times per month €60.49

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Methadone prescriptionand treatment cardMethadone prescriptionand treatment card


‘Hardship’ scheme‘Hardship’ scheme

“Essential non-GMS items”

Primarily medical card patients

Non-PCRS items

Price estimate for Community Care Centre

Order form

Payment claim for Community Care Centre– detailed cost breakdown– cost price + dispensing fee (sliding scale as before)– cost breakdown must show VAT separately where relevant


cost breakdown must show VAT separately where relevantPatient must pay 50c per item (max. €10 per month)Scheme also used for some ‘exempt medicinal products’ (unlicensed medicines) if not automatically pre-approved; covered in 2nd year

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‘Hardship’ purchase order‘Hardship’ purchase orderHSE Dublin South Central

Health Service ExecutiveFeidhmeannacht na Seirbhíse Sláinte

Medicine Supply SchemesJF, Hilary term 2012 30

Tax refundsTax refundsTimeframeMED 1 formQualifying expenses (self, dependant, relative). Amended 2007.Excluded:– Unprescribed medicines– Sight testing and advice as to the use of spectacles and the

supply and repair of spectacles– Routine dental treatment which is defined as “the extraction,

scaling and filling of teeth and the provision and repair of artificial teeth and dentures”.

MED 2 form (dental)Thresholds - Abolished 2007 Pre-2007: €125 €250


Thresholds - Abolished 2007. Pre-2007: €125, €250Relief at standard tax rate – Up to and including 2008, relief at marginal rate

Evidence of tax paymentReceiptsYear paid v. year incurred; Tax year v. med. insurance subscription yr

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Income Tax Relief - Example 1Income Tax Relief - Example 1

In Feb 2012, Mary Murphy wishes to claim tax relief on medical expenses for herself and her two children, aged 10 and 6 (spent during the tax year from Jan-Dec 2011). She paid income tax at the higher rate (41%) in that year.

Prescribed medicines (12 mths @ €120/mth*1) € 1,440Doctor’s fees € 450Total medical expenses € 1,890

No deduction for threshold since abolished in 2007*2

-> Sum on which tax relief can be claimed € 1,890


Tax refunded @ 20%*3 = = € 378 refund

* Note 1: The monthly DPS payment was €120 in 2011. * Note 2: Pre-2007 would have had threshold deduction: -€250 since >1 person* Note 3: From 2009 onwards, relief at standard rate only.

1,890 x 20100

Income Tax Relief - Example 2Income Tax Relief - Example 2Paddy Reilly wishes to claim income tax relief for the cost of a minor operation he had in Nov

2010. The operation cost €3,000, which he paid in two instalments: €1,000 in Dec 2010 and the remaining €2,000 in Jan 2011.

He paid tax at the marginal rate of 41% in 2010, but was then made redundant and paid no income tax in 2011.

2 choices:Claim tax relief for year in which expenses were incurredRelief due on €3,000 in tax year 2010⇒ relief due on €3,000 at 20% = €600 refund

OR

Claim tax relief for year in which costs were paid


Relief due on €1,000 in tax year 2010⇒ relief due on €1,000 at 20% = €200 refundPLUSRelief due on €2,000 in tax year 2011⇒ no relief due as no income tax paid = €0 refund

Total refund = €200 + €0 = €200 refund

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European Health Insurance Card (EHIC)– replaces E111 and E128– valid throughout European Economic Area (EEA) and in

Switzerland

Supply to foreign visitorsSupply to foreign visitors

– Rx on PCRS form– items with PCRS codes only– cost price + 20% pharmacy mark-up + dispensing fee

(scaled €3.50-€5)– 50c per item paid by patient


AustraliaOther countries

Syringes, needles and dressings SOF– triplicate form– limited list

doctor confirms receipt of items

Stock Order Forms (SOFs)Stock Order Forms (SOFs)

Dispensing doctor SOF– 4-part form– initial submission to health board– nominated pharmacy supplies drugs

– doctor confirms receipt of items– payment = flat rate in PCRS price list + 25%


– doctor confirms receipt of items– payment = cost price + 25%

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Syringe/needle/dressing SOFSyringe/needle/dressing SOF


Dispensing Doctor SOFDispensing Doctor SOF


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