Libre prescription under review -who responsible?

[Tdm]

I've calmed down now...but, seriously, there is something unsettling about a 'review' of the medication you need to actually stay alive.
Like, how would the gp like it if i 'reviewed' whether they should have access to food.

They may find it rather, i dunno, a wee bit threatening.

Of course its just bureaucratic nonsense but its a collosal waste of everyone's time

 

[helli]

@Spathiphyllum i am very happy not to have automatic repeat prescription. My insulin needs vary significantly each day depending upon stress, exercise and food, my strip requirements vary day by day depending upon exercise, driving and stress, even my Libre requirements vary because I receive replacements from Abbott when they fail.
i would rather make the extra effort to order when I need something than waste money. My fil has a cupboard full of prescribed aspirin which he doesn’t take but has never removed from his automatic repeat.

 

[helli]

I've calmed down now...but, seriously, there is something unsettling about a 'review' of the medication you need to actually stay alive.
Like, how would the gp like it if i 'reviewed' whether they should have access to food.

They may find it rather, i dunno, a wee bit threatening.

Of course its just bureaucratic nonsense but its a collosal waste of everyone's time

I understand how you feel but they have one process for all repeat medication.
it feels similar to needing to reapply for my medical exemption certificate every 5 years even though there is no cure for the condition that qualifies me for it.
Fortunately, my GP always approves my review without seeing or speaking to me. Unfortunately , they sometimes need reminding when I cannot submit another request.

 

[Spathiphyllum]

@Spathiphyllum i am very happy not to have automatic repeat prescription. My insulin needs vary significantly each day depending upon stress, exercise and food, my strip requirements vary day by day depending upon exercise, driving and stress, even my Libre requirements vary because I receive replacements from Abbott when they fail.
i would rather make the extra effort to order when I need something than waste money. My fil has a cupboard full of prescribed aspirin which he doesn’t take but has never removed from his automatic repeat.

I didn't mean having a particular quantity of stuff sent to me e.g. every month. What I mean is: In other areas, the GP can issue a prescription which the patient can have refilled as needed during a stated period of time, maximum six months. So people can order straight from the pharmacy when they need e.g. more needles, and this prescription only has to be reviewed by the GP once every six months. In my area, the GP has to review the prescription for e.g. needles every single time.

Now that I know this is the way it works in my area-- next time I'll ask for several months' worth of needles! Come to think of it-- I wonder why my GPs don't, off their own bat, prescribe more than one box at a time? ...

I agree with Tdm: it is "unsettling" and "threatening" to be subjected to 'reviews' of stuff one unquestionably needs in order to survive, as well as it being "a colossal waste of everyone's time." Even the six-month review, let alone every single time. And having T1D is quite unsettling and threatening enough in and of itself.

On the bright side, the pharmacist has never asked to see my medical exemption certificate-- which is a good thing, as I haven't got one! I've been thinking I'll only get one if I ever need medications/devices for anything other than diabetes, on the assumption that no pharmacist would be so daft as to ask someone picking up e.g. insulin pen needles to prove they were diabetic ... Am I being too optimistic?

 

[helli]

Now that I know this is the way it works in my area-- next time I'll ask for several months' worth of needles! Come to think of it-- I wonder why my GPs don't, off their own bat, prescribe more than one box at a time? ...

Can you request several months of needles? I can only tick a box to say I want the item on the prescription request. I cannot order multiple.
And why don't GPs allow you to order multiple in one go? Because it costs them. Things with diabetes do not remain the same. You may change your insulin, You may move to a pump. You may move house. PLus your GP has to budget throughout the year. I do not know how they are funded but suspect they don't get a year of funding on the 1st January (or 5th April) every year.

Do you do your prescription requests online/via an app? I find this makes it very easy. My GP approves every request within a couple of days and my pharmacist emails me when they have them - usually the same or next day. I believe there are ways to get to get prescriptions delivered but I am happy to pick them up.

On the bright side, the pharmacist has never asked to see my medical exemption certificate-- which is a good thing, as I haven't got one! I've been thinking I'll only get one if I ever need medications/devices for anything other than diabetes, on the assumption that no pharmacist would be so daft as to ask someone picking up e.g. insulin pen needles to prove they were diabetic ... Am I being too optimistic?

Yes. You are being too optimistic.
Please get a medical exemption certificate. It is free and could save you a fair amount of money. If you are claiming free prescriptions without the certificate (regardless whether you are getting insulin or not) you could be fined something like £100 a go. YOur current pharmacist has never asked for it but another one might.
Plus, it can take a week or so to arrive (after getting your GP to approve it) which will be too late if you need medication for something apart from diabetes.
I agree it is a pest to need to reapply every 5 years but getting fined or having to pay for prescriptions i much more of a pest.

 

[Leadinglights]

Reviews can be a good idea as they may pick up medications that people should be taking but aren't. When my daughter did her GP rotation she noticed that a patient had only requested 1 of the 3 medications he should have been taking and she asked him to come in for a review. It transpired his wife had passed away and she used to do his meds requests and he could not remember all the items he should have been having and that had gone on for several months.

 

[Tdm]

Serously, get a medical exemption cert (medex). Getting medication for diabetes does not entitle you to free px, the medical exemption cert does.
(Also you can't get a medex for diabetes managed by diet alone. )
If you get checked, you will be requested to get a medical ex cert. The penalty charge will then be waived, but you will have to pay the prescription cost for any px checked, which can add up.

 

[Tdm]

I agree best not to have too much in case your px changes, but, on the other hand, you need enough to weather any shortages ( eg novorapid over summer) or in case of feeling unwell and not being able to pick more up.
Anyway, i really need to chill out over px admin!

 

[BadaBing]

I've calmed down now...but, seriously, there is something unsettling about a 'review' of the medication you need to actually stay alive.
Like, how would the gp like it if i 'reviewed' whether they should have access to food.

They may find it rather, i dunno, a wee bit threatening.

Of course its just bureaucratic nonsense but its a collosal waste of everyone's time

Actually @Tdm medication reviews are an essential part of what GPs and other clinicians ought to do with their patients.

Over time patients can become more (or less) sensitive to particular drugs. Patients can start having adverse reactions to drugs that don't show up the moment a patient starts taking a particular drug.

That has happened to me over the years. So I welcome such reviews.

Drug reviews are in place to keep patients safe, stop the NHS being sued, and to try and ensure money spent on drug therapies and/or medical devices is spent wisely.

They also stop GPs wasting money continuing to prescribe drugs and medical devices that are either no longer effective clinically and/or no longer safe.

My local integrated care system/integrated care board (formerly clinical commissioning group) dictates precisely how many glucose monitors (and test strips) can be prescribed by GP surgeries to patients at any one time.

GP surgeries tend to follow whatever policy has been set out by their ICS/ICB (CCG) otherwise there can be consequences for them I understand.

My ICS/ICB (CCG) has a multiple-page policy document setting out precisely who is eligible for the Libre that GP surgeries are required to follow.

That document says only two Libres can be prescribed each month.

The document also dictates that patients using the Libre must be reviewed by a diabetes consultant or the community diabetes team every 6 months and if the consultant/diabetes team consider a patient using the Libre hasn't met certain falls in - or maintained a pre-set - Hba1c, then the Libre can be taken away and the patient put on cheaper alternatives.

 

[Tdm]

My medication is reviewed by my specialist diabetes team. I don't know why my gp should be involved. They don't manage t1.

I am exceeding my a1c target and have an a1c that isn't even diabetic so there are no worries there.

As for libre, i can get more 2 month. I have about 3 month in hand right now!

 

[BadaBing]

My medication is reviewed by my specialist diabetes team. I don't know why my gp should be involved. They don't manage t1.

Because - in theory if not in necessarily always in practice - as your primary care clinician, your GP is supposed to have overall pastoral oversight of your health.

From head to toe.

Your GP should be across the detail of other non-diabetic health issues that your diabetes team may not even be aware of, as well as the diabetes issues.

And those Libre you get each month come out of your GP's surgery's budget, and not secondary care's budget (hospital trusts).

That's why. Or rather that's that's how it was explained to me once.

I know how you feel though. But sometimes it can be helpful.

 

[Spathiphyllum]

Because - in theory if not in necessarily always in practice - as your primary care clinician, your GP is supposed to have overall pastoral oversight of your health.

Firstly, with regard to your first post above: I don't think either I or Tdm think medication reviews are always a bad thing! I certainly don't. Of course there should be regular reviews of what medications a patient is taking or what devices a patient is using.

The question is how often this should be done, in relation to the particular patient and his/her condition and the particular medication/device, and in what way it should be done. A blanket rule for all prescriptions is inappropriate, wasteful and harmful. And Tdm is right to question whether her GP should be reviewing her T1D prescriptions. Those prescriptions are as recommended by her specialist diabetes team; any review should be done by them.

As for your second post-- the problem is in part the distinction between theory and practice! In practice, most GPs are far too stressed and overworked to take "overall pastoral oversight of your health". Moreover, GPs are not in a good position to do so in relation to a condition like T1D. My diabetes team are likely to have a much better understanding of how "non-diabetic health issues" relate to T1D than my GP has, because my diabetes team know a lot about T1D-- whereas my GP doesn't-- and they see lots of patients with T1D-- whereas my GP doesn't.

None of this is intended to criticise GPs! The system is just not structured very well. Oh well! Keep warm, everybody.

 

[Lucyr]

I didn't mean having a particular quantity of stuff sent to me e.g. every month. What I mean is: In other areas, the GP can issue a prescription which the patient can have refilled as needed during a stated period of time, maximum six months. So people can order straight from the pharmacy when they need e.g. more needles, and this prescription only has to be reviewed by the GP once every six months. In my area, the GP has to review the prescription for e.g. needles every single time.

Now that I know this is the way it works in my area-- next time I'll ask for several months' worth of needles! Come to think of it-- I wonder why my GPs don't, off their own bat, prescribe more than one box at a time? ...

I agree with Tdm: it is "unsettling" and "threatening" to be subjected to 'reviews' of stuff one unquestionably needs in order to survive, as well as it being "a colossal waste of everyone's time." Even the six-month review, let alone every single time. And having T1D is quite unsettling and threatening enough in and of itself.

On the bright side, the pharmacist has never asked to see my medical exemption certificate-- which is a good thing, as I haven't got one! I've been thinking I'll only get one if I ever need medications/devices for anything other than diabetes, on the assumption that no pharmacist would be so daft as to ask someone picking up e.g. insulin pen needles to prove they were diabetic ... Am I being too optimistic?

If you are in England and don’t have a valid exemption certificate but are claiming free prescriptions on that basis then you are committing fraud. The penalty if you’re found out is the original prescription cost plus a fine of 5x the prescription cost, up to £100. You need to apply for an exemption and check if you need to pay for prescriptions (if you do then get a receipt to claim it back) until you are granted the exemption.

 

[Lucyr]

This page is useful for then showing you have a medical exemption if you’re asked and don’t have the card with you. Also useful for checking when yours expires so that you can renew it beforehand

Check if you have an exemption from paying NHS costs

An NHS exemption certificate helps you to pay for your NHS costs, such as prescriptions or dental treatment.

services.nhsbsa.nhs.uk

 

[trophywench]

Please don't continue without an actual medex. If some audit body happens to do a spot check of your pharmacy and picks on one of your prescriptions - the pharmacy will be in trouble and will at the very least be fined, at worst, could be struck off. It's not all about you!

 

[Spathiphyllum]

If you are in England and don’t have a valid exemption certificate but are claiming free prescriptions on that basis then you are committing fraud.

For the avoidance of doubt: I am emphatically not committing fraud, because I have never claimed I do have a medical exemption certificate.

What has happened is: At first, all I knew was what my diabetes team told me, on the day I was diagnosed-- that Type 1 diabetics don't have to pay for prescriptions. Then, when I went to the pharmacy, they asked 'Do you pay for your prescriptions?'; I said, 'Well, I'm Type 1 diabetic'; and they said 'Ok' and handed over the package.

I only found out much later that one is supposed get a medical exemption certificate. But it does seem ridiculous: I have T1D; this means I am entitled to the certificate-- there is no discretion for the certificate people to say 'you have T1D but'; there are no exceptions-- and the certificate means I am entitled to free prescriptions. So, in getting free prescriptions, I am not taking anything I am not entitled to.

Nonetheless, if anyone ever asked me 'Do you have a medical exemption certificate?', I would of course, being an honest person, say 'No.' But they haven't yet. They just keep asking 'Do you pay for your prescriptions?'; I keep saying 'I'm Type 1 diabetic'; and they keep saying 'Ok' and handing over the package.

So-- nobody could claim I have committed any fraud, because I demonstrably haven't. The worst thing that could happen to me is that, if they ever ask whether I have a certificate:

- I would say no and pay for the prescription.
- I would then apply for the certificate-- and, according to the website, "We will backdate the certificate to start one month before the date we receive your application." (https://www.nhsbsa.nhs.uk/check-if-you-have-nhs-exemption/medical-exemption-certificates , under the tab 'How long is it valid for')
- I would then consider applying for a refund of the payment I made, which, again according to the website, I would be entitled to. But it's likely I would decide applying for a refund was more trouble than it was worth, and would accept the loss of the £9.35 or £18.70 or whatever and simply be annoyed with myself for not applying for the certificate sooner. ; )

Jenny's point, though, does give me some pause. Could the pharmacy get into trouble for not asking me whether I have a certificate? Should I protect them from themselves? ...

I find it very hard to imagine that any regulatory body would penalise a pharmacy for giving free prescriptions to someone who is undoubtedly entitled to free prescriptions! Maybe a stern talking-to, but no more. On the other hand, the world is full of bizarre bureaucracies ... Back on the first hand, though-- if some audit body looks into what the pharmacy did e.g. 3 months ago, it wouldn't make any difference if I applied for a certificate now ...

But on the whole-- I think the factor of reducing risk to the pharmacy will motivate me to go ahead and get the certificate sooner rather than later. Thanks, Jenny!

 

[Lucyr]

“I find it very hard to imagine that any regulatory body would penalise a pharmacy for giving free prescriptions to someone who is undoubtedly entitled to free prescriptions!”

A quick google will show you plenty examples of people being fined for this exact thing. Just get the certificate.

 

[Spathiphyllum]

“I find it very hard to imagine that any regulatory body would penalise a pharmacy for giving free prescriptions to someone who is undoubtedly entitled to free prescriptions!”

A quick google will show you plenty examples of people being fined for this exact thing. Just get the certificate.

Links, please?

 

[Lucyr]

If you aren’t able to google yourself then here’s some I googled for you

News & Views | Diabetes UK

www.diabetes.org.uk

Patients face 'unfair' fines on free prescriptions

Patients with life-long conditions are being fined up to £100 for taking their free prescriptions, the BBC has discovered.

www.bbc.co.uk

Prescription fraud clampdown plan heavily criticised

Pharmacists strongly criticised plans to strengthen checks at the counter for entitlement to free prescriptions in England.

www.bbc.co.uk

Patients face “unfair” fines on free prescriptions - DiabetesontheNet

Increasing numbers of people with chronic conditions such as diabetes are being fined by the NHS for claiming free prescriptions because they do not have the

diabetesonthenet.com

 

[helli]

Unfortunately, there have been cases of people with Type 1 being fined for not having medical exemption certificates which have been discussed on forums such as this one.
There was a crack down a few years back when more people were fined and I was asked for my certificate every time I picked up a prescription and my number (and expiration date) was written on the signed prescription form.
For me, things were relaxed during covid: to avoid handling of more items by multiple parties, the pharmacist stopped asking me to sign the form and ticked the "medical exemption" box themselves.
The "you don't pay for prescriptions, do you?" question continued but only so the pharmacist could tick that box - the one that said I have a medical exemption certificate. So, either they are committing fraud by ticking the box without seeing the certificate or you would be by implying you have the certificate through your answer.

As I said before, please please please get the certificate to save yourself and your pharmacist any future problems. It costs nothing apart from a little bit of your time (and maybe some ink because, unfortunately, you cannot apply online).