don’t be shy about comparing prices – The Irish Times
Imagine: you’re not feeling well and you go to the doctor, assuming you’re lucky enough to get an appointment quickly, and she says you need to take something, and what pharmacy to go to. you looking for it?
You then walk up to the pharmacist, wait in line for a bit, then tell them you have a prescription pending. We joke a little about the weather, and we take a lot of interest in the shelves of vitamins and hot water bottles while waiting for your medicines to be prepared.
Finally, they arrive nicely wrapped and presented with a smile by the saleswoman. It will be €30, she said, brilliantly.
You are a little taken aback. It sounds expensive. Do you:
1. Accept it and pay quickly; you want to get better soon, after all;
2. Query the amount and search for a discount; Where
3. Ask for the script that the pharmacy printed out and walk to another pharmacy while the assistant unpacks the medications.
It doesn’t take a rocket scientist to figure out that most of us will opt for the first option, either out of embarrassment or lack of time. The timing is pure transactional asymmetry. As a consumer, you have tried too hard, gone too far in the process of buying the drugs, and you probably feel too bad to consider delaying getting them any longer.
The consequences of this, as experienced daily by all of us in the country’s 2,000 pharmacies, were laid bare last week in a study revealing massive differences in the prices we pay for essential medicines across arrangement.
The most expensive pharmacies charge almost double the price charged by the cheapest pharmacies, found the researchers from Trinity College Dublin and the Royal College of Surgeons in Ireland (RCSI).
Aspirin, for example, costs €9.12 in the 10% highest-paying pharmacies, but only €4.62 in the cheapest 10%.
The cost of prescription paracetamol ranged from €5.12 to €9.93, and that of the steroid drug prednisolone from €6 to €11.25.
With each of us spending an average of $44 per month on pharmaceuticals, these price variations really matter. Although there are public systems to provide free or subsidized medicines, up to 60% of the population cannot benefit from them and therefore must finance their own medicine costs. For example, you can spend up to €80 per month on medicines without receiving a subsidy under the Medicines Payment Scheme.
Price variations of essential drugs are not unique to Ireland. An American study found that the maximum price of prescribed ear drops was 20 times higher than the minimum price.
But the study highlighted a separate problem with transparency. Up to 15% of the 1,500 pharmacies surveyed refused to provide the price of a drug by telephone or e-mail. Hardly any provide them online – outlets such as Freynes Pharmacy in Clondalkin, whose website lists prices for 20 common drugs, are very exceptional.
In some US states, pharmacies are required to post the prices of most prescription drugs on websites created for this purpose.
Ireland differs from other countries in that chains are more expensive than independent pharmacies. A US study found chains were cheaper, but Irish researchers found they charged more for nine of the 12 drugs included in their study.
Paul Kenny runs two Haven pharmacies in Tramore, Co Waterford. With more than 7,000 product lines in its stores, across different drug strengths and quantities, it says it’s just not practical to list the price for each one.
“I am attached to price transparency. If a patient comes to me with an expensive prescription, the first thing I say to them is, “Didn’t the doctor tell you it’s going to be expensive?”
“In my experience, people choose their pharmacist for his expertise and professionalism, because he has a relationship with him or, on the contrary, because he seeks anonymity. The price goes down in order of importance with respect to these considerations.
“But if someone is price sensitive, I would always encourage them to ask about the cost of something. I will always provide the price before prescribing, if asked.
Kenny estimates that the Health Service Executive, through various drug plans, is the end purchaser of approximately 80% of the drugs it sells. Its prices are fixed, and have not changed “for years”. Pharmacists’ margins are becoming “tighter and tighter” while their operating costs are “skyrocketing”.
In the end, in many outlets, private customers end up more or less subsidizing the supply of medicines to HSE-funded patients.
E-prescribing, which was introduced as an emergency measure at the start of the pandemic, has been rightly welcomed, but it has had the unintended effect of locking patients into their designated pharmacy at the GP when their medications were prescribed.
“The system is great, but not fit for purpose,” says Kenny. “It’s a ‘push’ system, where the doctor asks you where you want to pick up your medication. What we need is a “pull” system based on a unique health identifier that allows patients to show up where they want to collect their medication.
This isn’t the first time the cost of prescription drugs has come under scrutiny. In 2013, the National Consumer Agency investigated the prices charged by pharmacies for 42 common drugs and found huge price differences between different outlets. However, it later emerged that the agency had gotten some prices wrong, forcing her into an embarrassing rundown.
The survey published this week, which covers more than 1,500 drugs, is detailed and comprehensive. Unlike the previous NCA survey, the scholars did not show their game by declaring their academic goals.
The authors suggest several remedies to the phenomenon of large price variations, starting with a “greater effort of transparency” on the part of the regulator, the Pharmaceutical Society of Ireland (PSI). They also suggest introducing fixed prices for medicines and variable dispensing fees depending on volumes, somewhat similar to the agreement the HSE has with pharmacists. In Denmark, they point out, prices are the same in all pharmacies due to state regulations.
But by effectively ending the cross-subsidization of public patients by private patients, this approach could lead to the closure of some pharmacies.
Price haggling is of little value. According to the study, only one in 20 pharmacies were willing to reduce prices, in the form of reduced dispensing fees, price equalization or discretionary discounts.
The Irish Pharmacy Union says pharmacies are independent businesses and therefore obliged to set prices independently. In this context, price variations “are to be expected” as in any other sector.
The price of prescription drugs fell 16% between 2016 and 2021, he points out.
“Pharmacists also regularly inform patients about the availability of lower cost drugs such as generic drugs to save patients money,” a spokesperson said.
PSI does not concern itself with pricing issues, except to advise members to be transparent.
“Everyone has the right to know the price of their prescription medicine before it is dispensed,” according to a spokeswoman. “It is reasonable to ask the pharmacist for the price of the drugs and to check the prices in a few pharmacies, if possible.”
The state’s consumer watchdog, the Competition and Consumer Protection Commission, told the Irish Times it had received 27 ‘contacts’ from consumers about pharmacies, five of which were about price issues . A spokeswoman said the commission would review the findings of this study “and whether engagement with the industry is necessary to ensure consumers can obtain prices before purchasing a prescription drug.”