Prescription charges for people with Asthma
Does anyone else think it strange that Asthma patients have to pay for prescriptions when patients with certain other long term conditions get them free? Please sign and share the petition if you do!
This subject comes up every now and then on the forum and my answer is always the same: as things are at the moment (and indeed as things have been for quite some time) the NHS cannot afford to give exemption certificates to asthmatics. It just isn't going to happen.
There are three things that need to be remembered:
1). Exemption certificates cover all medication required by a patient whether it is connected to their primary condition or not. So in the case of asthmatics in wouldn't just be medication for asthma that becomes free, antibiotics, painkillers etc become free as well. There are five million asthmatics in the U.K., the resulting bill to the NHS would be enormous!
2). Asthma is a condition that can change. It can get worse, but it can also improve to the point where an individual is symptom free. In that instance there would be an argument that an individual no longer qualifies for free medication. Keeping track of the status of every asthmatic in the country would be very difficult not to mention probably quite costly in terms of time and money. The condition is also very variable, Bear in mind that some asthmatics in this country need only a ventolin inhaler to use as and when required.
3). Until there is a clear approved method of identifying who has asthma and who has another medical condition that gives asthma like symptoms exemption certificates for asthma should not be considered. Things are improving in this area, but I don't think we're there yet. Part of the problem is that asthma is such a variable condition.
There has been an argument that perhaps it would be better if exemption certificates only cover the medications required for the primary condition. The problem you have with that, however, is that medications can cause side effects - some of them quite nasty, which in turn need medication to help with that. For example: the one time I was put on oral steroids, I was also given PPIs to help counter the effect of the steroids on my stomach. So where do you draw the line as to what is free and what is not?
Asthmatics don't do badly. We are entitled to pre-payment certificates which significantly reduces the cost for those of us who need more than one inhaler as well as other medications to keep our condition under control.
Also everyone should keep in mind what these drugs actually cost. I am British, but not currently resident in the UK. I pay for all my medications at full cost. The cost works out at about 3,000.00 GBP far more than the 104.00 GBP pre-payment certificate. My inhalers alone work out at 180GBP per month. I think everyone who can claim anything on the NHS should count their blessings.
I am gonna say though i think none workers should pay as well fed up of being punished because i work xx dont you agree then maybe prescriptions could be xheaper for all
I agree that the NHS can't afford the cost of providing exemption certificates to everyone who suffers with asthma but they should consider providing them to the 5% of sufferers who have been diagnosed with Severe/Brittle Asthma. I appreciate we can buy a pre-payment certificate, but you can argue so can people who are diabetic.
I think Type 1 diabetics get exemption certificates.
Type 2 Diabetes also gets an exemption certificate as does underactive Thyroid. I have relatives with one or other condition. Those with the underactive thyroid are also asthmatic - so they get their asthma medication covered as well.
Are you certain about that? My understanding was that type 2 does not get an exemption certificate - certainly my eldest brother was told he couldn't have one when he was diagnosed with type 2 diabetes.
Those with an under active thyroid gland who are asthmatic get their medication free because they happen to have an under active thyroid gland - not because they are asthmatic. I happen to know a type 1 diabetic who is also asthmatic. Same thing applies to her. She has an exemption certificate because she is a type 1 diabetic, not because she has asthma but it means that she gets her asthma medication free as a result of that.
My husband has type 2 diabetes....and has a payment exemption card. He never asked for or was even aware he was eligible. He was informed of it by his GP.
He also does not have or require insulin. His medication for diabetes are various tablets.
"Those with an under active thyroid gland who are asthmatic get their medication free because they happen to have an under active thyroid gland - not because they are asthmatic. "
Pretty much what I said.
"Those with the underactive thyroid are also asthmatic - so they get their asthma medication covered as well."
But to clarify....my mother, sister and grandmother all have underactive thyroids. They all have exemption cards *due* to that condition. They also get their asthma medication and *any* medication for any other ailment all covered by the exemption card.
They do not pay for any prescription medication at all. Neither does my husband.
if there are people who have conditions but don't get the exemption card but others with the same condition do get the exemption card, then that show serious and appalling eficiencies and inequity in the system.
Then presumably there's been a change of policy on type 2 then. Admittedly we're talking eight plus years ago but I remember my brother was furious when he was told that having type 2 did not mean that he got free prescriptions as he thought I was entitled to them as an asthmatic. Given that, he considered it was grossly unfair that asthmatics got free prescriptions and type 2 diabetics did not - which is somewhat ironic given the current debate.
It only applies to Type 2 if you are receiving medication (tablet or injection) but not on diet alone. Not changed, that has been the rule for many years.
Maybe that was it then. I thought he was on medication, but I could be confusing that with my father who was diagnosed at about the same time.
Thanks for the clarification.
I ought to point out (to avoid confusion) that the situation no longer applies as far as my brother is concerned. He died seven years ago (not as a result of type 2 diabetes I hasten to add). So if there was a change in policy he did not live to see it implemented.
If people are ill with asthma the. Their illness should be treated equally as other illnesses and medication should be free. One could argue that government cant afford drugs for cancer or m.s. which can be expensive. But people who are ill need medication. Thereforw why treat asthmatics differently?
So presumably you think that people who only require ventolin inhalers on an as and when basis (what I call asthmatic tendencies but I think is more properly called 'mild intermittent asthma' - someone please correct me if I've got that wrong) should be entitled to free prescriptions for everything? I'm sorry, I cannot agree with that.
Long term steroid use has caused adrenal suppression in my case as well as thyroid and testosterone deficiencies so I now have an exemption certificate which covers all of my medications. Previously I had a bought pre paid card which helped with the cost.
I believe it would be fairer to scrap the free exemption certificate and move all to the pre paid card as the current system is unfair.
Agreed. I get charged at least £16 everytime I need an inhaler and the cost is ridiculous. I have only had asthma for x2 years and I have been on x4 different inhalers, having to pay each time because my body doesn't agree with them and I have been on trial periods - which means I'm paying for inhalers I'm not using the full medication because it doesn't agree with me!
Jessbear, have you worked out whether it would be worth getting a pre-payment certificate? You can get quarterly versions if that would suit you better.
I have two long term health conditions one of them asthma. Every month I have one inhaler, monkelaust and amtriplyine for my interstitial cystis. That would be £24:30 a month. I pay £10.60 a month This month I expect to be switched to a preventer inhaler only as my asthma is better in the spring and summer. So my costs will stay the same.
Before my asthma got worse in November 2015 I didn't have a prepayment plan as I was only on one medication for my IC.
Having a prepayment card takes away the worry of having to pay for medication. When the doctor and asthma nurse was trying to get my asthma under control in december 2015 I went through at least 3 different types of inhaler.
I can't agree that all asthmatic get free prescriptions. I think the best way to manage it is prepayment. This method at least for me takes away all the worry about paying for my medication. At the moment I trying different tablets for my IC and Iron tablets too. I think I would have had to had to have second thoughts to trying something else. I am on iron tablets for the next 5 months so another extra cost too.
I don't think there is an easy solution to this question.
One of the biggest problems is that it now seems to be widely accepted that some people who are diagnosed with asthma may not actually have it. Until that is sorted out and a reliable method of testing for the disease is available, free medication for asthmatics shouldn't even be considered.
If all these arguments above apply to asthmatics, then why not also to someone who just takes one tablet a day for an under-active thyroid, and then gets all their other medication free. There is inconsistency in the system, either chronic diseases require free prescriptions, or prescriptions are based on an ability to pay/pre-payment system for all.
But unlike asthma, it is very easy to prove if someone has an underactive thyroid gland - a blood test will do it. That isn't the case with asthma. It's very variable and there are a number of conditions which can result in very similar symptoms; that doesn't help when it comes to diagnosing it.
I think the problem with free prescriptions for asthma is that it is massively over diagnosed whereas the other chronic conditions eg diabetes have specific tests. for example you wouldnt go to your gp saying you were peeing alot and be given insulin to see if it helps, without any tests being done. same with thyroid medication etc yet if you go to a gp with a long standing cough you may very well be given an inhaler to see if it helps.
Exactly. I can remember when asthma hit the headlines back in 2015 when the scale of possible misdiagnosis of the condition was revealed.
The arguments against asthmatics getting prescriptions covered seem to be focussed on ALL or NOTHING.
- Asthmatics can be effectively "symptomless" therefore they don't need an exemption card.
- Medications are expensive.
- Asthma is difficult to diagnose/Asthma is over diagnosed
There are many other arguments against but these are the ones I've identified here.
All of these arguments can apply to other conditions as well. There are others where the symptoms can go into remission and the sufferer of the condition is symptomless but like Asthma it can come back with a vengeance for no or little apparent reason.
Medication is expensive for ALL conditions across the board. It is not a valid reason to prevent people with a chronic, lifelong condition that is unpredictable from accessing medication. If that argument is used for Asthmatics, it should be used for other conditions.
As with the previous comment, there are conditions that are just as difficult to diagnose and can't be with just a "blood test" (even underactive thyroid can be very difficult to diagnose when the blood tests "say" its ok but it actually isn't. My mother had that problem. A simple blood test is not a perfect or 100% accurate indicator of all conditions).
A difficult-to-diagnose condition due to no single indicator, is not a valid reason to prevent people from accessing medications.
It is absurd that there are patients who have 1 major condition and get ALL their medications, whether related to that condition or not, covered by the exemption certificate.
Therefore, at present there is huge inequity in the system. An exemption certificate is a plastic card which is merely states no payment is required for any medications due to x condition. The card does nothing else. It is not a medical alert card. It is not an emergency card. Its just an expensive bit of plastic for one single purpose which is the All Medications is covered.
However, in this day and age of technological advances, particularly in touch card systems at the checkout counter, there is no reason whatsoever that a new exemption card system cannot be put in place which records what medications a person can have which are exempted from payment.
Thus, as someone with asthma I would get my inhalers covered when I went to the chemist to collect them. If on another occasion, I had a prescription for something else that was not related to asthma - say a cream for eczema (yes this is something else I suffer from) then that I would have to pay for that as it would not be covered by the exemption card.
The GP would have access to a system to detail what medications would be covered for a specific condition when the exemption is set up. The card could also double as an emergency ICE card too.
If a person had more than one chronic condition, such as asthma and diabetes, then their exemption card would cover them for all asthma medications and diabetic medications but no others which were not directly related to either condition.
It would not be a database of a person's medical history - the card chip would simply be recording what medications they can have due to specific conditions.
At present there is expense being spent on making a simple plastic card which has no other function except as confirmation that someone has an exemption certificate. It is not different to the old paper based system.
So, make it work for its living:
- Make it an ICE card (similiar to one I have by You-Id.me)
- Make it so it is a chip card. Doesn't even require a pin number as it would be a touch card and is simply reading an entitlement - no money is taken from it. No Magnetic stripe as this can be cloned (chip card cannot be cloned - trust me, I know the industry which makes them).
- GP uses a check box system to set what medications are covered. This can then be changed in real time. So, if an asthmatic with exacerbation due to a viral infection requires steroids and/or antibotics, these get covered too.
- This system would also save on the long wait for an exemption card - it can be set up by the GP and be centrally checked.
Putting this system in place, would allow greater control on the medications and not have the All or Nothing scenario we currently have. It would nix the arguments on costs as only the medications needed for a condition would be covered.
If you go back to my original response you will note that I do discuss the possibility of prescribing medication only for the primary condition.
You say "'If a person had more than one chronic condition, such as asthma and diabetes, then their exemption card would cover them for all asthma medications and diabetic medications but no others which were not directly related to either condition." But how then do you deal with side effects requiring medication that are caused by the drugs used to treat the primary condition - particularly something like oral steroids. There is an argument that as those problems have been caused, in effect, by the primary condition they should be covered too. It also could be argued that as asthma makes a sufferer far more vulnerable to infections, treatment for those should be free as well - and so and so forth.
It was reported back in 2015 that the number of people misdiagnosed with asthma could be as many as 1 million. You might want to think of the cost on an already cash strapped NHS if those 1 million were all allowed free medication - even if it was just inhalers. That is far, far too many.
Personally I think the suggestion put forward by MikeWhite concerning not having any exemption cards and only having pre-payment certificates is a better idea.
Personally, I don't mind having a pre-payment card. If someone is on benefits, they get their prescriptions paid for anyway, so if you are working, you should, theoretically, be able to afford £104.00 a year (remember, it is £10.40/month for only 10 months, then 2 months free). I understand the arguments about equivalence with other conditions. In an ideal world, no one would have to pay for any health care, but we don't live in an ideal world! The NHS already loses out because so many of us have pre-payment cards. With the NHS in the state it is in, we will all need to contribute a little more if we hope to keep receiving a good standard of care.
You have to wonder just how much the NHS loses through the exemption certificate programme, let alone the losses accumulated as a result of PPCs. Apparently a recommendation for a review of the system was put forward back in 2009, but I don't know whether anything has been done about it since.
I had not realized that the pre payment system was making the NHS having to take a lose. I don't work at the moment as I am a carer for a member of my family. We are so blessed to have the NHS and the treatment I have had for my other condition cost a lot of money. Someone left the price on the medication so I could see that this was just by itself £100 per treatment plus paying for the nurses etc. Its when you see this it makes you realize what you are getting and value it even more.
The NHS is a world class institution. Every one in my family and extended family have had excellent treatment. Remember is free for all of us whether we are rich or poor. God bless the NHS.
When you look at how much the medication we asthmatics require actually costs, the NHS must be taking a hit from these schemes. I did try to find out how whether there were any statistics which state how many people make use of them, either the PPCs or the exemption certificates, but couldn't find anything (if anyone does find them it would be interesting to see). Didn't you say that your PPC saves you about thirteen pounds a month - and that's based on (presumably) the cost of a prescription charge not the actual cost of the medication. You would like to think that taxes and NI contributions etc would be enough to help with this, but given the demands on the NHS now as a result of medical advances and the ageing population, I would be stunned if they weren't losing out from this area of the care they provide.
Although technically, talking in terms of 'loss' and 'losing out' is probably not accurate. Helping to stretch the system to extremes might be closer to the mark; there is only so much money in the pot and prescriptions are massively subsidised. We all know the system is under massive strain, it's been on the news often enough over the past few years. But for those who are trying to deal with this it must be a horrendous task working out what the priorities are.
It's interesting getting my husband's slant on this (who doesn't suffer from any medical conditions other than a hayfever in the summer - and In recent years he hasn't even had much of that). He's just made then comment, and he's got a point, why don't they just slap another penny in the pound on income tax and give free prescriptions to everyone. He adds that doing that might also take out a whole mass of admin who deal with who pays what when in comes to prescriptions etc (another saving). He's got a point, but the country would have to agree to the rise in income tax:-). Any thoughts?
Absolutely agree 100%!
My only worry with this is that a doctor can give prescriptions of over the counter medication like paracetamol. If all prescriptions were free, some may take advantage of the system for getting some medicines for free when they should be paying for them. It's a difficult conundrum.
Of course the reality is that even if an extra penny in the pound was added to income tax and protected for NHS use, the demands on the service are so high right now that there is no guarantee the extra money would end up being used to ensure free prescriptions for all. But it's still an interesting thought:-).
Mind you, when you read reports of GPs giving out toothpaste and suncream on prescription, you have to wonder. I was aghast when I read that; I even checked the date on the newspaper to make sure it wasn't April 1st. It was April, but later on in the month.
That should only be in line with the Advisory Committee on Borderline Substances (ACBS) guidelines. gov.uk/government/groups/ad...
Interesting read. I can understand it for certain medical conditions but I suspect it's open to abuse - or was. Hopefully it's been tightened up since. I couldn't see a date on that document you provided, though given proposed dates on it for meetings it looks to be recent.
It is current, and the vast majority of GPs are pretty strict on it. I suspect such things will always be open to some manipulation and abuse, but in my experience this is pretty minimal.
The subject hit the headlines back in 2015. In the grand scheme of things the numbers (which by themselves are enough to make most people gasp) are proabably quite small. But it shouldn't happen, and should not have been allowed to happen in the first place.
or they could knock a few billion off the foreign aid budget
Or you could come and live in Wales. There are no prescription charges for anyone here. It's a beautiful country!
I do know Wales having visited it many times (both North and South) and I agree it is beautiful. Sadly it is also on the West side of the UK and has a damp climate (even by UK standards); that would not suit my asthma at all. I lived in Bristol for two years and have already experienced the effect the increased humidity can have on my lungs.
I'm so sorry I can't attract you to Gods Wonderful Country, with no prescription charges! I hope your lungs improve soon in Bristol. Tbh I've not found any uk geographical changes that have improved my lungs. I think it's age that's taking me downhill in recent years......though I have to say that my new air purifier has made the past three months gradually much much better. I'm hopeful....🤞
I no longer live in Bristol.
The best I've ever been was when I lived in the extreme south east (so East Kent, Canterbury and surrounding area). Interestingly the same was true of my younger son, another asthmatic. Bristol was not good and the improvement was noticeable once we moved away from there.
It's great to hear that you've found something that works for you though. Keeping fingers crossed that things continue to improve ...
I totally agree! Signed 👍
Signed, fortunately I have an exemption certificate, but started off with Asthma first. Something has to be done, there are people out there who cannot afford all their meds. No, often they can be homeowners who are trying to keep there house, not getting enough benefits, illness and no reason of their own find themselves in a terrible state. I was one of them years ago. Don't smoke or drink and never got benefits, lived on what savings we had. I owned my own house, albeit, paying a mortgage. Would have cost me more to rent. When I started off with Asthma every few weeks/months I was changing my medications, plus steroids and other meds, it cost a lot. Yes, there is a prepaid certificate I agree, but sometimes its all just too much. Often people put themselves last and end up worst and in A&E, Hospital Stay etc, often fighting for their life. How much does that cost? Its a minefield. You can get it for Diabetes etc, but not Asthma. The system needs changing. I agree Cancer patients are fighting for treatment to keep them alive and the treatment, (I have had cancer). We should stop fertility treatment for a start. If you cannot afford fertility treatment then you cannot afford a baby. Sorry. I speak myself from having loads and loads of fertility treatment, all paid for by myself. No holidays, just saved, saved and saved. It was much more expensive then. The NHS give one or two goes now I think? I had loads privately, found nothing wrong, still never got pregnant. So the government wants cuts, then cut fertility treatment. Sorry but there is a saving straight away.
I agree this definitely needs to be reviewed...
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