Doctors In Charge Of Budgets

Has any one else had to change their dosage of any drug they take In order to save the NHS some money. The practice pharmacist rang me to ask if I could change the way I take lyrica to one 225mg tablet morning and night and 50mg top up if needed in the afternoon instead of a 200mg tablet morning and night and two 50mg in afternoon if needed. This she said would save the practice money as lyrica is an expensive drug, I find this very worrying as it means that due to the governments changes doctors are managing their own budgets and obviously looking at ways to save money. How long before doctors refuse to take on patients who need costly treatments on a regular basis.

Very disturbing!!

21 Replies

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  • Bit puzzled here. Can't do sums but it looks like a lower daily dose? As far as I know pharmacists cannot alter prescriptions without doctor's permission so best have a word with your GP.

  • My doctor told me they were £90.00 a packet. Does anyone get prescribed a whole box a month though? I usually get given a few sheets, never a full box.

  • I get pescibed more than a whole pack as I take 300mg three times a day there is one gp at my surgery who seems to review my meds regularly as he rings me every couple of months to go through it they had to originally have a managers meeting just to discuss my pregablin lol ,each tablet is the same price no matter what the dose

  • Hi, yes, I think all the local PCTs are putting pressure on the GPs to reduce costs. A drug that I take for migraine has been changed from a melt under the tongue to a tablet and apparently there's a saving of 75% in cost! I must say that my GP said if I didn't find them as effective he would of course still prescribe the melts, but so far I haven't had too much of a problem. The drug manufacturers have a lot to answer for as they set the price of the drugs they produce, maybe this could be the subject for an ombudsman to look into. When I get back from holiday I may have a word with my local MP and see if I could start a compaign on this as I feel it is a very important subject, effecting people even with critically life threatening diseases who one would think should get the drugs they need with no respect to the cost.

    Foggy x

  • Yes I think I am going to talk to my MP about this issue, because it's a worrying aspect to how the governments reforms are going to affect patients. It begs the question whats next doctors selecting patients who join their practice by how healthy they are. Not wanting patients who will cost the practice money.

    I thing this kind of treatment should be highlighted to the wider public.

  • Hello All,

    I am unaware about how surgeries budget their costs and wouldn't like to comment on that. However, in the case here where the dose has been altered I am sorry but it seems like common sense in my opinion.

    If you are regularly taking at least another 50mg on top of your 200mg morning & night it seems sensible to divide the 50mg into 25mg and add to the 200mg morning and night. Then leave you with one 50mg tablet to take in the day if needed - this new system is therefore the exact same dosage as before just split up differently.

    To explain further;

    200mg morning plus £50mg daytime plus 50mg daytime and 200mg at night = 500mg

    Changed to : 225mg morning plus 50mg daytime plus 225mg at night = 500mg

    I am in no doubt this will be saving money and Pregabalin is as others mentioned approximately £90 per box. However, I think here as the dosage hasn't been affected that it probably isn't a major problem. If they had reduced dosage to save money therefore affected patient care and causing poor symptom relief I think this would be a major issue

    I hope this helps :)

    Emma :)

    FibroAction Administrator

  • My worry is not that the way my dose has been changed but that it highlights a serious problem in the wider NHS. In short this may only be the start of major cost cutting throughout the NHS.

    Your comment about it makes sense to do this, maybe in your mind it does, But my body is fairly settled on the way I take them, messing about with my dose may lead to more health problems.

  • Hello Ktatmolehole,

    Thank You for your reply

    Although in theory in appears this small change may not have made much difference to your symptom control as;

    Pregabalin demonstrates highly predictable and linear pharmacokinetics, a profile that makes it easy to use in clinical practice. Absorption is extensive, rapid, and proportional to dose. Time to maximal plasma concentration is approximately 1 h and steady state is achieved within 24-48 h. These characteristics reflect the observed onset of efficacy as early as day two in clinical trials. High bioavailability, a mean elimination half life (t(1/2)) of 6.3 h, and dose-proportional maximal plasma concentrations and total exposures predict a dose-response relationship in clinical practice and allow an effective starting dose of 150 mg/day in clinical practice without need for titration

    ncbi.nlm.nih.gov/pubmed/153...

    If you feel it has and in your opinion affected patient care in your circumstances I would say that maybe as discussed on the community before medication affects people differently.

    I would consider discussing this with the Patient Advice & Liaison Service and/or write a letter to your practice manager.

    nhs.uk/chq/Pages/1082.aspx?...

    All the best

    Emma :)

    FibroAction Administrator

  • Thanks for that information extremely useful!!!

  • ive had similar change of meds for my lupus (I do have fibro too), its real name is Hydroxychloroquine Sulphate and my original one was called Plaquenil but was changed to Quinoric as is cheaper. has same drug in it but different fillers which give me nausea but chemist refuses to let me have Plaquenil :( x

  • Hello Caninecrazy,

    This does seem crazy, as if you find the other suits you better with no side effects then how can this monetary save not be affecting patient care.

    I would suggest contacting Patient Advice & Liasion Service and/or write a letter to your practice manager about this. If I find any other useful information for you all I'll post it

    Emma :)

    FibroAction Administrator

  • I was being given Ibuprophen liquid capsule which were easy to swallow and seemed to suit my IBS. Since the doctors have been in charge of their own budget I have been prescribed one very large tablet which I find difficult to swallow, the pink dye comes off all over my hand so am now wondering how far down it gets before disolving and doesn't seem to suit my stomach. When I asked if I could go back to the capsule the head doctor said the new system (they changed their computeriesed system last month) doesn't allow them to prescribe the liquid capsule. Yes you guessed it the tablets are dirt cheap whereas the capsule is expensive. I am not being awkward and if the tablet suited me I wouldn't give it a second thought, I even thought of buying them myself over the counter but it would have to be from a pharmacy which isn;t always convenient and it would cost me approx. £10 a week which on a state retirement pension would be a big chunk out of my money. I'm also on Pregablin so am waiting to see what happens to those when I ask for them on repeat as they are different doses taken in the morning and evening.

  • Reading through this a couple of questions come to mind. I have recently had my prescription changed from pregabalin to gabapentin. I don't think I ever had a problem with the former. I actually thought it was a generic (cheaper) form of the drug I was taking for several months! Now I've discovered its not even the same drug I suspect that I was half right anyway. I take 4x300mg a day and that's more than 100 capsules a month. Math was never my strongest subject. I wonder if the change in script was DRI en by financial considerations.

    My GP drives a Porsche and his wife does too.

    :-(

  • Some doctors are now saying it is a fallacy that they earn as much as the press say they do but alot of them do seem to have expensive sports cars. I used to laugh at my old doctor who was about 6' 5" and used to arrive in a mini, his wife had the 4x4. I have got to say the previous doctor was so nice I couldn't have begrudged him anything and he cried on his last consultation with him when i thanked him for his kindness to me and my husband over the 30 years he cared for us. Now this thing about them controlling their own budgets has come in I think we will have more of these changes to prescriptions. I know the one in charge now definately runs a tighter ship. Unfortunately we will have to move soon because of my health but if we weren't I would try to join the Patients Panel at the surgery to find out exactly what there thoughts for the future are. I know in the past the local NHS tried to get everyone on a cheaper chlorestrol controlling tablet but when the change didn;t suit me as it sent my muscle aches off the dial my then doctor changed it back immediately to the original one. I don't mind changing at all as long as the change doesn;t make me feel any worse.

  • Hello Lampain,,

    This story does seem worrying, yes they usually try Gabapentin as first line to see if it helps as some people get on OK with it and it is cheaper! But to be taken off Pregabalin after having taken it for a while (which is recommended for Fibro) Is another matter.

    I believe that as well as helping nerve pain it has an effect on Dopamine (neurotranmitter) levels as it works too. I am under the impression Gabapentin doesn't effect Dopamine as it works differently, but please don't quote me personally on any of this as it is purely from what I've read. If I find any info to support this i'll post it!

    Anyway, regardless of this it is recommended for Fibro and you have been changed from one drug to another completely different (albeit in the same family) it is beyond me as to how this can happen honestly (again my opinion) This I would probably say is a clear case where patient care has been affected and I hope you manage to get this changed back.

    I would suggest contacting Patient Advice & Liasion Service and/or write a letter to your practice manager about this. If I find any other useful information for you all I'll post it.

    Do let us know how you get on.

    Emma :)

    FibroAction Administrator

  • Hello Rosewine,,

    This does again seem crazy, as if you find the others suit you better with no side effects then how can this monetary save not be affecting patient care.

    I would suggest contacting Patient Advice & Liasion Service and/or write a letter to your practice manager about this. If I find any other useful information for you all I'll post it

    Emma :)

    FibroAction Administrator

  • Thanks very much for that Emmax

  • Hi Ktatmolehole

    I sincerely hope that you are feeling well today? I must admit that I had a migraine medication changed by my GP as the NHS would no longer pay for this brand and removed it from the prescription listings, (I won't advertise which brand). However I am sure many members who have migraines know what I am on about.

    I was initially very disappointed as I had used this drug for many years. However, on trying my new medication I was overjoyed by how much better it worked! So I am delighted with this, but I would not be very happy if the drug had not worked so well, as being given inferior products to save money would not be ethical in my opinion.

    I want to wish you all the best of luck with the new way that you are taking your medication.

    All my hopes and dreams for you

    Ken x

  • I take pregabaline too 600mg a day and I get a months worth every time x

  • No but I had d7fferent manufacture version of a drug, it didnt work for me had a word with GP he said pharmacy was trying to use cheaper suppliers but put note on system that I can only be prescribed original drug supplier.

  • Good to hear :)