Short Prescriptions

[helvella]

Recently we have seen that people are still getting short prescriptions for levothyroxine - typically one month. This inevitably results in problems for patients when there are supply issues. In my book, levothyroxine should normally be prescribed for a minimum of two months on each prescription – and you should be able to keep at least a month ahead of the game. That is, you should be able to request your next prescription while you still have about a month’s supply in hand. Then you can ring round pharmacists, ask questions here, submit your prescription to an on-line pharmacy, … That is, do whatever you need to do if there are any supply problems.

When first started on levothyroxine and there are likely to be regular dose adjustments, it might be reasonable for a GP to keep prescribing periods shorter. Once on simple repeats without any alterations, there is no reason to keep to short periods. Why even the MHRA agree! On page 21 of the MHRA’s levothyroxine report [1] from early 2013, it says as recommendation number nine:

Levothyroxine should be prescribed and dispensed in quantities covering three months supply, where appropriate, in order to address issues of continuity of supply and also to improve convenience to patients.

Please do whatever is necessary to avoid having short period prescriptions. In the first place, simply ask. Then maybe print off a bit of the MHRA’s report if you need to support your argument? Note that the report justifies its recommendation on two separate grounds: continuity and convenience.

I get a two month prescription but I have plenty in hand and it is relatively easy for me to get to the GP surgery, and to visit numerous pharmacies if required. So I won’t bother going through the process of asking for a change for me.

Obviously, if you obtain any medicines by other means, the argument that you need to keep plenty in hand applies even more strongly.

Rod

[1] MHRA publishes a report on levothyroxine tablet products: A review of the clinical and quality considerations

mhra.gov.uk/Safetyinformati...

[shaws]

That is very sensible and it's a pity GP's are unaware of the recommendation.

Definitely, members should point it out to the GP's if they are only getting monthly prescriptions when on optimum meds.

[Piedo]

Hi

I have got over the problem by my GP sending 6 separate prescription to my pharmacy at once I then collect them one each month

Works for me.

[helvella in reply to Piedo]

Sorry but I don't see how that helps in several ways.

You still have to pick up a dispensed prescription every month.

You haven't said how much you have to hand, but if not a decent amount you could still have a problem - with getting the same ones or, indeed, getting any - if there are supply issues.

I hate the other aspect of prescriptions going directly to pharmacies - you cannot then wander round if your pharmacy fails to come up with the goods.

The only advantage I see is not having to contact your surgery on such a frequent basis. But if you feel it works for you, I am pleased.

Rod

[beaton]

This is a good point,with all the shortage history this year. I order my 'scripts on line but in the past if I order too early the order is rejected but I am not told why until I phone the surgery. All pretty messy.

[helvella in reply to beaton]

So far, our surgery doesn't seem to be very aware. I simply put in a request when my personal reminder pops up (that is, on my own computer calendar) and no problems. But one day it might be different.

[beaton in reply to helvella]

I think "they" think we are going to flog the tabs on the black market.

[editfmrt]

Thanks for posting this Helvella. I'm sick and tired of collecting my prescription monthly and had given up arguing with the surgery about the stupidity of this. Can't wait to hand this report over next week. The thought that I only have to face that lot three times a year instead of 12 fills me with joy.

[helvella in reply to editfmrt]

I contacted my local PCT the day after I found the report - their response included:

I passed your query on to our medicines Management Team and they have provided the following response.

Thank you for highlighting this report to us, as this is a very new report we have not yet had time to read and implement its contents. We still recommend 28 day prescribing for most situations, but there has always been discretion for GPs to give longer-term supplies for stable patients. The suitable length of supply depends on many factors especially how stable the patient is.

Since the wording of the report states

Levothyroxine should be prescribed and dispensed in quantities covering three months supply, where appropriate, in order to address issues of continuity of supply and also to improve convenience to patients

that each patient on thyroxine needs to be individually assessed by his GP. If a patient shows the report to their GP it seems likely that they will be able to persuade him to give longer term prescriptions.

I hope this addresses your query,

I wish you the very best in your efforts at persuasion.

Rod

[PinkNinja]

I got two months at a time for all my long term medications for the last few years. That's one thing my GP surgery did right. Of course, now that I am on the right thyroid medication I don't need any of them anyway

[Hidden]

It's really annoying too if you live in a rural area. It's an 8 mile drive for me and i find the whole business of going to the practice stressful. If there was a prize for the most miserable receptionists they would get it. It's rather like they don't trust you?? I've been taking meds for over 10 years without incident. I wish i could go back to 3 month prescriptions!

[beaton in reply to Hidden]

They don't trust us. A friend of mine ran out of levo because she is on other meds. and the surgery wouldn't let her have all her meds. in one go!! So for her it is two trips a month. ???

[Hidden in reply to beaton]

I can't see how this is cost effective. I think it's a "power" thing! A few years ago i couldn't get hydroxyzine because the UK factory had burnt down. I was having 3 monthlies then so had a bit extra around. I had a decent pharmacist then who used to import from the US for me. I remember us people with Interstitial Cystitis were absolutely hysterical this drug was such a lifeline. If i hadn't had a bit spare it would have put me back to square one. This fiasco went on for 2 years as the NHS only bought it from one source. The same with gabapentin a couple of years ago. People with chronic illnesses need 2.months spare prescriptions to hand.

[summer01]

Thanks Rod, I've been having this problem. I use the pick up service from boots as my GP is closed but the time I get back from work, twice boots have had to issue me an emergency supply as the ores riptide hasn't come back in time. I feel like I'm begging for the tablets,. Going to write to the GP with the information, thanks so much.

[Ruby1]

Thanks for posting this. I think it is to do with managing their budgets having once had a chat with a pharmacist ( who was nothing to do with my practice).

My GP put me on 3 monthly as I requested it, but then when I saw another GP she took me back to monthly which is an inconvenience. Only now after several years am I better at remembering in time. My practice is rural and therefore dispenses, but there is a 3 day lead required and they can't give me a presciription to get them elsewhere.

You know we can be a bit forgetful? Well I once put my order in twice ha ha!

They stayed open an extra 5 mins once as I suddenly realised I hadn't picked up my prescription and phoned ahead in desperation!

[helvella in reply to Ruby1]

I was under the impression that patients have every right to get a prescription and take it to any place that can legally dispense the items. That is, simply because yours is a dispensing surgery does not stop you getting paper prescriptions.

Indeed, if anything, the issues have often been the other way around where patients are refused the possibility of getting items dispensed at the surgery because another pharmacy exists within 1.6 km of the patient's home.

Rod

[Hidden]

My Doctor's practice doles out NOTHING in more than 1 month blocks... actually only 28 days! It's a problem at times for many meds

With Controlled drugs (Opiates, which I use) it's even worse, I turn up and the prescription hasn't been issued if it's "too early" by as little as one day.