Displaying drug costs on prescription items is another attack on the vulnerable

// 6 July 2015

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Light through a white plastic tub filled with white pills.Prescription items worth more than £20 are to carry a label, detailing this cost along with the phrase “funded by the UK taxpayer”. This move proposes to reduce waste, but is very likely to make it harder for vulnerable patients to take the drugs they need.

The cost of drugs is already taken into consideration before they are made available for prescription and doctors are well aware of the cost of the drugs they are prescribing. If a drug is too expensive, or if a prescribing doctor doesn’t believe a patient has a need for such a drug, it simply won’t be used. When there’s a range of drugs which might combat a particular problem, the cheapest drug will generally be tried first.

Drug therapies, when effective, save an awful lot of public money. They help prevent the spread of infectious disease, help keep people in work and better able to function. They reduce accidents, incidents of self-harm, illegal drug-taking and associated criminal activity. They help keep people out of hospital and reduce the need for expensive treatments like transfusions, dialysis and surgery. In purely economic terms, sick people cost “the taxpayer” an awful lot less if they take the appropriate drugs.

The move is being justified by the claim that £300 million pounds is wasted on unused medicine. This figure comes from a 2010 study, called Evaluation of the Scale, Causes and Costs of Waste Medicines and includes the cost of medicines people have in their homes for future use (so not wasted), the cost of medicines which are partly used (so not completely wasted), and then an extra £50 million for “under-reporting”. The biggest reasons this study found for genuine waste were that symptoms cleared up or doctors changed the prescription. While the study makes suggestions about reducing waste, it nowhere suggests or even implies that informing patients of the cost of their drugs would help.

And of course, it wouldn’t. This isn’t really about waste. This is about drawing attention to a made-up problem, creating a scapegoat, namely that people – disabled folk, poor folk and immigrants (why else, “the UK taxpayer”? Did we think the French were funding our statins?) – are using expensive drugs they don’t really need. This administration has been incredibly adept at focussing on the supposed bad behaviour of vulnerable people, with much talk of rewarding those who “Do the right thing”.

And so to these vulnerable people, mostly women, who rely on multiple prescription medicines to stay as well as possible. Guilt is a fairly normal reaction to significant health problems, along with all disasters we have little control over. Sick and elderly people often blame themselves, feel themselves a burden on others and our culture does little to discourage these feelings. Simon Blackwell retweeted the news, adding,

Label will also include the phone number of Dignitas and the phrase “Your son could do with the house, you know.”

Often, people are reluctant to take drugs, in the belief that it’s giving in or wimping out, or even that they don’t deserve to feel better.

My friend Philippa Willitts told how she was made to feel self-conscious about the cost of drugs she was taking,

“Years and years ago, I picked up meds from a chemist and there was a post-it note on one of the packets that said “These are very expensive”. I assume it was some kind of internal message that was supposed to have been removed before I got it but, regardless, I still feel guilty when I take that tablet.”

One time, maybe ten years back, my GP handed me a prescription saying, “You’ve got about ninety quid’s worth today!”

I’m fairly sure this wasn’t a dig; I think he was just remarking about the length of the shopping list – my immune system was particularly weak so I needed medicine for multiple infections, as well as the three or four drugs I usually took.

It is impossible to be blithe about such information. You can feel very lucky that you live in a part of the world where untreated illness and death is not a punishment for being poor. But, if it’s a bad day (and I did feel like a walking pustule when my GP made that remark) you can also think about whether you and your health are money well spent. This happens to people with physical health problems; people with mental ill health, whose personal cost-benefit analysis for taking prescription drugs is often already complex, are even more at risk. Again, most of those affected will be women. The largest group will be poor elderly women.

The only time I’ve ever seen wasted prescription drugs – actually wasted, as opposed to partially used, rejected due to a bad reaction or saved for later – has been with sick elderly relatives on automatic repeat prescriptions where nobody is checking what the patients needs or what they are taking. That’s a problem with systems, not patients. And if money is to be saved, it is by improving systems, not by bullying those who truly have no choice in the matter.

[Image is a photograph of some white pills in a white plastic tub with light shining through the plastic. Photo by me, found on Flickr, used with permission.]

Comments From You

IndigoJo // Posted 6 July 2015 at 7:44 pm

Hi there,

Actually years ago my doctor prescribed me statins. I was 30 years old, healthy (apart from my long-standing thyroid deficiency which was treated with supplements and was, and remains, stable), had a balanced diet and cycled almost every day. I had gone for the usual six-monthly review (which had only been necessary since moving to a new borough; in my old home town they had been less frequent) and the doctor ordered a cholesterol test along with my usual thyroid test, without my consent. He prescribed simvastatin on top of my usual medication and gave me a list of foods to avoid as part of a “low-lipid” diet (basically all the nice foods). I had a friend who was a doctor and he basically advised me not to take the statins. Years later I changed GPs and my new GP said I’d done the right thing. But the statins are still sitting in my drawer. I wonder how many others wasted meds because they were prescribed out of the blue, for no reason (other than perhaps meeting targets) when they were perfectly healthy.

Laura Dee // Posted 7 July 2015 at 2:22 pm

I don’t agree, I’m afraid. It’s very tiring to see every article being spun out of the “everyone is attacking the poor” angle. Many people are doing that, it’s true, but not by providing full disclosure of drug costs in a healthcare system that is one of the main symbols of equality – and the envy of the world.

There are many families who for generations used the NHS like a vending machine. I used to be that way when I was younger – “I pay taxes so it’s my right”. Then I moved abroad and had to pay thousands and thousands a year for health insurance. Healthcare is very expensive. One accident can bankrupt a person for life in other countries. THAT is oppression against the poor.

You might feel small when your doctor tries to tell you how lucky you are to be receiving expensive drugs, but maybe you actually should feel lucky. Your alternative in other countries would be to go home and discuss with your partner whether you can afford the drugs you need. Whether you need to take on a part-time job to cover the payments. Whether you need to sell the car, move house, or take out another loan. It doesn’t even have to be expensive drugs. There are many people in developed countries who go without acne medication, asthma drugs, even moisturiser, because it’s too expensive.

British people need to be informed. They need to respect what they have in the NHS (which is a great deal) and I for one am happy to try this full-disclosure labelling if it helps pull the NHS back from extinction. We’ve had everything for so many years and we didn’t know what we had, because no one was telling us its real value.

D H Kelly // Posted 7 July 2015 at 6:47 pm

@Laura Dee,

I’m unconvinced by arguments that because things are very much worse in other parts of the world, things that make our lives more difficult are not worthy of complaint – worse, that disadvantaged people should feel lucky that they are not even more disadvantaged. It’s a common argument against disability equality.

The NHS is funded through taxes and through small payments like prescription and dental charges – it’s not a generous legacy we inherited from a kindly aunt. We all pay for this and if there isn’t enough money there, there are two very obvious solutions – we need to pay more tax or we need to find efficiency savings. The NHS won’t be destroyed because of drug wastage (even the inflated figure of £300 million is a drop in the ocean in terms of government spending). Any discouragement to people taking the prescription drugs they need risks far greater costs in hospital care, as well as being cruel, shaming and deeply unegalitarian.

The NHS may be – and is being – undermined by a government which tries to present it as an ailing system being abused by its users. I wholeheartedly agree that the wider public are ill-informed of its true value. However, I’m entirely unconvinced that heavy users of the NHS don’t realise how vital it is. It is, after all, keeping us alive.

Mister_Goldfish // Posted 7 July 2015 at 6:48 pm

I’d have more respect for the government’s latest idea if the cost of all medicines were being printed on packaging, but when this only applies to drugs over £20 the number being marked will be relatively small. Meanwhile, when people are paying a prescription charge of over £8 for an item, if they saw that the drug cost significantly less, this might cause a certain degree of resentment.

It really is ridiculous. I take three different kinds of pain-relief. Of those, the most potent (which is also the one with the highest ‘street value’) is the cheapest. And the most expensive medicine on my entire prescription list is simple peppermint oil capsules. And *none* of them cost £20! What good does that information do anyone? They’re not going to start giving heavy opiates to people instead of ibuprofen because it costs fractionally less. Drugs are what they are, and listing the cost (especially when the government is so keen to help people forget that they’re already funding this via national insurance and prescription charges) is meaningless at best and extremely damaging at worst.

Laura Dee // Posted 9 July 2015 at 2:39 pm

No one is saying the NHS is funded by a ‘kindly aunt’. Everyone knows the taxpayer funds it, but everyone also knows that the current model is unsustainable.

No one is presenting any argument against disability equality, either. There are disadvantaged people in every country in the world. The UK is arguably the best country in the world in which those people could live, since high users of the NHS pay very little for their care. Like it or not, they are speaking from a position of privilege.

Why does labelling a drug with how much it cost shame them? Why is it cruel? Most people have no idea how extraordinarily expensive drugs are. Drugs aren’t funded by a kindly aunt either. It’s the whole basis of the NHS: you pay for other people’s healthcare when you pay prescription charges for a cheap drug.

There isn’t some ideal world somewhere where everyone has free or low-cost access to all their healthcare needs. British people are not being shut out of some healthcare utopia. They don’t have some ‘right’ to it. Healthcare in every country has a long way to go and no country is there yet.

Arguing over the full disclosure of drug costs misses the point. It’s one tiny step from a multitude of others in trying to save the NHS. We should be focusing on the accountability of doctors and the education of the public.

If people don’t like having limited funds in the pot they should be campaigning to move to an insurance-based model. As I said in my first comment, disadvantaged people will find they are far worse off in that situation.

D H Kelly // Posted 11 July 2015 at 9:23 am

Laure Dee, I think we just see the world a little differently.

Everyone should have healthcare as and when they need it – this is as fundamental as ensuring that every child gets an education. You’re obviously in favour of this too, but I would call it a right. There will always be a debate over terms; how much tax folk should pay (or National Insurance), what money should and shouldn’t be spent on. But without either healthcare or education, massive potential is lost and there are higher levels of individual suffering, sometimes lasting for generations.

I also believe that everybody has equal value, regardless of impairment, and should be treated as such. I’m sure you agree with this on principle, but for me, this means nobody should be singled out to receive provocative messages (and if this message on prescription packets is not, at least, provocative, then it is absolutely pointless – I had hoped my post covered why it was shaming). Nobody should be treated differently because of the type of medical condition they happen to have – that is disablism, with a big intersect with sexism and ageism since women and older people (who are mostly women) are more likely to have chronic ill health.

This move may even prove to be illegal under the DDA, but it’s certainly immoral.

There are certainly arguments to be had about improving the NHS, but this is the basis of my position. The fact I’m arguing from a position of privilege, in global terms, is irrelevant – elsewhere in the world, I might well be dead by now. That doesn’t mean it doesn’t matter what happens to me here.

Tired // Posted 26 July 2015 at 4:31 pm

I have two medical issues. Both put me at considerable risk if I don’t take medication. One is physical– I have no thyroid gland. I needed a total thyroidectomy because benign tumours made my neck swell, and scar tissue was winding around ny windpipe, making it difficult to breathe. Had I waited another year I would’ve suffocated to death. Because of this I’m on thyroid medication for life. Without this medication, I would suffer weight gain, sluggishness, extreme sensitivity to temperature, depression like symptoms, and pain in my limbs.

My second medical issue is depression. I’ve tried to do without antidepressants, in fact for years I refused to take them as I believed my depression was rooted in a sickness of the soul, an inability to cope because I wasn’t tough enough. Finally I accepted it was a medical problem, and antidepressants have been a lifesaver for me. Without them I would become severely depressed and likely harm or kill myself.

So naturally I don’t appreciate the inference that the UK Taxpayer has some supreme right to make it known they’re paying for me to remain alive. I know this already. We all pay tax, directly or indirectly, and, to be honest, most people in this country fulfil their social obligations every single day, whether that involves being in paid employment or not. It’s unfair to then say to some, ‘your health costs us this much money every month’.

I also don’t like the ‘you should be grateful to have X because there’s starving children in Y’ argument. As everybody knows, poverty is relative. A poor person in Britain has different difficulties than a poor person in, say, Paraguay, but the fact remains, both people are still poor according to their respective country’s standards. It’s disingenuous to suggest we shouldn’t complain because we somehow have it easier compared to other societies. Some of us don’t have it easier, and shouldn’t have to be reminded of it every week or month at the chemist’s. I know how much my medication costs; when I lived in Europe I paid for it, even though I could’ve got my EU health exemption card. I chose not to as I wanted to pay my way. Why should inability to pay one’s way be further punished?

I think that’s what this government doesn’t realise; most of us would gladly pay our way if we had the means to. Those of us who don’t, don’t deserve to be further guilted into feeling like useless meatbags taking up resources the UK Taxpayer may think is better used elsewhere. Honestly, none of us decided ‘hey, I think I’ll have multiple health difficulties that make me a burden of the state’. We just have to make the best of a difficult situation. That includes healthcare. It’s unfair, then, to target those of us who, for whatever reason, can’t pay for our prescriptions.

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