Many New Zealanders are not getting free prescriptions when they should and these people are likely to include our most vulnerable, new findings from an ongoing University of Otago and Victoria University study into equity in prescription medicine use suggest.
Most people pay $3 per medicine when they pick up their prescription from the pharmacy but after paying for 20 prescription items in a year, individuals or families are supposed to be exempt from this charge.
Using anonymous data from community pharmacy computers, the research team identified individuals who had more than 20 items dispensed to them in a year and found that the majority were from the most socio-economically deprived areas. The researchers' analysis showed that 40% percent still paid the prescription fee for 90% of the medicines they got, after they should have been entitled to the exemption.
Associate Professor Jackie Cumming from Victoria University says "In fact the average amount people paid for medicines hardly dropped at all after they reached 20 items."
PHARMAC data shows that 180,000 people pay for prescriptions after they should be exempt. This costs patients about 2.5 million dollars a year.
Otago's Dr Simon Horsburgh says that these data are likely to underestimate the extent of the problem because the exemption should apply after a family has had 20 items. "Neither our study or PHARMAC can identify families from the data, so these estimates are based on individuals. Because many of these people will have family members who also get prescriptions they should be receiving free prescriptions after fewer than 20 items."
Standard charges for prescription medicines will go up from $3 to $5 in January 2013. This should mean that the maximum that families will be required to pay will be $100 per year.
However, Professor Pauline Norris says "Given that the exemption after 20 items does not seem to work in practice, people with multiple health problems, who use a lot of prescription medicines, will potentially have to pay much more than that". She points to New Zealand and overseas studies which show that prescription charges lead to less use of medicines and poorer health outcomes.
Exemption for the prescription charges requires people to have a Prescription Subsidy Card, to have one main pharmacy, to collect receipts from any other pharmacies they visit, and take these to their main pharmacy.
"Many people may not know about the card, they might visit multiple pharmacies, or pharmacists may not be aware of family relationships. Vulnerable people, such as those with multiple health problems, the elderly and people with low health literacy may particularly struggle with these bureaucratic procedures. These are the very people who we need to ensure get the health care they need," Professor Norris says.