Should gluten-free foods be available on prescription?

January 10, 2017, British Medical Journal

In The BMJ this week, experts debate whether gluten-free prescriptions for people with coeliac disease should be removed.

Removing prescriptions for unfairly discriminates against people with coeliac disease, argue gastroenterology experts David Sanders and Matthew Kurien, and Sarah Sleet, Chief Executive of Coeliac UK.

They explain the NHS is facing unprecedented financial pressures, and gluten-free food prescriptions might seem like an easy target for clinical commissioning groups (CCGs) trying to make savings.

However, annual prescriptions costs for gluten-free foods were £25.7m in England last year - just 0.3% of the total NHS prescribing budget.

They argue that "a is the only treatment for coeliac disease and adhering to this diet is challenging."

The average cost of gluten-free products are 3-4 times the price of standard equivalent products, and there is limited availability of such products in shops.

The National Institute for Health and Care Excellence's quality standards for coeliac disease highlight the role of prescriptions to ensure that the diet is affordable and accessible for all patients.

Despite this, around 40% of CCGs in England are restricting or removing these prescriptions, while Scotland, Wales, and Northern Ireland are not following suit.

The experts say there is no other example in the NHS of a disease having its treatment costs cut by 50-100%, and ask if CCGs would consider this if the treatment for coeliac disease were an immunosuppressive drug and not food?

The alternative gluten free products being suggested by CCGs contain nutritional deficiencies - an isocalorific portion of rice contains 90% less iron and 82% less calcium than bread.

They warn that "targeting gluten-free food prescriptions may reduce costs in the short term but there will be long term costs in terms of patient outcomes."

On the other hand, James Cave, a general practitioner, argues that "it's ludicrous for the NHS to be treating a food product as a drug and to require GPs and pharmacists to behave as grocers."

He says the "complex rules" imposed by the NHS governing what can be prescribed and how often are stressful for people with coeliac disease and their GPs.

"It's a time-consuming rigmarole and, for the NHS, a very expensive one," he argues.

"The eight basic gluten-free staples advised for people with coeliac are all cheaper from a supermarket than the NHS price," he explains. "This is a scandal."

The NHS pays up to £6.73 for 500g of pasta, yet 500g of gluten free pasta will cost £1.20 at a supermarket. Additionally, there is a dispensing fee which is charged on top of all .

"If we stopped prescribing gluten-free products tomorrow GPs would shout for joy and the NHS would stop being ripped off," he says.

He suggests an alternative would be a national voucher scheme or a personalised health budget for patients so they receive the difference between the cost of gluten free and the prescription.

"This could be funded from the money saved by no longer paying for overpriced NHS gluten-free food," he says, and "the price of gluten-free food might fall further once proper market forces were in play."

"Most importantly, people with who currently struggle with the logistics of a lifelong gluten-free diet and a cumbersome and antiquated supply system, would have the convenience and choice we all enjoy," he concludes.

Explore further: How much gluten is in foods labelled 'gluten free'?

More information: Should gluten-free foods be available on prescription? The BMJ www.bmj.com/cgi/doi/10.1136/bmj.i6810

Related Stories

How much gluten is in foods labelled 'gluten free'?

October 3, 2016
A study by The University of Western Australia of foods labelled 'gluten-free' published this week in the Medical Journal of Australia has found that some produced overseas do not comply with the Australian standard that ...

New study links protein in wheat to the inflammation of chronic health conditions

October 17, 2016
Scientists have discovered that a protein in wheat triggers the inflammation of chronic health conditions, such as multiple sclerosis, asthma and rheumatoid arthritis, and also contributes towards the development of non-coeliac ...

Ongoing dietary challenges for people with coeliac disease

January 27, 2015
University of Otago researchers have completed the first national survey of people with coeliac disease in New Zealand and found that many experience ongoing health challenges despite adhering to treatments.

Fourfold increase in the rate of diagnosed cases of Celiac disease in the UK

May 11, 2014
Coeliac UK, the national charity for coeliac disease announces today, May 12, 2014, new research from the University of Nottingham that has found a fourfold increase in the rate of diagnosed cases of coeliac disease in the ...

FDA defining what "gluten free" means on packages

August 2, 2013
Consumers are going to know exactly what they're getting when they buy foods labeled "gluten free."

Recommended for you

Lung-on-a-chip simulates pulmonary fibrosis

May 25, 2018
Developing new medicines to treat pulmonary fibrosis, one of the most common and serious forms of lung disease, is not easy.

Reconstructing Zika's spread

May 24, 2018
The urgent threat from Zika virus, which dominated news headlines in the spring and summer of 2016, has passed for now. But research into how Zika and other mosquito-borne infections spread and cause epidemics is still very ...

Tick bite protection: New CDC study adds to the promise of permethrin-treated clothing

May 24, 2018
The case for permethrin-treated clothing to prevent tick bites keeps getting stronger.

Molecular network boosts drug resistance and virulence in hospital-acquired bacterium

May 24, 2018
In response to antibiotics, a gene regulation network found in the bacterium Acinetobacter baumannii acts to boost both virulence and antibiotic resistance. Edward Geisinger of Tufts University School of Medicine and colleagues ...

Past use of disinfectants and PPE for Ebola could inform future outbreaks

May 24, 2018
Data from the 2014 Ebola virus outbreak at two Sierra Leone facilities reveal daily usage rates for disinfectant and personal protective equipment, informing future outbreaks, according to a study published May 24, 2018 in ...

Early lactate measurements appear to improve results for septic patients

May 24, 2018
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a bundle of recommendations defining optimal treatment of patients suffering from sepsis, a life-threatening response to infection ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.