Price tags on medication: why it’s a stupid, callous idea

Image reads: How Your Money Was Spent: £522.89 at the 5-star Carlton Hotel in Osaka, Japan; £1,147.95 at John Lewis; £3,346 at Searcy's, which has several champagne bars across London; £624.88 in a store specialising in bar equipment and bottle openers; £1,382 at the Hotel Melia in Berlin, 'one of the best in Germany'; £788 at the Miramar luxury hotel and spa in Santa Monica, California; £542.68 in a store which rents out drills, shredders and other toolsYesterday the government announced that labels on drugs prescribed by the NHS in England that cost over £20 will have the cost printed on them along with the words “funded by the UK taxpayer”. According to the BBC report, the decision is part of an effort to reduce medication wastage — medicines prescribed but never used — which allegedly costs £300m a year. Quite a few of my friends online are chronically ill and rely on medications to keep them alive or at least to make some semblance of normal life possible. Personally, I’m on thyroid supplements daily, and have been since age 5, and get free prescriptions, which I suspect many of my friends don’t. The reasons this is a bad idea were obvious.

First, over the past few years there has actually been demand for the state to finance expensive new drugs, particularly for rare diseases and cancer. I have seen more than one petition over the past couple of weeks for a particular drug that is licensed for use on some conditions but not others to be made available for a young girl who has one of the conditions for which it is not licensed, but which evidence suggests could allow her to live a normal life. This week, for example, NHS England refused to license a new drug, Vimizin, which is available in several other countries, to treat Morquio’s syndrome, to people who had already been part of a clinical trial, while NICE investigates its “cost-effectiveness”. Media reports say that people who took the drug found their health improved dramatically and that they were able to work and school and undertake university courses which they would otherwise be unable to. So it is clear that the public is willing to have expensive medications available on the NHS if they work.

Second, the reason prescription charges are set as they are is that cheaper medications are used to partly fund the cost of more expensive ones, yet these cheaper medications would not be subject to these rules as it would be politically impossible, putting the prescription charge scheme in jeopardy.

Third, drugs have side effects and it has been known for drugs to kill rather than cure a patient (especially chemotherapy drugs) or to expose them to an infection that kills them. Admittedly, some of these are likely to be administered by staff rather than given to the patient to administer themselves, so they might not see the label unless the person administering it is obliged to read it out to them. But why lecture a patient about the cost of their medication (based on the assumption that they’re going to waste it) when, even though it may be relieving another health problem, it is destroying their immune system or causing osteoporosis or some other life-altering complaint which costs them an awful lot? And of course we will be reminding them of the cost of all the medication for the side effects as well.

Fourth, whether or not drugs to treat mental health conditions are to be exempted from this, mentally ill people get physically ill, some chronically ill people also have mental health problems and some conditions affect both. Reminding someone with depression that they are a burden on the taxpayer (something many are already keenly aware of) is cruel, and is going to make their condition worse, affecting their decisions about seeing doctors or accepting prescriptions. Some of this will cost ‘the taxpayer’ in treating their future health (perhaps requiring some patients who refuse medication to be sectioned), but the real cost will be to that person, and their family, in suffering and perhaps loss of life.

Fifth, some ‘wastage’ of medication is due to mistakes at the pharmacy, where medication is prescribed but not delivered (or when it cannot be delivered); even if unopened, it cannot be reused. Other ‘wastage’ is due to medication being prescribed on a PRN (pro re nata) basis, to use when necessary. If the necessity never arises, or does not arise enough to use all the medication, or the patient decides to go without, some of it will get poured down the toilet or returned to the pharmacy for disposal.

Picture of a red London brick, with the word "London" and the number 33 etched into itSixth, why the focus on drugs? They are not the only expense the NHS has to cover. Perhaps every nurse, doctor, cleaner, occupational therapist, healthcare assistant, receptionist and whoever else works in a clinic or hospital should carry a name badge saying “Hello, my name is [whoever] and I cost the taxpayer £50,000 a year (or however much) a year”. Perhaps we should price-tag every bit of furniture, every lift, every vehicle, every syringe, tube and cannula.

Seventh, the use of ‘the taxpayer’ makes it sound like a single individual is footing the bill. The whole point of a public health system is that the cost is shared between anyone who might have to use it, so that poor people do not die or suffer lifelong disability (and thus impoverishment) because of an illness which could easily be treated. The individual taxpayer does not feel the cost of any individual drug, let alone any individual prescription.

The fact is that running a good national health service costs money, and if it is going to be free at the point of need, some of it is going to be under-utilised; this has been cited as a reason for closing whole centres down, much to the detriment of the health of the people who needed it (see Beth’s story from the previous entry). I do not really think that reducing drug wastage is the real reason for labelling medications with cost; it is to make people routinely aware of the cost so as to soften us up for cutting public healthcare. As all the evidence shows that the public currently supports maintaining the NHS and providing drugs that improve or save lives, however much they cost, the issue of ‘wastage’ of supposedly expensive drugs is being used as a ‘wedge’ to gradually open up the possibility of restricting medication availability, particularly to people who might be portrayed as less than deserving. Yet it is more likely to reduce legitimate usage than wastage, adding to the cost of treating ongoing and future illness, worsening mental health problems and costing lives.

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