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Prescription Costs...

I had an interesting discussion with my local pharmacist this morning when I went in to collect my next 3 months of imatinib. Many of us, myself included, have had our prescriptions changed so that we have to 'cash them in' [cant think of the proper term....age or imatinib???? :-))] at the local pharmacy rather than have them dispensed through the hospital pharmacy.

I knew that the local PCT saved the cost of the VAT by doing it this way, but it isnt quite as simple as that. My local pharmacist gets paid 99p per prescription dispensed [ peanuts for our drug cost] but when the cost of the prescription rises above £125, he gets paid a flat rate commission of 5% of the drug cost. So he is pleased to see me walk in since with 3 months on one prescription he gets a fee of £225.99, and considers it worth the effort of registering with Novartis, the extra paperwork etc.

He did comment on one or two downsides, which are worth mentioning though -
1 - he prefers prescriptions to be in multiples of 30 tablets so that he has none left sitting on the shelf, that can be quite costly. My haematologist has changed his prescribing habits to fit in with that - he says 'total of 90 tablets' rather than '12 weeks supply'.
2 - Novartis gives the pharmacist 60 days to pay, but the NHS is a 90 day payer - so that leaves him out of pocket for about a month...

Take care all
Janet

Hi Janet,

The 'on cost' which your Pharmacist told you about is a consideration, but as he says, he gets 5%, whereas vat on medicines is 17.5% so there's still a net saving of 12.5%, which on the cost of Glivec is substantial.
I go along with the comments about having your doctor prescribe to the actual pack size because any 'overage' left on the Pharmacist's shelf is a cost to the Pharmacist.
Incidentally, the NHS Trust for which I work continues to supply the small number of cml patients that we see with Glivec from the hospital pharmacy.

Paul

My son's medication is delivered to our house. I was told this was to help the NHS not having to pay VAT on the medication if it didn't come into the hospital.I dont know if this is just local to my trust, i live in Somerset, but the company that delivers them is based in Featherstone.

susan dickerson
Hi to all, just wondered if any of you still have a bone marrow test, at any time even though most of us are having regular PCR tests. If so how often.
sue

Hi Sue,
I'm from Australia. I still have six monthly bone marrow biopsys. I have a blood test every 3 weeks also. I'm on a 400mg daily dose of Glivec. I'm in remission at the moment.
I have heard that maybe they might stop the BMB and just have the blood tests but I'm not sure of that.

Take care
Debbie

Hi Sue
I was dx 6 months ago. I had a bone marrow test done immediately and I was told the next bone marrow test would be at 1 year.

Flora

Hello Sue,
I was dx Nov 1995,I didn't keep any records till I went onto Imatinib in Oct 2000, since then I have 17 BMB & A. In the last two years I have averaged one every three months, but this is unusual as I have other problems. Until 2000 I just had them done every 12 months. I am a bit of a wimp, and at my local Hosp' I always have sedation, I used to have a local anasthetic but Dr had a problem once and had to do the proceedure again, so now I don't mind what they do when I'm out. It's a bit different if its done at the Hammersmith,it has to be a local as I have to drive home. As I said , it seems to be unusual to have it done more than once a year.
kind regards
les.

Hi Sue - Hope you are all well 'up north'. When I moved down here Addenbrookes were not sure whether I would still need to have bone marrow biopsies but have now decided that I should continue to have them annually. I am still on the 106 trial now that it has been extended so I don't know if that makes a difference.
Lorraine

I asked the question at this years seminar and there was some slight disagreement as to how often you need to have one. All the consultants were of the opinion that once you PCR results were very low then biopsies were need less frequently Some said annually and some said every 2 years or so, but certainly the mood of the consultants was to do biopsies less and less.

I had one last Xmas and not expecting another one for a year or so hopefully.

Steven

Hi all, hope everyone is doing ok and looking forward to Christmas!
I am treated at Addenbrookes too, but I have not had a biopsy for almost 2 years.....I did wonder if this was normal?? I had a biopsy upon diagnosis (Jan 05) and another one at 6 months and approx. one year after diagnosis, not had one since.....I am now worrying that I should have had one more recently? Can anyone reassure me?!
thanks,
Anna

There's a lot of debate about frequency of monitoring, and also what monitoring is done when.

In my wife's case, she has an annual bone marrow biopsy. This is for full range of tests I believe FISH, pcr etc.
There is a debate about whether pcr is best done on peripheral blood (from vein) or from marrow, I think that until someone gives conclusive evidence either way, bone marrow biopsies will continue to be done.
In reality, if pcr's are stable, the the FISH test should show zero abnormal cells (assuming that ccr has been achieved). FISH will only detect obvious abnormalities in the marrow, whereas pcr is a far more sensitive test and will reveal minimal residual disease if present.

I think that the reason fro inconsistency across the country is because no-one is really convinced one way or another.
Paul