The Chronicles of the Expired Exemption Card

January is almost over and to all NZ pill counters this only means one thing: explaining to the regulars why they have to start paying $3 per item*

The OFDs don't like change, they like their routines. Remember when Coronation Street's time slot on TV was changed because they wanted to slot in Master Chef? The grand total of 5 people were devastated (yet it made headlines in NZ, which just goes to show that really little happens here in the deep southern hemisphere, other than that one time when I was piloting this helicopter and made a mess). It doesn't help that those who qualifies for an exemption card are usually polypharmacy and reaches the twenty item threshold* within the first 3-6months. For the latter part of that year they then proceed to forget they ever paid the $3/item and accuse you for working for the big pharma corporations to rip off the common layman.

This is what I propose:

• Have the option of being able to mark someone as suffering from chronic illness and hence we are paid full dispensing fees (similar to UK). Patients don't pay any $3 co-payments.
• Those who suffer from chronic illness pays a bit more extra (via tax or ACC or other valid avenues) to cover for their $3 x 20items = $60 dispensing fees
• Everybody else, no exemption cards (this avoids the awkward situation of walking out around end of Jan and say to a patient that they're exempt yet the card only last for a few days hence its not really even worth the paper that it's on.)

Simple? Yes

Idealistic? Yes

Practical? Maybe

Priority? Low

I won't hold my breath as PHARMAC and DHBs is too preoccupied with coming up ways to prevent us from getting close controls** on scripts to be bothered with something like this to make things easier for us pharmacists. In the words of Sigourney Weaver from Avatar: "They're pissing on us without even the courtesy of calling it rain"

*Patients (and also children under their care) receive a "high-user" or exemption card when the person/family has paid for twenty prescription items in one pharmaceutical year. From the 21st item onwards, they don't need to fork out the $3 co-payments until the pharmaceutical year recurs again on Feb 1st.


**In NZ most meds are deemed stat and have to be given out in 3 monthly lots. If one wants it to be given out monthly then the Dr have to "close control" on the script so we can earn the 2 extra dispensing fees.