The regulation supporting ‘professional’ or ‘dispensing’ fee charged by pharmacies for providing counseling services to patients while reading a doctor’s prescription, has seemingly been revoked.
The announcement made by Rasoul Dinarvand, head of the Food and Drug Administration (FDA), on Saturday, was apparently “welcomed” by pharmacists; not surprising, as the fee is still in place, only its name has been changed.
Based on the Health Ministry’s new tariffs entitled ‘Relative cost of clinical and diagnosis services’, which will come into effect from the second half of summer in the upcoming fiscal year (starts March 20), pharmacists will charge ‘Medicinal Services Tariff’ for reading each prescription.
The amount may appear meager: only $0.5 (20,000 rials) for private pharmacies and $0.2 for state-run pharmacies, the Persian language newspaper ‘Etemad’ reported. But if the entire collection is summed up, it amounts to a huge sum.
Last year (ended March 20, 2015), the Majlis (parliament) Research Center announced that annually, pharmacies in the country totally receive $58.6 million in the form of dispensing fees.
The National Pharmaceutical Authority at the Ministry of Health oversees the provision and utilization of medicine in the country through the deputy for Food and Drugs. All public health facilities/pharmacies procure their medicinal needs from the same distributors as private facilities.
A national generic medicine policy promotes and enforces the prescribing and dispensing of generic medicines. While generic substitution by pharmacists is permitted, however, prescribing and dispensing outside the Iranian Drug List (about 1100 chemical entities; 3750 registered products) is not permitted.
The Commission for Pricing sets the price for all medicines, as well as mark-ups or margins. All prices are made publicly available on the website of the Health Ministry of Health. Pharmacy remuneration consists of a percentage mark-up (mark-up is the amount by which the cost of a product is increased in order to derive the selling price) plus a dispensing fee.
Costly Drugs
The grouse of patients is that most of the prescription drugs are already costly and it is not fair to add a separate extra charge for reading the prescription or providing advice on how to take medication. Further, why should pharmacies charge a fee, even for simple prescriptions like common cold medications; surely nobody needs technical advice and explanation on how to use common cold drugs!
The new tariff stems from the disagreements between the Health Ministry and the Court of Administrative Justice during the last few years, when the latter insisted on complete removal of dispensing fee from the list of tariffs.
However, the ministry while deleting ‘professional fee’ from the list has replaced it with Medicinal Services Tariff. But it is one and the same and with its registration in the new tariff book it can be increased annually as per the rules.
Besides criticism from the Court of Administrative Justice, disgruntled patients are unhappy that they have to continue to pay the extra amount, however small, over and above their high medication costs.
Pharmacists Happy
On the other hand, pharmacists are pleased. An owner of a pharmacy located in central part of Tehran told ‘Etemad’: “As a mid-level private pharmacy, our daily income from sale of drugs, cosmetics and medical equipment is about $1350. Each month, we read about 1,000 prescriptions which translate into $6000 annually.”
“Charging professional fee is not unfair; the taxes we pay have also increased to $3250 in 2016 from the previous slab of $1350.”
“If the people are unsatisfied, from now on, they can read their own prescriptions and we will dispense the medicines accordingly. Also we will not give any advice on the correct use of the medications.”
Dispensing fee is charged in several countries. In America, for reading a medical prescription (e-prescription) a little amount automatically gets deducted from the patient’s account. Also, in Germany and Sweden, dispensing fees are collected as a part of insurance premium, and people pay more money if they buy medications without using insurance.
In Canada, pharmacists receive a dispensing fee for filling a patient’s prescription. This fee covers services such as: talking about the treatment with the patient; maintaining and checking medication records; providing drug information to patient’s doctors; dispensing the drug products and stocking patient’s medication.
