Some information on how to minimize costs
Medication Costs
For many who become ill with Long Covid, they have not been on long term prescription medications before, they may be therefore unfamiliar with how the DPS (Drug PaymentScheme) and GMS (General Medical Services) Schemes work.
Both schemes exist to reduce the financial burden on those who are taking regular prescription medications and for whom prescription costs may be considerable.
To use both schemes effectively you need to use ONE pharmacy (eg pharmacies do not share information on what a person has spent in a given month, your cap therefore only applies for ONE pharmacy). However, should you need to use another pharmacy (eg out of hours pharmacy following an ER visit, you can claim back from the HSE the amount that you have spent over 80 euro (DPS)/ 15 euro (GMS).
HOWEVER you will not be refunded the amount you paid for the item, only the amount that the HSE has agreed to cover for that drug (there is often a significant difference). So only use a second pharmacy in the same calendar month when absolutely necessary.
Drugs Payment Scheme card
https://www2.hse.ie/services/schemes-allowances/drugs-payment-scheme/card/
Below taken from the above link
Under the Drugs Payment Scheme (DPS) you or your family will not pay more than €80 each calendar month for:
- approved prescribed drugs and medicines
- rental costs for a continuous positive airway pressure (CPAP) machine
- rental costs for oxygen
Apply for the scheme if you do not have a medical card and you pay more than €80 a month for any of these.
Note: this is the total for a family unit, NOT per person. Always monitor your spending in your pharmacy, to ensure you are not charged more than 80 euro in a month. Errors may be made if all relevant family members are not linked on the pharmacy’s system leading to overcharging. Note also, there are exceptions to the cover of prescription medications (eg unlicensed drugs such as Low Dose Naltrexone and Melatonin, see below), certain creams, sprays etc.
GMS (General Medical Services Scheme)
https://www.citizensinformation.ie/en/health/medical_cards_and_gp_visit_cards/medical_card.html
Below taken from the above link
If you have a medical card issued by the Health Service Executive (HSE), you can get certain health services free of charge. Normally, your dependent spouse or partner and your children are also covered for the same range of health services.
Anyone who is ‘ordinarily resident’ in Ireland can apply for a medical card. This means that you are living in Ireland and intend to live here for at least one year.
To qualify for a medical card, your weekly income must be below a certain figure for your family size. Cash income, savings, investments and property (except for your own home) are taken into account in the means test.
Further information at:
https://www2.hse.ie/services/schemes-allowances/medical-cards/about-the-medical-card/
Under the GMS, a family will pay no more than 15 euro per month for prescriptions, with cost per item of 1.50euro. Again if you are not purchasing all of your prescriptions together, track your payments per month to ensure the pharmacy has not overcharged you in error.
Medical cards can be notoriously difficult to obtain, in that a means test is always conducted and there are strict income cut-offs. If you are married, the income of your partner will also be factored in (so even if your only income is social welfare, if your partner is earning a certain amount or if you have assets of a certain value a medical card may not be issued). Generally speaking medical cards are issued based on income. However there is an appeals process. A patient can make the argument that there are additional circumstances which mean that there outgoings are such that the income cut off should not be the only determining factor.
Important: to avail of medical card reduced prescription cost, you need to have a GMS script (green slip). Public hospital scripts can be used within 24 hrs of receipt, and you will only be charged GMS price (note during the pandemic, pharmacies were given greater flexibility on this issue, and some are still willing to make exceptions eg to allow a GMS cost on a private hospital script). This means that for Long Covid patients who are seeing private consultants, they will have to have any prescription they write re-written on to a GMS script, or they will have to pay private costs.
It’s important to note that GPs are not under an obligation to transcribe every private script you obtain. It was not envisioned that someone whose income fell below the cut off needed to avail of a medical card would be using private services. However in reality there are patients using both the public service and their medical card when they can and also using the private system (due in large part to waiting times). This is particularly common in Long Covid patients who often report not being able to access adequate care in the public system.
The majority of GPs will transcribe your script for you, however since it is their name on the script the items prescribed to you then become their responsibility, so if a consultant prescribes something which is controversial, unlicensed, or which is being used ‘off label’ (when a drug is used for an issue for which the drug is not primarily marketed), they may not be willing to do so. You will then need to use the original script and pay for the items privately.
If you take regular pain or other medications (eg anti-histamines) that are available over the counter, you should ask your doctor to include these on a prescription for you.
This has a number of benefits; items like paracetomol can be bought in larger quantities for a person who is on it daily for example. Also if the item is covered by the DPS/GMS, because it has been prescribed it will count towards your 80 euro/ 15 euro maximum (whereas purchasing it OTC will not count towards the 80 euro/ 15 euro max). Also at the end of the year, tax relief can be claimed on prescription costs (see section below)
You can check if a medication is covered by the HSE on the DPS and GMS at this link;
https://www.sspcrs.ie/druglist/pub
Prescriptions not covered by the DPS or GMS
Some medications are not covered. In many instances it is possible to apply to have an exception made.
Medical Card/GMS Hardship scheme
If your doctor provides confirmation that you require a certain medication, it can be added to your own GMS file so that it will be treated like any other item and covered in your particular case. This is done under the hardship scheme.
You need to complete a form to apply for access to the medication via the hardship scheme, the pharmacy can usually provide you with the form. Your doctor will have to sign it. Some pharmacies will charge the GMS price for the item while awaiting the hardship application to be processed (this varies and will depend on your history with the pharmacy). Should the application be denied, you would then pay the pharmacy the outstanding amount. It will depend on the medication as to whether your hardship application will be approved.
Time taken to process these applications varies significantly and at times can be approved in a matter of weeks. There is contact information online for the HSE group that process these applications , PCRS (Primary Care Reimbursement Service).
More information
DPS exceptions
There is a less formal process for obtaining medications that are not normally covered under your DPS (so that they count towards your 80 euro family max monthly payment)
Your pharmacist can use an exception code on their system to submit a request for the item to be covered by the HSE. In many cases, it will be permitted. It is often dependent on the cost of the item, more expensive medications may be flagged/rejected.
Speak to your pharmacist to see if they can have your medication put through on your DPS in this way.
Note on Melatonin
Melatonin is prescription only in Ireland and the UK unlike it many other countries.
Melatonin is not covered on DPS or GMS scheme. Generally melatonin is approved via the hardship scheme for anyone under the age of 18 and denied for anyone over the age of 18 years. This is not official policy, however many patients have reported this trend. However it is worth applying for it, as it may be approved. If you have it covered when you are under 18, you will likely carry this forward.
Do not attempt to ship melatonin from abroad (where it is available OTC), even if you have a prescription this is not permitted and may be stopped at customs.
Note on LDN – Low Dose Naltrexone
LDN is being used by some patients with Long Covid.
Many patients have applied for LDN to be added to their GMS and it has been approved (Note, because it is an unlicensed medication in Ireland, the prices varies HUGELY, for example, 35 euro vs over 100 euro). Note the capsules of LDN are much more expensive than the liquid, and liquid is preferable for titrating up and down as needed. When applying for hardship scheme, request cover for both the liquid and capsule version (so you dont need to re apply in the future).
Whilst you await the processing of your application, ensure to shop around pharmacies to ensure you do not over pay (reasonable price for a months supply of LDN at a dosage of 4.5ml/mg per day is 35 euro ) (Merlin Pharmacy Galway is well known amongst the ME community for supplying LDN, they offer a good price including reasonable monthly delivery).
Tax Relief on Health Expenses
If you or anyone in your family has never had health issues, you may not be familiar with the process for claiming tax relief on your health expenses.
If you have not paid tax in a given year (eg if your income was too low, this might apply in cases where a single person is on illness benefit and their tax credits covered their social welfare income so that no tax was paid), obviously there will be no tax refund. If you are married and joint assessed for tax with your partner, your tax bill is calculated as a couple, so you would in that case be able to reduce your tax bill via a health expenses claim.
Here is the process as per Revenue (you need access to your online Revenue account);
Note: always check that the totals that Revenue have on file for you are correct (eg in terms of income whether that be social welfare or employment are correct, that the totals that they have for you in terms of PAYE, PRSI and USC match up with your payslips for example).
When the year is complete, gather the following information in order to calculate your total eligible health expenses that can be submitting to Revenue;
-Pharmacy print-out (also referred to as Med 1) of prescription costs (you should also keep your blue receipts (applies to those on DPS, not GMS) to allow you to reconcile to ensure the print out is accurate). Keep note of additional pharmacies that you have had to use so that you ensure you have a print out from ALL pharmacies used during the year
-All medical receipts that can be claimed (see details at Revenue link above or what may/may not be claimed).
Receipts such as;
-GP visits (for a medical card holder, they may still be charged for blood tests and certain vaccinations eg Tetanus)
-Consultant visits
-Scans or tests
-Visits to Emergency Room, VHI and Laya urgent care centres etc
-Physiotherapy
-Optical appointments/Dentist/Alternative therapies (some can be claimed eg acupuncture)
-Equipment that you require
Remember to include hospital excess fees for day case or overnight cases (private admissions).Whilst they can not be claimed back from your health insurance (as the purpose of the excess is that it is the amount you pay, and they cover the rest), they can be claimed on your tax
(Note, large costs such as ADHD/Autism Assessments can be claimed for both adults and children)
To make it easier to calculate your total Health Expenses Amount, at the end of the year the following routine can be helpful;
-Keep your receipts in one place (eg large folder) (all receipts, consultations, hospital excess costs, prescription blue slips etc)
-Note on your receipts when you have claimed it from your health insurer and the amount you were refunded by them (for those that have health insurance).
Important: you are only permitted to claim the amount which remains after refund eg if your appointment cost was 150 euro and you were refunded 75 euro from VHI for example, you then have 75 euro balance for which you can claim tax relief.
-Keep a summary sheet of all consultant appointments, hospital admissions, tests, scans, ER visits, physiotherapy (Eg. all claimable medical visits) etc (this will ensure that if you are missing a receipt you will know and can request a copy of it from the practitioner). Although some professionals discourage patients from seeking a re-issue of receipts, they will provide them. Using your bank statement can help you ensure you are missing no receipts, if you consistently pay with your debit card.
Note: technically physiotherapy is claimable for tax relief provided a doctor suggests/recommends it for your complaint. Therefore if you have a number of receipts, you may wish to get your doctor to note their recommendation in a letter/script so that you can keep this for your records.
When you claim tax relief for medical expenses you are only required to enter the figure (usually goes under ‘other health expenses’. They generally do not seek a breakdown or the uploading of receipts.
However Revenue can seek this information any time. Often if your health expenses bill is significantly increased from previous years, this could trigger them to look for the documentation. Therefore it is in your own interest to ensure your calculations are correct, and the breakdown is clear.
Important: you are required to keep records of your health expenses (eg all receipts, to be able to demonstrate how you arrived at the total amount that you provided to Revenue) for six years (in case of audit).
You can only claim tax refunds on the previous four closed years (eg during 2023, you will be able to claim for 2019, 2020, 2021, 2022). Therefore DO NOT forget to submit this information, it is good to get into the habit of doing it in Jan/Feb of each year.
Once you submit your request for a balancing statement after inputting your total health expenses, it is usually processed within a number of days and a letter issued detailing the tax refund you are due (if for any reason you underpaid tax in that year, some or all of your health expenses refund may be lost to that correction)
Health Insurance
ALWAYS check your insurance plan each year before renewal (or within 14 days of new year, if you cancel within that time, there will be a full refund). New HI plans are released by the insurance companies regularly and just because your plan was the best value for your situation last year does not mean it still is. HIA.ie is a fantastic resource which is independent where you can compare cover and cost of various plans.
If you do not hold health insurance, you will likely have heard that there are waiting times for any condition or health issue which began when you did not hold cover (usually five years). Note these waiting times DO NOT usually apply to the ‘everyday cover’ aspect of the plan. The everyday cover refers to such costs as GP and consultant visits, alternative practitioners dental etc.
DO NOT ASSUME it is too late to get a HI policy to help with the medical costs of your Long Covid if you can afford it. In addition, even for costs that are not covered, it may be worthwhile starting with a low level basic plan to work through your 5 year waiting time. Obviously some people may not be in a position financially to purchase private HI.
IF IN DOUBT do not use a service
Health Insurance cover is now based on onset of symptoms (NOT on diagnosis), so whether you are covered for something will depend on what is on your medical records. Since most of us do not obtain our full medical records, it may be difficult to know if the health insurance company might cover it or not. If the cost is significant (eg several nights in a private hospital), it is likely not worth taking a risk on whether or not the claim may be rejected
ALWAYS check your cover before any hospital procedure, you will need the procedure code, name of consultant and name of hospital, With most of the companies, you can now do this easily yourself online.
General Tips for saving money
-There are some pharmacies which offer an annual membership and in return they offer a percentage discount off OTC products and generally cheaper prescription costs (if there is a medication you buy every month, it is worth checking a few of your local pharmacies to see which one comes in cheaper, prices can vary greatly). So put a small bit of work into choosing your pharmacy to minimize costs.
-Check OTC medication costs with a number of pharmacies in your area
If there is an over the counter medication that you regularly buy, shop around for the best price, the difference in pricing can be SIGNIFICANT!
-Do not stock up on a new supplement until you ensure you can tolerate it/it has a benefit (eg buy a small amount to begin with, even if it is prescribed by a doctor. Side effects can happen with supplements as well as medications
– Try buying supplements online rather than in local high street Health Food Stores, they are often significantly cheaper. Companies such as piping rock, iHerb, HPNutrition are often cheaper even allowing for delivery costs. Of the local shops, Holland & Barrett often have good deals and offer a good rewards card scheme. They are also online, and often have a wider selection online. Delivery is free when you spend over 25 euro.
-Start a new supplement one at a time, (with a 2k gap ideally) so that you can tell if it is having a positive effect on your symptoms. There are now many many supplements often referenced in the Long Covid community. It is possible that what you may benefit from, may not be the same as what another Long Covid patient may benefit from. It is easy to spend a huge amount of money on supplements
-With alternative therapies, be selective on what you wish to invest in trying. Research. It is understandable to be desperate for an improvement in symptoms, however there are also many individuals out there trying to take advantage of this desperation. Is there any evidence behind the treatment? What is the cost? Is it covered by my health insurance/can I claim tax relief for it at the end of the year?
-Shop around
Always check multiple providers, for alternative therapists, for supplements, for pharmacies, for tests and scans, even consultants fees, prices vary considerably. In terms of a consultant you will want to attend a person who has the required expertise but there may be multiple options with varying fees.
-Cancel appointments if you do not need them.
If you are scheduled for a review and you feel that it may benefit you better at a later stage (eg you are still trying some of the doctor’s suggestions), feel free to postpone. If you give plenty of notice, they are usually happy to have the appointment back as it will usually be easily filled as services are heavily in demand.
Long Covid Advocacy Ireland 