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How much do multiples and independents charge for EHC?

Pharmacist Nat Mitchell: "Cost is obviously a consideration for younger people"
Pharmacist Nat Mitchell: "Cost is obviously a consideration for younger people"

After the cost of emergency hormonal contraception (EHC) hit the headlines last week, C+D examines where multiple and independent pharmacies stand on charging for the morning-after pill.

Last month, Superdrug launched its generic Ezinelle pill, priced at £13.49 – half of the £27 it charges for branded Levonelle, and 1p less than Tesco sells Levonelle for.

It prompted charity the British Pregnancy Advisory Service (BPAS) to urge Boots – which currently charges £28.25 for Levonelle and £26.75 for its generic version – to cut the price of its emergency contraceptive pills and bring it in line “with other European countries”.

BPAS claims that "progestogen-based emergency contraception can cost up to five-times more in the UK than elsewhere in Europe".

In Scotland, EHC is free from community pharmacies to any female client aged 13 years or over, while the Welsh Assembly made a commitment in 2011 to make EHC available for free through all pharmacies in the country.

In a statement last Friday, Boots said it is “truly sorry” for its “poor choice of words”, after suggesting in a letter signed by chief pharmacist Marc Donovan on April 19 – and seen by C+D – that the reason it would not cut the cost of the morning-after pill is because it “would not want to be accused of incentivising inappropriate use”.

Read Boots’ latest statement in full below.

In light of the recent headlines, C+D contacted a range of pharmacy businesses – both multiples and independents – to ask what price they sell private EHC for, whether they are considering lowering the cost, and if they offer the NHS service – which provides free EHC at the point of delivery.

 

Lloydspharmacy

“We expect to sell Ezinelle for £13.49”

Steve Howard, Lloydspharmacy quality and clinical standards director and superintendent pharmacist: “Our pricing policy is determined by several factors, including the competitive environment, and it is subject to regular reviews.

“We currently offer two products: ellaOne at £34.95 and Consilient at £24.99. We are looking to source a further option – Ezinelle – which we expect to be available from September at a retail price of £13.49, subject to stock being available.

“The priority is to determine the correct product for the patient – regardless of price – in line with the latest Faculty of Sexual and Reproductive Healthcare guidance. For most women, this will now be the ellaOne product, unless they have a body mass index of less than 26 and are seeking advice within 24 hours of unprotected intercourse.

“The consultation with the pharmacist will establish the most appropriate course of action – which could be referral – and will also include guidance on contraception and sexually transmitted infections. As part of standard business practice, we monitor the market to ensure our products are competitively priced, and this is ongoing.

Just over 700 Lloydspharmacy stores [across the UK] currently provide free EHC under locally-commissioned services.”

 

Flagg Court Pharmacy, Sunderland

“We haven’t sold the morning-after pill since 2010”

Pharmacist owner Tony Schofield: “We would sell the levonorgestrel pill at about £10 for the new generic, and ellaOne at about £20. I'm [being] vague because we have a locally commissioned EHC scheme and haven't sold any [morning-after pills] since the scheme was introduced in around 2010.”

 

Well

“We are competitively priced at £22.99 for our generic option”

“We are committed to the health and wellbeing of our customers, providing holistic family planning support, and ensuring that women have easy access to the EHC service. In line with this, 91% of our pharmacies offer a commissioned EHC service that is free to the customer.

“For the small proportion of our pharmacies that do not provide a free EHC service, our pharmacists offer a paid-for service that includes a private consultation to discuss the need and effectiveness of the EHC, based on their circumstances, and – where appropriate – they provide the medication. The customer does not pay anything if the medication is not provided following consultation. 

“Our customers are provided with a choice of premium brand or generic EHC, offering a lower-priced option. We review our prices on a weekly basis and, compared to our direct competitors, we are competitively priced at £22.99 for our generic option.

“We firmly believe that what we offer is a service, not just a product, and the time and expert advice of our pharmacists is incorporated into the current price, along with the cost of the drug.  

“For women who cannot afford to buy EHC, our pharmacists will provide her with advice and support, and signpost to alternative services where the medication is free of charge, including NHS walk-in centres, GPs, family planning clinics, and sexual health clinics.”

 

Weldricks

“We have an emergency generic contraceptive which is £9.90”

“We have Levonelle One Step priced at £16.90, ellaOne at £23.95, and a generic emergency contraceptive which is £9.90.

“All the EHC we offer is priced below recommended retail price and has been since we [introduced the EHC service].

“Where the local public health scheme allows it and the pharmacist is accredited, then no charge will be made for EHC. Unfortunately, free access is not available across all of our pharmacies. This is another reason why we have added a cheaper, generic product to ensure that price is less of a barrier and women in need do not need to be referred to other healthcare professionals with the inconvenience that can bring.”

 

Boots

“We are committed to looking at the sourcing of less expensive EHC medicines”

“We firmly believe in the right of all women to access the EHC service with ease and convenience, and have long been at the forefront of increasing accessibility of contraception for women.

“The provision of EHC requires a regulated mandatory consultation to protect women’s health and is a professional healthcare service provided by highly trained pharmacists. As a leading pharmacy, we will not compromise or undervalue this professional service. The consultation with the pharmacist is necessary to understand the patient’s individual circumstances, and ensure we provide an appropriate, safe and effective medicine for her.

“The pricing of EHC is determined by the cost of the medicine and the cost of the pharmacy consultation. We are committed to looking at the sourcing of less expensive EHC medicines for example, generics to enable us to continue to make a privately funded EHC service even more accessible in the future.

“In addition, the NHS EHC service where it is locally commissioned is provided for free in over 1,700 of our pharmacies, and we continue to urge the NHS to extend this free service more widely.”

 

JWW Allison & Sons Ltd in Cockermouth, Cumbria 

“Younger patients often ask how much the service costs”

Pharmacist and director Nat Mitchell: “At present we are fortunate to be part of an NHS scheme where we can provide EHC free of charge.

“Younger patients often confirm whether the service is chargeable before proceeding, so cost is obviously a consideration when deciding whether to access emergency contraception.

“If the scheme wasn't available, then we would probably operate a private PGD, so that we could set the price lower than the over-the-counter pack.”

 

The Royal Pharmaceutical Society

“Price shouldn’t be an issue”

Royal Pharmaceutical Society English board chair Sandra Gidley: “We are supportive of initiatives that improve access to emergency contraception and sexual health advice for women. Cost is a barrier to access to medicines, and for that reason we would like to see all community pharmacies in England able to supply emergency contraception free through the NHS.

“NHS emergency contraception services have been available free through pharmacies in Scotland and Wales for some time and we would like to see that replicated across the whole of the country, so women get better access, regardless of their ability to pay."

 

The National Pharmacy Association

“We currently have a postcode lottery”

"Access to contraception shouldn’t be based on ability to pay, we should have a consistent national service to provide coverage to women free at the point of need. We currently have a postcode lottery which isn’t acceptable.”

And the rest...

Rowlands Pharmacy did not wish to provide comment, while Cohens, Asda and Day Lewis were unavailable for comment at time of going to press.

16 Comments
Question: 
How much does your pharmacy sell EHC for?

John Ashworth, Community pharmacist

We provide the locally commissioned service so it's at no charge. Can't blame Boots for what they do because they are obviously selling it to people prepared to pay for it , I've also locumed at Boots branches providing a locally commissioned free service. I would suspect that the whole debate has been mis-reported . Did any of the would be purchasors ask if they could obtain it for free , how many were advised that there was a local free service available ?

A Hussain, Senior Management

Boots are expensive for everything and I can't see that changing. 

Chemical Mistry, Information Technology

Nice to see sandra living in the real world*
 

*This comment has been edited to comply with C+D's community principles*

 

Angela Channing, Community pharmacist

She was a Lib Dem MP for years, they don't do real world!!  c.f Nick Clegg with EURef2, with the under 30s getting 2 votes!  I mean....  come on, WTH is wrong with these remoaners?!!!!   Thank God he lost his seat. 

Ilove Pharmacy, Non Pharmacist Branch Manager

A nice way of C&D trying to take the heat off Boots. This whole issue was actually about their scant regard for patients and their fight to keep ripping them off. C&D completely ignore this despite it making all the national newspapers and being debated on SKY News. But if Boots/GpHc were 'hanging' a pharmacist for over claiming  MURs after management bullying C&D would be all over it, gleefully poring over the minutae as he/she is struck off and Boots absolved of all blame and responsiblilty

 Not such an impartial journal I'd say.

Valentine Trodd, Community pharmacist

The race to the bottom continues... what price is put on the pharmacist's time and expertise?

Angela Channing, Community pharmacist

That's exactly what I thought.  Well if the tablet is about 6 pounds or so, then in some cases 3 to 4 pounds for 'professional input'.   Seriously kids, (if any 6th formers are reading this,)  go and join an accountancy firm after A levels or become an electrician or plumber!  More money, less stress, be your own boss.   Roll on retirement ! 

Ilove Pharmacy, Non Pharmacist Branch Manager

ZERO.

Myke Kofi, Locum pharmacist

Has anyone else read the home page of the British Pregnancy Advisory Society (bpas) website recently? I noticed they have a "link" to an online pharmacy offering three EHC products (in my opinion) at prices that frankly undervalues the real world logistics/supply chain costs AND pharmacists expertise and the time required to properly conduct requests for EHC compasionately, discreetly and non-judgementally.

Has anyone else independently scrutinized the bpas "survey"for potential undue bias? Which pharmacies in which specific EU countries were surveyed? And what exactly is the "quality" of  the generic levonorgestrel product they obtained in France for £5.50? What was the pound sterling:euro currency exchange rate at the time of the survey? My personal experience of French pharmacies is of much higher prices. And what excipient(s) did the French levonorgestrel contain that might potentially trigger allergies in an unsuspecting EHC customer? 

 It might well be that someone at bpas has been watching too many "game of thrones" episodes recently; and decided last Friday to "slay" the giant Walgreens Alliance Boots.

Thus kicking up a hyperactive media storm and instigate (in my humble opinion) an unnecessary mass boycott campaign. Did no one at bpas not know that the founders of Boots, John and then Jesse Boot of Nottingham were Victorian retail entrepeneurs "par excellence"? [a plug for the British Society for the History of Pharmacy].

Alas, where was the RPS media team to strongly promote pharmacists expertise when it comes to the professional, discreet AND non-judgemental provision of EHC? 

Moreover, why did Boots responded so meekly and back down on their original media response? Perhaps the "giant" is wounded and bleeding? Down but probably not out, yet?

Much more important than the pricing issue, I think it is apparent that a lot of continuing education and awareness raising about the pros and cons of EHC is STILL required in 2017.  As is improving information about accessing EHC via other non-GP providers - especially when GP surgeries are closed after 6.30pm weekdays; at weekends and bank holidays. I really like the way how the NHS Choices website lists many alternative options to non-GP providers. 

Overall, EHC is a hugely emotive issue, but it is noticeable that far too many social media "conversations" seem to be advocating EHC as a simple packet one should be able to "purchase on demand" without any questions asked whatsoever by pharmacists; nor any counselling to be provided either.  Surely, this perspective cannot be in the interests of the vulnerable patient/customer group.

Optimistically, I had "hoped" to see the RPS challenge this - not at all in a patronizing way; but that the pharmacists "artem secundum" always has patients/customers at the heart of everything we advise and may or may not supply.

Finally, I wonder whether bpas have bothered to even read the NHS Choices website (or MHRA Drug Safety update of September 2016) whereby if practical, the IUD coil; ullipristal acetate and then levonorgestrel is recommended in that order?

Conflict of interest declaration: (i) I have previously locumed for Boots; but not since 2006.

(ii) I was a foreign-intern pharmacy graduate and then staff pharmacist for Walgreens phamacy (2000-02).

Angela Channing, Community pharmacist

Yes, where were the RPS and Sandy, telling the media that the reason it isn't £5.99 is because you are paying for the input of a healthcare professional in a clinical consultation, to make sure it is suitable for you? !  i.e. a community pharmacist with 5 years' training. Not a 'shop gal' on minimum wage who just waves the box at the dispensary! I'm sure Sandra G. reads these pages, so perhaps she would like to come and explain why the RPS weren't all over the news and what exactly I'm paying nearly £200 a year for?  Professional Representation to the public and the government?  Pah !   Waste of space organisation.   I won't hold my breath!   And for once I agree with Boots somewhat.  And this is from someone who hasn't worked for them for nearly a decade and a half because they became such an awful company to locum for! 

 

Sharon Stone, Communications

Michael, you are only stating facts about Boots in its infancy, which it was a great retailer and for the benefit of the people. But you forgot ( whether intionally or not ) to mention what an awful company it was and is to work for under Stefano Pessina , who has scant regard for the workers or still further its customers because customer service due to drastic staff cuts and shortages is abominable and not the Boots it was . Boots nowadays is running on the back of its historic reputation and is definitely NOT the company it was and those ladies are quite right to boycott it .

Myke Kofi, Locum pharmacist

Hey Sharon, I welcome your feedback. Yes, I have heard many reports from customers and staff that Boots is "unrecognisable"since the arrival of Mr Pessina's private equity plutocrats.  And yet, the Boots brand and the stores remain incredibly popular! Most non-pharmacy people I know think pharmacy is Boots is pharmacy! Crazy, I know, huh?

How many times have you heard the phrase: "Oh, I'll just go to Boots!"

Although the pricing of EHC is out of employee pharmacists hands, we can still collectively ensure that all requests for EHC are treated with dignity and non-judgementally; counselled or signposted appropriately. Thus somewhat allaying some of social media's collective "angst" with Boots.

L H, Community pharmacist

If I spent £66.8 million pounds a year on advertising, the UK population would probably think of me as well.

Ilove Pharmacy, Non Pharmacist Branch Manager

I trust Boots handsomely reward you for all this boot licking.

Beta Blocker, Primary care pharmacist

Just another article showing how the 'big boys' are ripping people off and putting money before anything else...

I've worked in a Weldricks before and noticed how everything in their shops was cheaper than it was in Lloyds. Surely Lloyds would have the buying power to allow bulk buy discounts to take effect and therefore pass these discounts onto the patient? Or am I missing something...

A Long Serving Pharmacist, Community pharmacist

Just another way to devalue the input of the pharmacist. The advice given during the consultation, which takes 5-10 minutes in my experience, cannot be undervalued. There is no way that the profit on something around £10 will cover the cost of the time involved. It would be ideal if every pharmacy was covered by a PGD and could supply EHC free of charge to women who need it BUT at the moment, where this is not the case, then pharmacy is a business and has to rely on making a profit to survive. Pharmacist tend to be altruistic but we cannot afford to lower our income and continue to provide a necessary service to the public. The whole funding structure needs revising. 

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