"Prescription Cost vs. Clinical Need"

About: NHS 111

(as the patient),

Following laproscopic adhesiolysis surgery earlier this week, I was sent home with multiple TTO’s for pain relief. Before my discharge I met with a pain nurse specialist where we discussed the recommended change of medications from Gabapentin to Pregabalin. This medication change had been recommended to me previously by the local Pain Management Team, but I delayed this as I did not want to do this between recovering from my ilioinguinal nerve injection and latest surgery. So following my discussion with the nurse on Friday afternoon, I was told it would be beneficial to now begin the medication change but she explained that my local hospital did not stock Pregabalin to give as TTO’s and that I would need to get this from my GP.

Although I was initially happy to wait until Monday as I could in the interim, continue with the Gapapentin, I contacted the emergency 111 service over the weekend as it stated on the medication information sheet that Gabapentin may interact with the Oral Morphine I was also taking. Following this I contacted the 111 service to ask if I could get a prescription of Pregabalin, as I didn’t want to have an adverse reaction. Especially as I have quite a few drug sensitivities. During this conversation the doctor repeatedly stated that Pregabalin was very expensive. Repeating over and over ‘did I realise how expensive this medication is’, and ‘how much the drug costs’. In fact cost of the medication was referred to four times during the ten minute conversation. The doctor did explain to me that the contraindication of medications would just mean that I would be made to feel more drowsy and sedated and also said that Pregabalin does not count as an emergency medication and that due to the cost of the medication,only two days worth could be prescribed and that it wouldn’t be worth it and they wouldn't do it. The doctor tried to reassure me that they weren't being deliberately obstructive and stated if I was their patient they wouldn’t want any other doctors getting involved in prescribing this medication as it needs to be carefully titrated, using the analogy that ‘too many cooks spoil the broth’. The doctor said that although Pregabalin was very expensive it is the ‘gold standard’ of pain relief medication and that they took it and find it very effective. So by the end of the conversation I was no closer to getting my prescription, but was made very aware of just how expensive this prescription is. Clearly that was the focus of the whole conversation. It made me feel that this medication is good enough for doctors themselves, but too expensive for the likes of me, a mere member of the public.

Furthermore, this doctor questioned me about all of the other TTO medications I was on, wanting to know the reason why I needed each medication. The doctor seemed to focus on the anti-sickness and anti-biotic medications. I was made to explain my problems with nausea and the fact that I have a post-operative infection. The doctor also asked if I work with my current ongoing pain, and I explained that yes I do manage to hold down full time work, the response to which was ‘well done’, which felt hugely patronising. I came away from this conversation feeling both very angry and guilty that I need to take such an expensive medication. The change in medication is being made due to my ongoing pain and due to the fact that I find the side effects from the Gabapentin so debilitating as it negatively effects my thinking, concentration and ability to work. I was left feeling highly frustrated that the focus of the conversation was based on cost rather than clinical need. This doctor had the opportunity to reassure me that it was safe to take the combination of medications as opposed to continually focusing on cost and money. Especially as this cost is not relevant to my care. It felt like I was being bullied out of accepting the treatment. And even trying to get the prescription from my local GP practice I have met yet more barriers, being told that ‘if the hospital wanted me to have it so urgently the could and should have written the prescription’. So I am still waiting to hear back from the GP to ascertain whether I can in fact begin the process of titrating down one drug to start the other and avoid the highly sedating effects of taking both Gabapentin and Oral Morphine together some 72 hours later.

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