Mobidoctor scripts no longer accepted in pharmacies?

S

Sarah Ryan

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Has anybody encountered any issues filling scripts in their pharmacy that has been prescribed to them from Mobidoctor?

I have been using this service since the start of 2022, video consultation with script emailed to you and can be emailed to your chemist as well but NOT via the Healthmail system. Husband went to fill a script 2 weeks ago and the pharmacist said the legislation has changed and they can no longer be accepted (he was able to fill this one under the emergency rule but no further ones)

According to this link, the script from a doctor within the EU, in paper format with an electronic signature is valid.
https://www.citizensinformation.ie/...y in Ireland,certain information (see below).

Here are the updated guidelines from the pharmacy union, they were updated in January and previously it did say that paper scripts with electronic signatures would be valid. That is gone but these guidelines seem all very geared towards care received in Ireland not from a doctor based outside of Ireland but within the Eu under the Cross Border Directive.
https://www.thepsi.ie/gns/Pharmacy_Practice/Queries_and_FAQs/FAQsforPharmacistsDuringCOVID19.aspx

However point number 5 on this fac link states that the script should be valid.
https://www.thepsi.ie/gns/Pharmacy_Practice/Queries_and_FAQs/FAQs_for_the_public.aspx

I have asked my pharmacist to get clarity on this for me but just wondering if anybody else uses this service? There are Irish services that can be used but I do like brand loyalty and I find the doctors on this very good to deal with so just want to exhaust all avenues before I leave them.

They do not have plans to get on the Healthmail system that I am aware of, and emailed scripts need to come from Healthmail and not a corporate email address under the new National Electronic Prescription System. We do have a physical GP of course but that is reserved for more important face to face issues.
 
Just an update on this, legislation has been changed, this service can no longer be used. I had a discussion with the Irish Pharmacy Union today.

You can't get a script filled in a chemist anymore unless the copy is emailed via Healthmail or you get a postal copy from a provider directly.

Once you print a script from your account online with a telehealth provider the script is no longer valid even if it has a electronic signature etc, what an unbelievable step backwards cutting off access to healthcare like that to people.

So basically you now are very much stuck to dealing with Irish healthcare providers using the National Electronic Prescription Transfer System aka Healthmail.

Time to annoy the local politicians!
 
Hi Sarah,

Just wondering if you have tried using the doctors on-line through your health insurance, if you have any? Would that solve the problem?
 
Sue Ellen said:
Hi Sarah,

Just wondering if you have tried using the doctors on-line through your health insurance, if you have any? Would that solve the problem?
Click to expand...
I think I might have something I will check it out. Just found this company great to deal with so annoyed the change now stops it.
 
It seems like a restriction of competition if you can de facto only receive telemedicine services from a doctor registered in Ireland and not elsewhere in the EEA. That seems to be what the Healthmail system means. Have you queried this with the Consumer and Competition Protection Commission?

OTOH Healthmail really is a very good system and far superior to fax and more secure than regular email. People carrying around handwritten bits of paper was wide open to abuse too.
 
I am in the middle of drafting a letter to my politicians and but the Competition authority is a good shout I will include them in it thanks! You always need another set of eyes to spot something like this!

Yeah I can understand the risk of paper etc, the mobidoctor scripts all have codes so the script can be verified on their website before it's filled by the pharmacist and then when it has been dispensed, they can also mark it as dispensed on their website so the code can't be used again.
Time consuming perhaps, but a security feature none the less.

If the Mobidoctor team can email the script direct to the pharmacy not sure what the problem is, it's coming direct from the provider taking the patient out of the equation.

However, I think with this text from the Pharmacy regulator it really is a case for the Competition authority?

A prescription sent outside the Healthmail system is not recognised in the legislation as a legally valid prescription, for example, prescriptions sent through personal or commercial email accounts or fax. In cases where pharmacists receive prescriptions by other electronic means, in relation to an emergency supply at the request of a prescriber, the original prescription must still be received by the pharmacy within 72 hours in accordance with the emergency supply provisions of Regulation 8 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003 (as amended).
 
@Sarah Ryan

Don’t waste time with TDs they won’t understand the issue!

As I think about it the legislation would have been approved by the Attorney General here in Ireland so the CPCC can’t really fight something that is already law.

The closer I look at it the more I think it might be a case for the European Commission as it looks like a restriction in the cross-border supply of services. When I have a bit of time I will see if there are grounds for bringing it to their attention.
 
Oh wow that would be amazing thank you, yikes have I opened a can of worms?? I have actually drafted this and sent onto some people already but feel free to use the text.
I'm on my phone and just copy and pasting so I hope the links work. I also robbed your sentence lol!

Hello all

I am looking to bring the following issue to your attention.
The legislation regarding prescriptions has changed since January 2024 which is stopping people from accessing Telemedicine services within the EU.

For the last 2.5 years since I moved to Navan, my local pharmacy were able to accept a printed prescription provided to me by a company called Mobidoctor. The company is based in the EU, you have a video consultation with a doctor, your prescription with all the relevant information is applied to your account. It's an excellent service for when you are unable to secure an apt with your own GP especially if money is tight or you are out of hours.

You then print off your script and bring it to the chemist. Or alternatively, you can upload the document onto the app, apply for it online and then bring a copy to the chemist with you as they always ask for the paper copy.

Now the Covid19 regulations have been updated post pandemic by the Irish Pharmacy Regulator and the legislation only allows for scripts to be sent to pharmacies in Ireland via the closed Healthmail system as per the National Electronic Prescription Transfer System.

Frequent Questions-COVID19-PSI (thepsi.ie)

This effectively closes off cross border access to medications from health services based in the EEA. Mobidoctor do not have a Healthmail account nor are they able to post prescriptions. However, the Citizens advice website would appear to suggest that a script with an electronic signature is valid. I have spoken to the Irish Pharmacy Union and they state this is a grey area.

Cross-border prescriptions (citizensinformation.ie)

The script is valid on your Mobidoctor account but, once you print the prescription it then becomes invalid – this is absurd! Mobidoctor can email the prescription direct to the chemist, but they do it from their own commercial website as they do not have access to Healthmail.

What is the difference with the patient printing the prescription and the pharmacy printing the prescription. With that logic, if I upload the script onto the Hickey’s app to request my prescription and, the pharmacist prints the prescription for his ‘yellow bag’ for any potential HSE spot check what exactly is the problem here!! Has common sense left the building?

The FAQ document on the Pharmacy Regulator website clearly states the following:

· 5. I have a prescription written by a doctor who is registered in another country in the European Economic Area (EEA). Can I have it dispensed in Ireland?

Yes, normally you can use a prescription that is written by a registered practitioner practising in another European Economic Area (EEA) Member State, provided that it meets certain legal requirements and that the type of medicine is available. When you give the prescription to the pharmacist, they will check the prescription to make sure all the legal requirements are met and they must also be satisfied that the medicine, including dose and quantity is safe and suitable for you to take. To do this they may need to ask you questions, discuss the treatment with you or contact your doctor to check details. Generally you will have to pay for the medicines that are being given to you.

Some medicines may only be dispensed by the pharmacist if the prescribing doctor is registered in the Republic of Ireland. These medicines include ‘controlled drugs’.

The pharmacist should be able to assist you if you have questions about this type of prescription.

Frequent Questions-COVID19-PSI (thepsi.ie)

What are the legal requirements? Why is this not clear on the regulator website of all places. There should be no grey areas for people when their health is concerned, it’s not good enough.

If I can go onto my Irish Life Health insurance plan, get a prescription for something approved by a doctor in Pakistan who, is registered in Ireland and uses Healthmail, why can’t I get a prescription filled from a doctor within the EU that has been sent to me and that I have printed out or that they can email direct to the pharmacy via their corporate email address which I have zero access too?

Can a prescriber use electronic prescribing software other than Healthmail to send a prescription securely to a community pharmacy?​

A prescription sent outside the Healthmail system is not recognised in the legislation as a legally valid prescription, for example, prescriptions sent through personal or commercial email accounts or fax. In cases where pharmacists receive prescriptions by other electronic means, in relation to an emergency supply at the request of a prescriber, the original prescription must still be received by the pharmacy within 72 hours in accordance with the emergency supply provisions of Regulation 8 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003 (as amended)

https://www.healthmail.ie/index.cfm (Healthmail Registration Portal)

Healthmail is a service provided by the HSE in partnership with Three Ireland. Healthmail accounts are available only to healthcare professionals who are registered with the Irish Medical Council and based in the European Economic Area (EEA).

This surely is a restriction of competition if you can De Facto only receive telemedicine services from a doctor registered in Ireland and not elsewhere in the EEA unless they have access to the Healthmail platform?

Irish people should have full autonomy over what doctors they see and when. Webdoctor in Ireland charges €49 for consultations during business hours and €65 for early morning, evenings and weekend apts – that is more than my GP charges! And of course that is when you can get an appointment!

Mobidoctor charge €29 from 7am till 11pm 365 days of the year, no price gouging like the Irish sites.

Not everybody has a medical card in Ireland, some of us work and pay taxes and this is a kick in the face to have a service like this which helps the stretched workers massively!

I am asking can the elected representatives please try and get to the bottom of this to see what can be done to make this service available again by having the legislation changed to allow for email scripts to be sent from corporate email addresses from health providers situated outside of Ireland but within the EU.
 
That’s really useful detail @Sarah Ryan

No harm to bring to attention of elected reps on this but I fear the die is cast at national level.

I will see if there is an EU law angle. The European Commission can take action against member states in breach of EU law, but sadly uses this power not frequently enough. That said they generally only act in the basis of a complaint and if you can spoonfeed them an issue it always helps.
 
That was a wild Friday night for me steam coming off the keyboard!!!

Right time to stalk some meps so, I'm like a dog with a bone on this one it's after really annoying me.
 
Hello Sarah, this is a very interesting thread.
Can you advise if the doctors you're dealing with are registered with the IMC?

While not necessary, it might be the reason.

Healthmail is a great system, but it looks like cracks are starting to show.

I remember about 2 years ago, I was told I could no longer have a paper script. I challenged it and once they realised I wasn't going to accept that, I got the paper script.

I'd personally like a cc of my healthmail script to my own email.
 
No they are not registered with the IMC so I guess that's a part of it but again that's really limiting you to Irish doctors only. Nothing against them but they sure know how to charge.

I have my 3 stepchildren every second weekend, there are times they have gotten sick and this service has been invaluable. Their doctor is 150km and so are their medical cards with their mother so avoiding out of hours doctors and their charges is something I think anybody would prefer.

I checked my Health Insurance plan and sure enough I do have doctor access, I managed to get a prescription for heartburn tablets to my pharmacist (for free!) and I checked the doctor info, a doctor from Pakistan registed with the IMC.

I'll definitely be using that again however I need to see this through I've started so I'll finish.

Great request re the cc on the email. I open every letter etc I was given from the doctor, I always ask for copies of my bloods and test results for my own file, it's me I am the subject matter so I want all the info you have on me please and thank you!
 
Tip for people sending emails to busy political and other organisation inboxes - keep the email as short as possible, and (super hard) stick to facts with zero emotion about the absurdity of the issue.

Would direct this towards competition and MEP people.
 
As well as the Laya and VHI free online consultations for some policy holder, there are at least ten Irish web businesses offering the same service, - most with fast access and competitive fees. I understand the principle involved but in the OPs place I would probably save myself time and effort and use one of those.
 
Agreed but they are significantly higher cost.
Every cent counts these days so I'll see how far I get with it, I might get nowhere but at least I will have tried x
 
I am not sure if I understand the issue correctly, but Irish pharmacies do not have the right to refuse prescriptions from doctors in other EU countries (or actually EEA). If they have invented their own electronic to block this, that is indeed in breach of EU regulations. This would (in my view) not be for politicians to handle, at least not in the first instance, only if lrish authorities would insist and then indeed the best is to first contact the EU Commission.
I am not allowed to post links but search on europa dot eu for "prescription-medicine-abroad"

Irish insurance companies have tried something similar as far as I understand, below is from 2019 and it should have move on since.
"The Commission preliminarily considered that Insurance Ireland arbitrarily delayed or in practice denied access to its Insurance Link information exchange system, which contains information important to be active in the motor vehicle insurance market in Ireland. The Commission preliminarily considered that restricted access to Insurance Link placed certain companies at a competitive disadvantage on the Irish motor vehicle insurance market in comparison to companies that had access to the information exchange system. According to the Commission's preliminary assessment, this acted as a barrier to entry, reducing the possibility of more competitive prices and choice of suppliers for consumers seeking motor vehicle insurance in Ireland."
 
I have been involved with electronic prescribing/dispensing projects on a local and national level so can give some insight.

It is generally true that a prescription from a healthcare professional (doctor, nurse prescriber, dentist, or anyone else who can legally prescribe) in an EU country will be valid in any other EU country once certain requirements are met.

Some prescription requirements are common across the EU (e.g. patient demographic details, prescriber name, drug dose, etc.) but they are not universal and there can be significant variation. Differences can include the types of drugs available (e.g. generic substitution is not allowed everywhere), the types of prescriptions required (e.g. high-tech drugs), the duration a prescription is valid for, etc.

There is an EU-wide project being rolled out that will allow electronic prescription in one country and dispensing of the drugs in another. It is already live in a handful of countries and Ireland will eventually be covered by this but there is no firm date yet.

Another part of this is accessing general patient information, which is also live in a handful of countries, so if you are a French tourist in Spain who needs medical attention, the hospital in Barcelona can view your past medical history online. This will eventually expand to include blood results, radiology, etc.

In Ireland as it stands, you can either present a paper prescription from a prescriber from anywhere in the EU or you can get a prescription from a prescriber on HealthMail. Outside of the HealthMail system, normal email prescriptions are not valid in Ireland. This is not a contravention of any EU rules or regulations, in fact it is specifically permitted under EU law.

Estonia and Portugal are world leaders in this and there is no reason we could not implement all of the above, and more. I would be encouraging politicians and decision makers to emulate their approaches.
 
Thanks for this information I have been reading about that new scheme.

I think the main problem here is that if I present a paper prescription to a pharmacist, it's a prescription that I have printed out myself from my online account with the online doctor.

It has all of the relevant particulars name, address, medication type, dosage, validity of prescription, and electronic signature from the prescriber.

I'm just so confused at what point does everything become invalid because I'm printing out a prescription and bringing it to a chemist.
 

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