The True Cost of Gluten Free Prescribing?

Between eating cake, I have occasional moments of coeliactivism. Some time ago I wrote this article, speculating on some of the issues surrounding gluten free prescribing. As I work on the border of the healthcare system I guessed that the NHS may not be getting value from gluten free product manufacturers. Discussion on twitter inspired me to look into this a little more deeply- specifically by creating a Freedom of Information request to understand the cost of gluten free foods to the NHS so that I could make a comparison with high street equivalents.

We’re spending a lot of dough on dough…

This required a little more investigation than planned, as my PCT directed me to the BNF who hold the information. Anyone can request access to the BNF and access data on how much the NHS pay for a prescribed product (excluding any discount or rebate agreements they might have with the manufacturer) however the BNF heavily restrict use and reproduction of their data.

I had intended to complete a properly referenced, thorough analysis of the data I received to draw conclusions about average % difference in price between prescribed and consumer products. Combined with another information request about volumes of prescriptions, this would be evidence for or against wastage in the NHS system. Unfortunately the full time job and the restrictions on using the BNF data get in the way, so instead I have used the BNF as a guide to pinpoint some interesting items of data and turned to my friendly local pharmacist who was able to tell me specific details to illustrate my points here.

Whilst this doesn’t show you conclusively that NHS money is being wasted, it is pretty suggestive that the NHS is not getting the best deal from some of the gluten free brands.

My findings:

For products that span consumer and prescription markets, the NHS pays a comparable price to the high street

I was relieved to find in the majority of cases, the NHS pays a comparable price per unit for food as you would on the high street. For example, a loaf of white Genius bread costs the NHS £2.59, or £2.60 to you from Tesco. A similar story for other brands where the product spans both the prescription and consumer market like Glutafin and Warburtons.

But on further consideration, it surprises me that considering the volume of purchases that the NHS must be making of these products, and that the price we pay in the supermarket also includes a mark-up from the retailer, that the NHS doesn’t pay less per unit that we do with our own pennies. It seems there is definitely some room for negotiation there.

In some cases, the NHS seems to pay over the odds for gluten free foods

The shocking finding was that in lots of cases, particularly where brands don’t compete with their products on the open market, prices are exorbitant. For example Juvela spaghetti costs the NHS £6.51 for 500g compared to the £1.99 Waitrose equivalent. Shop-bought Doves’ Farm Flour mix is less than 1/4 the price of NHS Barkat flour mix.

There are many examples spanning all of the food categories including breads, pastas, crackers and biscuits. To me this suggests manufacturers profiteering in a dreadful way from the NHS.

What can we do?

Let’s be honest. Changing massive, heavy institutions and challenging profit-making businesses is hard – and that’s probably why the easier route for the NHS is to cut prescription provision rather than address these problems. But that doesn’t mean we shouldn’t try. Some suggestions we coeliactivists can personally take up to help our beloved healthcare system:

  • Be a good citizen and sign up to the BNF to see how much your prescription is costing the NHS. You might find that there are some cheaper alternatives that your GP could switch you to.
  • Contact the gluten free manufacturers to ask why they are charging the NHS so much for their products compared to their supermarket counterparts.

If anyone does receive a reply from a manufacturer, or has time to look into this more in depth or do a more complete analysis, I would be very interested to see their findings! Or if you have any thoughts or ideas on what else use coeliacs can do to make sure there are no more cutbacks.

6 responses to “The True Cost of Gluten Free Prescribing?

  1. Great blog as always :-)

    But for the Genius bread, i dont get it on prescription etc…. so not certain… but I understand that the prescription loaf is smaller than the supermarket loaf! Is this correct? Because the prescription loaf only counts as per 1 unit for prescription purpose, yet the unit guidelines for bread is 400gs and the shop bought loaf is over this at 535gs if i remember rightly???

  2. I think it’s because Genius do two different products – their ‘original’ loaf is smaller and that’s the one on prescription. Their ‘new recipe’ one is bigger and slightly more expensive. The one I mention here is the ‘original’ 400g one.

    Both you and Kevin have raised a good point though which is that not all products are directly comparable. E.g. those with GF wheatstarch in could be more expensive to produce whereas those in supermarkets tend not to have it.

  3. With the recent prescriptions cuts in Oxfordshire you may find that companies start to revise their pricing strategies with the NHS out of fear that more cuts will happen across other counties in the UK, and when you consider that organisations like Juvela almost exclusively only supply the NHS rather than the high street, further cuts would devastate their business model.

    IF Juvela and so on moved to the high street and priced their goods competitively I would be thrilled, mainly because their products in terms of quality and extra nutrients are by far superior. However prescriptions play a larger part then just access to GF food staples, keeping the Coeliac in contact with their GP and dietician is crucial especially as our local PCT has found that the care and advise given (or not given in some shocking cases) is so greatly inconsistent that Coeliacs are receiving different levels of care which ultimately impacts the NHS more when complications occur due to bad health management by both GP and patient.

    • All excellent points. I am currently writing a follow up considering the ‘value’ to the NHS of gluten free prescribing in health economic terms.

      The point around inconsistencies in care is a tricky one – there certainly is enormous variance in the level and quality of follow up (even within the same practice). I can’t see how they healthcare reforms (e.g. moving to prescribing consortia) will help this situation.

  4. Hi, We in West Cumbria started a “Pharmacy Led Scheme” in 2009-we go monthly direct to Pharmacy cutting out the GP(all GP’s were delighted to be freed up from products being removed from within their drug tarriff list)this scheme has saved our PCT a lot of money & is still running well-(Coeliac UK have a Pharmacy Led Toolkit available now to get set up in other PCT’s if requred)we capped a £10 delivery/handling /distribution charge-so any products ordered over that we are NOT allowed(requested Coeliacs to explain to manufacturer that if they wanted us to order their products they need to address the costs of distribution/handling etc)the scheme aslo works well with waste reduction as units are not carried over! Jean Foster

    • That’s great to hear, sounds like it’s a model that could work well in lots of other areas and is obviously the reason for the recent announcement from Genius about caps to delivery charges.

      It’s certainly something I will investigate in my area – as I would appreciate access to some of the prescription-only products e.g. Glutafin/Juvela that you cannot easily buy in supermarkets etc. and my GP is reluctant to prescribe. Do you pay the actual cost or the consumer cost of the product? Does this not impact those who are e.g. on lower income?

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