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c/glp1uk·posted 8 months ago by u/adaeze_krastev

genuine question about tier 3 that I am slightly embarrassed to ask

Question Well Actually ×1

The title is the whole question — genuine question about tier 3 that I am slightly embarrassed to ask — but here is why I am asking.

Read the MHRA notice rather than the news coverage and the actual scope was much narrower than the panic threads suggested.

The online consultation asked me three questions, none of them about my history. I did not go ahead.

Discharged at goal back to the GP, who would not continue it. Nobody had mentioned that this was how it ends.

Corrections welcome, especially the pedantic ones. Pedantry is how this board earns its reputation.

963 up / 293 down77% upvoted32 commentsid 417b8j1 Dec 2025

32 comments

25 in this archive, depth 4

best — the order this archive was captured in

u/bence_ibarra-4 points·8 months ago

Supply notices from the regulator describe expected availability at a national level. They do not predict what any individual pharmacy has on the shelf next week.

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u/ice_pack_auditcold chain-6 points·7 months ago

Discharge at goal, which nobody warns people about.

Specialist services in England are commissioned to deliver a defined intervention. Reaching goal is a successful outcome and it typically ends with discharge back to primary care. Whether prescribing continues after that is a local decision that varies, and plenty of members here have discovered it at the point of discharge rather than at the start.

The useful thing to do is ask early: what happens when I finish, and does prescribing continue in primary care in this area. Ask it in writing, keep the answer, and you will at least know which conversation you are heading for.

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u/gradient_goblin92 points·7 months ago

Agreed. The ICB variation is the thing that makes national advice useless here.

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u/teodor_duarte72 points·7 months ago·edited

Not convinced — the US threads are a different system entirely and importing their advice here does real harm.

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u/jonas_cardoso59 points·7 months ago

Disagree. That is the pathway in one ICB and it does not generalise even to the next one over.

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u/ignacio_roos62 points·7 months ago

Correction: that threshold is your ICB’s, not a national one. They differ and they change by year.

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u/hassan_castellanos47 points·7 months ago

Pharmacy pricing on a private prescription is set by the pharmacy. The spread between them in a given month is routinely substantial, which is why a tracker built from member reports is more useful than any headline.

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[removed]33 points·7 months ago

[removed by moderator]

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u/controversial_only45 points·7 months ago

That is Scotland’s arrangement and the post is asking about England.

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u/elise_ramos18 points·7 months ago

Right, and reading the actual supply notice rather than the coverage of it saves a fortnight of speculation.

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u/coring_the_stopper26 points·7 months ago

GP said no in the spring, specialist said yes eighteen months later. Same person, same numbers.

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u/camila_marchand12 points·7 months ago

GP said no in the spring, specialist said yes eighteen months later.

Disagreeing with this line: that is the arrangement in one nation and the question is about another.

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u/camila_sandvik20 points·8 months ago·edited

Scotland, Wales and Northern Ireland have their own arrangements. An answer that begins with "in England" should say so, and most of the confusion here comes from answers that do not.

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u/sten_palacios16 points·8 months ago

Small fix — that is the Scottish pathway. The post is asking about England and the answer is different.

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u/mei_cardoso9 points·8 months ago

This. The monthly pricing tracker is the most useful thing on this board and it works because nobody is allowed to link anything.

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u/ferran_mensah13 points·7 months ago

Four pharmacies, four prices, same product, same month. The spread was larger than I expected and none of them were the headline offer.

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u/osman_eriksen11 points·7 months ago

Discharge from a specialist service at goal is a normal end point of that pathway. Whether prescribing continues in primary care afterwards is a local decision and is worth asking about at the start rather than at the end.

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u/ireland_drugs_payMOD5 points·7 months ago

Left up. It names a nation and an ICB, which is all we ask of a pathway post.

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u/rasmus_kimani5 points·7 months ago·edited

Discharge from a specialist service at goal is a normal end point of that pathway.

osman_eriksen is right that the two routes are separate. A private prescription does not move you up the list.

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u/marisol_moreau7 points·7 months ago

BMI thresholds vary by ICB and by year

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u/adaeze_krastevOP5 points·7 months ago

BMI thresholds vary by ICB and by year

Adding the practical bit — ask what happens at discharge before you start, not after.

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u/adaeze_krastevOP3 points·7 months ago

Which pharmacy, and what did they quote for the month rather than the first month?

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u/tomas_lehtinen1 point·7 months ago

specialist service, not GP, for tier 3 in most of England

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u/declared_value_dv2 points·7 months ago

the Irish scheme cap is the single most useful fact in this board

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u/mei_cardoso1 point·7 months ago

Correcting myself: the referral was 12 months ago, not the figure I gave. I keep rounding it down.

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