ds(19) referral to dermatology suggesting he is a candidate for roaccutane

[BrokenWing]

ds's acne is terrible now. He has gone through the topical and oral antibs with the GP and finally has got his dermatology referral last week suggesting he should be considered for roaccutane. We are extremely fortunate, I have some private healthcare through my work and today he has managed to grab a cancellation appointment for next week as the first private appointment was the end of January 2024 (I dread to think how long the NHS one will be!).

I have a huge list of questions for ds to ask the consultant as it sounds like a serious medication and he needs to be fully informed about what he is signing up to.

The next problem for me will be I think our private health care through work is limited to initial consultations for this - it might not cover the cost of the actual prescriptions and/or the ongoing checks, blood tests etc needed and they cannot pass back to the GP to prescribe/do the checks as only a dermatologist can prescribe (which I suspect we wont see on NHS for many months).

Has anyone been in this position? Did you have to pay privately for the prescriptions and ongoing treatment etc or are their other options available for the GP to prescribe if approved by a private dermatologist? If you paid privately was the cost prohibitive? Both the GP and private hospital seem to be a bit non-committal about how we would do it and I would like to be armed with any options we could look into before next week.

About £3k fully private but if your GP will do the regular blood tests it would be cheaper

We waited a year with NHS for the first appointment ... so shit!

I managed to get the GP to do the blood tests for me so just paid for the private prescription, my insurance, also through work, doesn’t cover this and I think it was around £70 per month but I was on a low dose as I had it years earlier too so just needed a top up. The consultations were £250/300 a time but I only had to pay a % of that. The dose goes on weight and severity so may increase but I will say 100% worth it for my skin and mental health

I was on this when younger and it really was amazing my skin was flawless bar a little over scarring. No idea about the cost stuff but just wanted to say that for some people they'll do a course and that will do the job and 'cure' the acne, but for other people like myself, a second course is needed. I left it too long between finishing the course and my acne returning and going back to the gp again so they wanted to start ruling everything out from scratch again so if I could do it again I'd have gone straight away and demanded a second course right off the bat. But it's something to consider with your pricing. Also you'll need heavy duty moisturisers because it dries your skin out so much. I had to use double base all over and it's £12 approx a bottle but I got it on prescription through NHS. It's such a shame the waiting times are so long now.

We initially had a private consultation (which I'm not sure our health insurance covered). From memory, the medication was around £200 a month and our GP kindly offered for us to have the blood tests at our surgery to keep the costs down. D

In the end, a cancellation came through at our NHS dermatology clinic so we ditched the private option and used that instead. I'd probably get the GP referral as we had a choice of local NHS hospitals with likely wait times.

My DD saw a dermatologist using our private medical insurance. Ours did cover the consultations but there was no way around the prescription as it could only be dispensed from the hospital pharmacy. From what I remember it was about five or six hundred pounds for the excess and the medication.

Thanks for so many replies so quickly!

I suspected we would need to pay for the roaccutane ourselves. I am hoping the private health insurance will cover at least some of the cost of the consultations.

Good to hear there is a possibility the GP could cover the blood tests and anything needed to help out with any side effects (such as double base).

For the GP doing the blood tests, did you ask your GP prior to the private appointment if they would do this or did you ask the consultant at the appointment if they work together with the GP?

You could ask the private consultant to do the paperwork to get into a shared care agreement with the NHS GP. But in the past year, in my county, most GPs are turning down shared care agreements down. The moment they see private, they don't want to know. Hope you live somewhere more flexible.

We are in Scotland so it will depend what the NHS allows up here. When he went to the private consultant before around 6 years ago (for a different issue), the NHS GP did the blood tests and prescribed for him so hopefully it might still be an option here. Good to know what I need to ask for.

A Gp can’t prescribe roaccutane and you have to go a hospital pharmacy for it because local ones won’t be allowed to order it.

I had it on the nhs and it was great.

For the GP doing the blood tests, did you ask your GP prior to the private appointment if they would do this or did you ask the consultant at the appointment if they work together with the GP?

From memory, I asked the surgery after I'd had the first private consultation.

They're pretty good about shared private care though as lots of patients have private healthcare. They've covered my mother's blood tests for private alopecia treatment. Plus prescribing blood thinners post two surgeries I had privately plus my dad's heart drugs (via a private consultant), both of which are quite expensive.

He had the consultation on Wednesday and the consultant is going to start him on a 16 week roaccutane course.

He gave him a Drs note to give to our GP for a steriod NHS prescription and he has to take that for 2 weeks to reduce the inflamation before starting the roaccutane which we have a private prescription for. The consultant said no need for blood tests and he will go back in 6 weeks for a review.

He is to continue using his oral antibiotics but forgot to ask about the DUAC - think I advise him to continue to use to help reduce the inflamation while on steriods unless his skin gets too dry using both.

He was pleased the Dr told him he was still allowed to drink alcohol as long as he doesn't binge to excess which is a bit confusing as the Internet is pretty clear alcohol should be avoided.