Group items tagged

Department of Health of Social Care (DHSC) has confirmed that the Dexcom One Transmitter will be added to Part IXA of the March 2023 Drug Tariff. "Previously, patients were advised to obtain the free-of-charge Dexcom One transmitters directly from the pharmacies, without a prescription, as the original Drug Tariff application for the transmitter was unsuccessful," said the Pharmaceutical Services Negotiating Committee (PSNC) It has raised concerns with DHSC and Dexcom that these distribution arrangements for transmitters are unacceptable because they result in extra unfunded activity for community pharmacies. Both, DHSC and Dexcom acted upon these concerns by agreeing to add the Dexcom One transmitter to the Drug Tariff from March 2023. At the same time, Dexcom One CGM System (containing 1 sensor, 1 sensor applicator, 1 transmitter) will also be added to the March Drug Tariff.

There has been a lot of coverage in the national and pharmaceutical press of the prices being charged to pharmacy owners for certain medicines. Leaving aside the reasons for steep price rises, I have been asked on social media and elsewhere whether pharmacy owners can refuse to supply prescribed medicines if they would make a significant financial loss. Legal obligation The first thing to point out is that the National Health Service Act 2006 imposes a legal duty on the Secretary of State and NHS England to make arrangements for people to receive sufficient prescribed drugs. These arrangements involve the publication of the Drug Tariff. The Drug Tariff includes reimbursement prices or a method for determining prices. Various factors can be taken into account in determining reimbursement prices. The Drug Tariff does not provide a pound for pound reimbursement for medicines that pharmacies supply on NHS prescriptions.

A further 18 new products have been entered the list of 'Drugs for which Discount is Not Deducted' (DND) in Part II of the Drug Tariff on 1 November, following applications made by the PSNC. This takes the number of products added to the DND list by the Department of Health and Social Care (DHSC) and the NHS Business Services Authority (NHSBSA) in the last 18 months to over 400. The latest list of products include Aciclovir 200mg/5ml oral suspension sugar free, Acitretin 25mg capsules and Strattera 4mg/1ml oral solution. The DND list is updated monthly by the DHSC and includes grouped and individual items, the latter being separately listed in Part II of the Drug Tariff. Any items covered by the 'Group Items' heading are not listed again individually in Part II. See here to see a list of all the monthly changes to the DND status of products.

The Department of Health and Social Care (DHSC) has added further 28 new products to the list of 'Drugs for which Discount is Not Deducted' (DND) in Part II of the Drug Tariff from 1 August 2022. PSNC said, "It will continue its work to assess whether other drugs and appliances fulfil the current DND entry requirements under either the 'Group' and 'Individual item' criteria and make applications to NHSBSA and DHSC, accordingly." A total of 529 products have been granted DND status following checks made by PSNC within the past 26 months.

Department of Health and Social Care (DHSC) has increased the rate of discount deduction for generics from 17.52 per cent to 20 per cent. The Drug Tariff for April 2023 will contain changes to the discount deduction arrangements for pharmacy contractors, which will include- all concession lines to be considered as Group Items for Discount Not Deducted i.e. DND or zero discount (ZD) items; and rate of discount deduction for generics to increase from 17.52% to 20% The Pharmaceutical Services Negotiating Committee (PSNC) and DHSC agreed on the changes for all concession lines to be considered as Group Items for Discount Not Deducted. Therefore from 1 April 2023, a new category will be introduced into Part II of the Drug Tariff 'Drugs for which discount is not deducted'. However, the committee had rejected the changes in the rate of discount deduction for generics. It said, "Following pressure from NHS England, Ministers have now chosen to impose changes to the previously agreed discount deduction arrangements, which come into effect from 1 April, and will be kept under review."

FreeStyle Libre 3 Sensors and Budesonide 500microgram orodispersible tablets sugar free have been included in the Drugs for which Discount is Not Deducted (DND) list (Part II of the Drug Tariff) from January 2024, according to Community Pharmacy England (CPE). Following applications made by CPE on behalf of pharmacy contractors, the Department of Health and Social Care (DHSC) agreed to give DND status to these products to ensure that "pharmacies are not faced with dispensing these sensors at a loss." Updated monthly by the DHSC, Part II of the Drug Tariff includes grouped and individual items. Recently launched by Abbott Diabetes Care Ltd, FreeStyle Libre 3 Sensors have also been added to the Appliances section in Part IXA of the January 2024 Drug Tariff. As the sensors can only be ordered by pharmacies directly from the manufacturer without any discount, CPE requested the DHSC to exempt this appliance from any discount deduction.

The Department of Health and Social Care (DHSC) is pushing ahead with its plans to implement a new drug tariff from April 2024. However, this move has sparked strong opposition from Community Pharmacy England (CPE), raising concerns about its potential impact on pharmacies and patients. Earlier, it was announced that the April drug tariff will include the new 'Retrospective top-up payment for Concessionary prices, which will be applied automatically for the products listed in Part VIIIE each quarter by the NHS Business Services Authority (NHSBSA), according to the volume the contractor was paid for. However, CPE argued that the government has imposed these "untested" changes without their agreement, and strongly opposed them stating that "no recovery or downward pressure on margin is acceptable given the financial fragility of community pharmacies." Janet Morrison, chief executive of CPE, has voiced strong opposition to these changes, arguing that "any system expecting pharmacies to dispense at a loss" jeopardises the sector's financial stability and compromises patient care.

The Pharmaceutical Services Negotiating Committee has announced that the Department of Health and Social Care (DHSC) has granted final price concessions to further items for the month of October 2021. This is the fourth list of price concessions for the month. Contractors can find information on the first two batches of price concessions here, and learn about the process involved on PSNC's website. A price concession only applies for the month in which it is granted. No additional prescription endorsement are required as the new price is automatically applied by the NHS BSA to all items submitted for payment in the same month for which a price concession is granted. PSNC is still working with the DHSC to agree further concessionary prices on other drugs reported to be unavailable at the stated October 2021 Drug Tariff price. Check Pharmacy business website for the price concession lists.

The regulators have added 10 new products to the 'Drugs for which Discount is Not Deducted' (DND) list from Thursday (01 June). Community Pharmacy England on behalf of its members had made further applications to the Department of Health and Social Care (DHSC) and the NHS Business Services Authority (NHSBSA), resulting in the inclusion of 10 new products in the DND. More than 610 products are granted DND status following checks made by Community Pharmacy England's dispensing & supply team over the past 3 years to ensure fair reimbursement for our members. The DND list is updated monthly by the DHSC and includes grouped and individual items. Individual items are separately listed in Part II of the Drug Tariff. Any items covered by the 'Group Items' heading are not listed again individually in Part II. "We will continue our work to assess whether other drugs and appliances fulfil the current DND entry requirements under either the 'Group' and 'Individual item' criteria and make applications to NHSBSA and DHSC, on behalf of our members accordingly," said Community Pharmacy England.

Dr Bharat Shah CBE regrets that neither community pharmacists nor pharmaceutical wholesalers in the UK have any control over how Category M reimbursement prices in Part VIII A of the Drug Tariff are determined. The co-founder and chief executive of Sigma Pharmaceuticals was speaking at a conference organised by Avicenna in West London on Sunday (March 6). Introduced into the Drug Tariff in April 2005, Category M is used to set the reimbursement prices of over 500 drugs. The Department of Health and Social Care makes the final decision on the amount of reimbursement (cost of drugs and appliances supplied against an NHS prescription form) and remuneration (fees paid as part of the NHS community pharmacy contract for the provision of a service).

Any prescription for Promethazine hydrochloride 10mg tablets x 56 submitted for payment to the NHSBSA for July 2022 will be reimbursed at the new price of £17.77 not as per the price concession of £13.45 announced in the 4th concessions update published on 29 July 2022, said the Pharmaceutical Services Negotiating Committee (PSNC). In July 2022, PSNC received several reports from contractors unable to obtain Promethazine hydrochloride 10mg tablets (56) at the published Drug Tariff price of £4.24. Therefore, it submitted a request for a price concession, which was granted and subsequently published but this was later withdrawn after confirmation from the Department of Health and Social Care (DHSC) that due to the price change mechanism, the reimbursement price for Promethazine hydrochloride 10mg tablets has increased from £4.24 to £17.77 for July 2022. PSNC said, "Following the price change mechanism rules, for generic drugs (excluding drugs in Category M), a price change up to and including the 8th of the month takes effect for prescriptions dispensed in that same month. Any price change after the 8th takes place in the following month."

Department of Health and Social Care (DHSC) has updated the final price concessions for June 2023, following a discussion by Community Pharmacy England regarding medicine pricing issues reported by pharmacy owners (its members). A price concession only applies for the month it is granted; any prices agreed for concessions requested late in the month will roll over into the following month. Community Pharmacy England encouraged pharmacies to report any problems obtaining a Part VIII product at or below the stated Drug Tariff price, using the online feedback form on the Community Pharmacy England website along with full details of the supplier and price paid for any products sourced above the Drug Tariff price. The association will investigate the extent of the problem and, if appropriate, discuss the issue with DHSC.

Nine more new products have been classed as 'Drugs for which Discount is Not Deducted' (DND) from 1 July 2022, announced Department of Health and Social Care (DHSC). This takes the total number of products granted DND status over the past 2 years to over 500 following checks made by the Pharmaceutical Services Negotiating Committee. The Committee had made an application to DHSC and NHSBSA for the following 9 products to be added to the DND list of Individual items to which the discount deduction scale will no longer apply from July 2022: Fludrocortisone 50micrograms/5ml oral suspension (Group) Lorazepam 1mg/5ml oral suspension (Group) Lorazepam 500micrograms/5ml oral suspension (Group) Zopiclone 3.75mg/5ml oral solution (Group) Zopiclone 7.5mg/5ml oral solution (Group) GA explore5 oral powder 12.5g sachets HCU explore5 oral powder 12.5g sachets MSUD explore5 oral powder 12.5g sachets TYR explore5 oral powder 12.5g sachets The DND list is updated monthly by the DHSC and includes grouped and individual items. Individual items are separately listed in Part II of the Drug Tariff.

The NHS Business Services Authority (NHSBSA) has published the Drug Tariff Category M price list for July which reflects an increase in reimbursement level of approximately £5m per quarter. An adjustment of -£23.8m was announced, in light of the results of the margin survey (latest result up until end of December 2022), and the phasing down of the additional £100m agreed across years 4 and 5 as part of the Community Pharmacy Contractual Framework and uplifts for underlying market prices (between January - March 2023). Community Pharmacy England has agreed the adjustments based on the analysis of margin delivery and on current projections for 2023/24. It said: "The objectives are to ensure full delivery of agreed margin and smooth delivery as much as possible. As always, the impact on individual pharmacies will vary depending on dispensing mix."

The new Flat Fee payment to roll out in April 2023 to all pharmacy contractors who dispense at least 101 items a month, up to a national total of £70m on an annual basis. "The value of the Flat Fee payment has now been determined at £533 per month and will be introduced in the April 2023 Drug Tariff," said the Pharmaceutical Services Negotiating Committee (PSNC). "As with all payments, the Flat Fee payments are subject to change throughout the year depending on the overall level of funding delivery to Community Pharmacies. This will be carefully monitored by PSNC and DHSC, and any funding changes will be communicated to pharmacy contractors as soon as they are known," said PSNC.

The Department of Health and Social Care (DHSC) will introduce new arrangements for the setting of Drug Tariff Category A reimbursement prices from April 2024. Driven by ministers, DHSC's decision aims to equalise access to margin on Category A medicines and it's part of a series of drug reimbursement reforms proposed by the department following a public consultation in 2019. Currently, prices of medicines in Category A are subject to monthly adjustment. From 1 April 2024, these will be updated quarterly based on sales and volume data obtained by DHSC under the Health Service Products (Provision and Disclosure of Information) Regulations 2018. The transition will conclude in July 2025 when the reimbursement prices will be exclusively determined by the new method. Advance notice for contractors regarding the 'new arrangements' has been outlined on the NHSBSA website. However, Community Pharmacy England (CPE) did not support the introduction of the changes at this time as pharmacies are currently grappling with "wider challenges" and there is uncertainty about the potential impact of these changes on the already "turbulent" medicines supply chain

The Pharmaceutical Services Negotiating Committee (PSNC) has announced the margin delivery rates will increase from October as the agreed £100m write off is implemented. "The baseline margin allowance will remain £800m per year in 2022/23 and 2023/24," said PSNC. "Margin levels in the last two full years (2020/21 and 2021/22), as measured by the Margin Survey of independent pharmacies, were in excess of the baseline allowance, meaning that an excess was accrued." As new services have been introduced and take up of these has accelerated, the amount of unallocated funding left in the CPCF is now less than it previously was. As such, the value of the Transitional Payments will decrease from its current level. Some of the unallocated funding remaining in 2023/24 will be repurposed into a Flat Payment for all contractors (see details below). Over the course of the second half of 2022/23, the value of the Transitional Payments will be phased down. This will start in October 2022 with a reduction in payment levels to approximately 85% of the current level, as shown in the following table:

The Department of Health and Social Care has updated the list of community pharmacies eligible for the Pharmacy Access Scheme (PhAS) and approved 43 cases out of 63 applications, bringing the the total number of eligible pharmacies in England to 1,445. Earlier this year, NHS England and NHS Improvement (NHSE&I) invited community pharmacy contractors to apply for a review if they believed there were any inaccuracies in relation to pharmacy premises addresses or unforeseen circumstances affecting access, such as a permanent roadblock. Submitted applications were reviewed by the relevant NHSE&I regional pharmacy contract team, and determined by the relevant pharmaceutical services regulations committees (PSRC). Due to the workload pressures seen over winter, the review deadline was extended, giving contractors applying for a review two full months to complete their applications. This also pushed back the announcement of the outcome of the review, but where an application has been successful, PhAS payments will be backdated to the start of the scheme.

The Department of Health of Social Care (DHSC) has re-determined that all six Madopar (Co-beneldopa) preparations meet the special container criteria as outlined in Part II Clause 10 of the Drug Tariff. "The NHS dictionary of medicines and devices (dm+d) has now been updated with special container status applied to the complete pack sizes of all Madopar preparations," said PSNC. "The special container rules apply immediately to all branded or generically written prescriptions for Madopar dispensed from December 2022 onwards." The following products will be treated as special containers for prescriptions dispensed from December 2022 onwards:

The Pharmaceutical Services Negotiating Committee (PSNC) has expressed its concerns over sustained pressures on medicines supply that are having a very serious impact on community pharmacy teams and their patients. It has asked contractors and their teams to continue using its regular reporting tools to help them demonstrate the scale of the problems to the Department of Health and Social Care (DHSC) and to support escalations as needed. The committee said: "The sustained increases in price concessions that we have seen so far in 2022 - with more than 100 concessions being granted in some months - show no signs of abating, and we know that many pharmacies now find themselves in a critical situation trying to source medicines in timely manner and facing significant financial risk due to greater uncertainty around expected reimbursement prices for a large number of medicines." "We know that some concessions being imposed by the Department do not match contractors' experience on the ground, and we would ask all contractors to continue reporting pricing issues to us on a regular basis to support our representations: Report product over Drug Tariff price."