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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it submitted a request for a price concession, which was granted and subsequently published but this was later withdrawn after confirmation from the Department of Health and Social Care (DHSC) that due to the price change mechanism, the reimbursement price for Promethazine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."

Pharmacies across Northern Ireland are in financial turmoil, reporting that they are dispensing prescription medicines at a loss due to inadequate reimbursement from the Department of Health (DoH). This crisis has led to the closure of almost a dozen pharmacies over the past 18 months, with many others struggling to stay open. Siobhan McNulty, who runs Melvin Pharmacy in Garrison, County Fermanagh, described the dire situation. "We're dispensing medicines at a loss," she said. "The reimbursement rates don't match the cost of the drugs, and we're left to cover the gap." McNulty relies on sales of non-pharmaceutical products to keep her business running.

The National Pharmacy Association (NPA) has raised the alarm that many community pharmacies are facing losses on NHS prescriptions due to the "broken" funding system. An analysis of prescription drug prices by the NPA revealed that pharmacies are being underpaid by the NHS by up to £75 a pack for common medicines, resulting in losses of thousands of pounds each month. The analysis report released today (16 October) shows the government reimburses £18.06 for a 56-tablet pack of Amantadine, a drug used to treat Parkinson's symptoms. However, the market price of the drug is £94.05 per pack, leading to a loss of £75.99 per 56-tablet pack for pharmacies-amounting to a shortfall of over £1 per tablet. In some instances, NHS funding covers only one-fifth of the cost that pharmacies have to pay for medicines, according to new figures from the NPA.

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.

We know remuneration influences behaviour. If I have a construction company and I pay a bricklayer a fee per brick to supply and fit, I suspect he will source them from the cheapest supplier and lay as many bricks as he possibly can. If one day, I reduce the fee such that it barely covers the cost of the brick, at a time when bricks are in short supply and labour costs have gone up, oh and I take some money off him for the profit he made on bricks he supplied the previous year, I suspect he will tell me to stick my job where the sun doesn't shine. It may be a crude analogy, but it is pretty much what's happened in community pharmacy over the last 20 years. The remuneration we get for dispensing does not cover the cost of providing the service. The reimbursement for the drugs does not cover the cost of the drugs. In fact, we make a loss on many items given all the clawbacks and supply shortages. Wages have gone up. And then each year the government claws back profit they say we've made, apparently! Yet, despite all this, we continue providing the service under this archaic system, allowing our paymaster to repeat the injustice because they know they can and, unlike the bricklayer, we will just suck it up and take it. So, what makes us carry on like this? Is it our conscience towards patient care? Is it that we don't know what else to do and the fear of the unknown? Or is it like the boiling frog story, where the temperature has increased gradually around us that we haven't noticed the government heat slowly killing community pharmacy. I suspect the answer is a mixture of all these factors. The pain is somewhat masked when we see fee paying services

Walgreens Boots Alliance (WBA), the parent company of high street pharmacy Boots, plans to close 1,200 stores in the United States over the next three years in response to a slowdown in consumer spending and low drug reimbursement rates. As reported by The Times, the closures are part of a strategy by new CEO Tim Wentworth to restore growth for the group, which runs over 8,700 stores in the US and 2,000 Boots pharmacies in the UK. Wentworth described the 2025 financial year, which started last month, as a crucial "rebasing year" for the company. He expressed confidence that, although the turnaround will take time, it will yield significant financial and consumer benefits in the long term. The announcement of the store closures coincided with the release of the fourth-quarter results, which slightly exceeded Wall Street's lowered estimates. Walgreens' stock, which has declined by 65 per cent this year and is now trading near 30-year lows, rose by $1.44, or 16 per cent, closing at $10.44 on Wall Street.

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."