Group items tagged

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.

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.

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.

NHS England has secured a deal for 'Dexcom ONE Real Time-Continuous Glucose Monitoring' device which will help type 1 diabetes patients to keep track of their glucose levels at all times without having to scan or take a finger prick test. Once the patients receive their starter pack - which will include information on the product and usage, a sensor and transmitter - from the hospital or GP surgery, they can go to the community pharmacy for their repeat prescription. The wearable arm gadget sends information to a mobile app and allows diabetes patients to keep track of their glucose levels. "Traditionally, continuous glucose monitors are more expensive than their flash monitor counterparts - which record glucose levels by scanning a sensor - but thanks to the NHS agreeing on a new cost-effective deal with manufacturers DEXCOM, they will now be available for NHS patients on prescription at a similar price," said NHS. Dexcom ONE Real Time-Continuous Glucose Monitoring, uses a sensor no bigger than a bottle cap that attaches to the arm for up to 10 days and measures glucose levels from just under the skin. The wider rollout of the technology will help diabetes patients manage their condition better - reducing hospitalisations and associated diabetic illnesses which will ultimately ease pressure off the NHS. Karen Baxter, vice president, UK & Ireland, Benelux, France and Spain at Dexcom: "The addition of Dexcom ONE to the NHS England drug tariff is enormous progress towards improving the choice of diabetes tech, providing an alternative to burdensome finger pricks and scanning.

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).

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."

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.

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 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.

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 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 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.

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.

Along with pharmacists, pharmacy technicians in England are now able to perform blood pressure checks as part of the Hypertension Case-Finding Service and deliver the Smoking Cessation Service (SCS). The government has amended Drug Tariff and includes the amendments to The Pharmaceutical Services (Advanced and Enhanced Services) (Amendment) (England) Directions 2023. Pharmaceutical Services Negotiating Committee (PSNC) said: "The service specifications for both services are currently going through NHS England's publication process; when these are published PSNC will alert contractors through their normal communication channels. PSNC resources for both of these services are also currently being updated."

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 reminded Community pharmacy contractors to ensure that the correct flu vaccines are being used for each patient cohort. The pharmacies have also been asked to ensure that they recorded accurately in the patient's clinical record for the NHS Flu Vaccination Service. The move was followed by PSNC after the cases where the standard egg-cultured quadrivalent influenza vaccine (QIVe) was administered in the 65 years and over patient cohort. PSNC said: "On investigation, it appears that a number of these errors are due to data input errors; however, it is important to be careful when selecting a flu vaccine for this patient cohort as there is no provision for the use of the QIVe vaccine in patients aged 65 years and over in the NHS Flu Vaccination Service." The Joint Committee on Vaccination and Immunisation has advised it is not an effective intervention for patients aged 65 years and over.

Following discussions with Community Pharmacy Scotland, the Scottish government has agreed to a six per cent rise in the global fund allocation for community pharmacies in 2023-24, bringing the total remuneration to approximately £219.5 million. A finalised agreement has been reached with Community Pharmacy Scotland for a one-year funding package for the financial year 2023-24, as stated in a Scottish government circular distributed to community pharmacy contractors and NHS Boards on August 4. The circular said this settlement will lead to the most substantial increment ever approved for the community pharmacy network. "The global sum remuneration will be £219.533 million, signifying a 6 per cent increase from the previous year and setting the groundwork for 2024/25," stated Professor Alison Strath, Chief Pharmaceutical Officer for Scotland, in the document. "The guaranteed income from the drug tariff will remain at £80 million for the financial year, without yearly changes."

Pharmacy contractors will no longer need to print and submit a paper copy of their completed FP34C declaration made through the Manage Your Service (MYS) portal when submitting their paper prescription bundle to the NHS Business Services Authority (NHSBSA), said the Pharmaceutical Services Negotiating Committee (PSNC). Instead, from August 2022 (for July 2022 prescriptions), NHSBSA will post out a paper Account Identifier Document along with the red separators and pharmacy address labels each month. "The Account Identifier Document should be placed alongside the paper prescription bundle before it is dispatched for payment to the relevant pricing division of NHSBSA," said PSNC. With the help of Account Identifier Document, NHSBSA will be able to easily identify the pharmacy that has submitted the prescription bundle, which will help to speed up prescription processing. "If the Account Identifier Document is lost or misplaced, contractors will still be able to download and print another copy from MYS. The July 2022 Drug Tariff will be updated to reflect this change."

The price concession for Atorvastatin 80mg has been increased to £3.91 from the previously set £3.45 for prescriptions dispensed in July, the Community Pharmacy England has said. The Department of Health and Social Care additionally introduced a concession price of £3.38 for Atorvastatin 20mg. "In July, our Dispensing and Supply Team experienced an unusually high influx of reports from pharmacies struggling to acquire Atorvastatin 80mg tablets at the listed Drug Tariff price," said CPE. CPE requested a price concession early in the month. However, after extended discussions, an agreement on the price wasn't reached. Consequently, on July 31st, the DHSC imposed a concession of £3.45. Addressing enduring pharmacy concerns over the pricing, CPE intensified advocacy with DHSC. This endeavour resulted in the revision of the Atorvastatin 80mg tablet concession price to £3.91 for prescriptions submitted and dispensed in July. According to CPE, this adjusted price sufficiently covers costs as reported by the majority of pharmacy owners. However, DHSC has refrained from modifying concessionary prices for the other two requested lines by CPE. DHSC communicated that their team's data collection for July, employing real-time sales and volume data, was incongruent with the adjustment of these prices, CPE further said.