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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.

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 new deal struck by the NHS will enable provision of a life-saving treatment for babies and young children who suffer with a rare and fatal genetic disease, metachromatic leukodystrophy (MLD). The revolutionary gene therapy treatment, known by its brand name Libmeldy, is used to treat MLD, which causes severe damage to the child's nervous system and organs, leading to a life expectancy of just five to eight years. Having a reported list price of more than £2.8 million, it is the most expensive drug in the world, but can now be offered to young patients on the NHS in England after the health service negotiated a significant confidential discount. the drug works by removing the patient's stem cells and replacing the faulty gene that causes MLD before then re-injecting the treated cells into the patient. The most common form of MLD usually develops in babies younger than 30 months and can cause loss of sight, speech and hearing, as well as difficulty moving, brain impairment, seizures, and eventually death.

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 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.

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.

When Ignasi Biosca-Reig heard there were shortages of amoxicillin in Spain, he quickly added shifts at his drug company's factories to boost production of the popular antibiotic. But a few extra shifts was as far as he could go. Much as he would have liked to significantly increase supplies, Biosca-Reig said he couldn't justify investing millions of euros in new production lines unless he was paid more for the generic drug to cover sharply rising costs. But, like many other European countries, Spain set the price manufacturers are paid for paediatric amoxicillin when the generic version of the drug was first launched in the country two decades ago, and it has barely budged since. "It's a non-business," said Biosca-Reig, chief executive of Spanish drugmaker Reig Jofre. "We wanted to react, but we had a problem," he said. "The costs go up, the price remains the same."

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.

Kelso Pharma, the growing UK based specialty pharma business, has announced its first product launch with the release to the UK prescription medicines market of Acepiro (Acetylcysteine) 600mg effervescent tablets. Acepiro 600 mg effervescent tablets are indicated in adults only and are being made available to hospital and community prescribers in 20 and 30 day packs, with the 30 day pack consistent with monthly prescribing. The NHS List Price for the 30 day pack is £4.40, with the 20 day pack priced at £3.65. Acepiro is being launched by Stirling Anglian Pharmaceuticals (SAP), which was acquired by Kelso Pharma one year ago, providing a new UK platform and springboard for future sales growth for the business. The new product complements SAP's existing portfolio of three medicines: CosmoCol (macrogol 3350 plus electrolytes) powder for oral solution - an osmotic laxative indicated for the treatment of chronic constipation and faecal impaction. Stirlescent (naproxen) 250mg effervescent tablets - containing naproxen, which is a non-steroidal anti-inflammatory drug (NSAID).