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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 Pharmaceutical Services Negotiating Committee (PSNC) has challenged price concessions imposed by the Department of Health and Social Care (DHSC) on some of the medicines. It has raised concerns on the process for setting price concessions to senior government officials responsible for medicines supply, warning that the system is not working in the current environment from a community pharmacy contractor perspective. "When a new government takes over next week, this will be one of several urgent topics being raised by PSNC to new ministers, alongside the fuel price crisis, inflationary pressures and winter pressures on pharmacy businesses," said PSNC. The final update to August price concessions was announced yesterday taking the total concessions granted to a record 138 for August. PSNC said: "Of those, 99 were in line with PSNC requests, but prices for 39 lines were imposed by the Department of Health and Social Care (DHSC): those impositions do not match the purchase prices reported by contractors and the evidence of market prices which we passed on to DHSC. In particular, the final imposed prices of Apriprazole and Temazepam tablets has generated a lot of concern amongst contractors due to the large variation between their reimbursement prices and purchase prices during the month of August."

Department of Health and Social Care (DHSC) has implemented a process to roll over certain concessionary prices to the following month. From May 2023, the roll over process will apply to any products where agreement is reached on the final prices granted by DHSC for any price concession requests submitted late in the month (on or after the 23rd of the month) by Community Pharmacy England. Community Pharmacy England said: "As part of the Year 4 & 5 funding settlement for community pharmacy, it was agreed that an urgent review of the price concession setting system would take place." It has been working with DHSC to determine improvements to the price concession system. Community Pharmacy England said: "Pharmacy owners (members) will be able to see the lines that have rolled over on our price concessions page here. Please note any rolled over prices can be adjusted upwards if we receive reports from our members to indicate suppliers' selling prices have increased. The review can be requested at any point during the month."

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.

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.

The Pharmaceutical Services Negotiating Committee (PSNC)'s members are seeking immediate rescue packages for the sector to help with energy bills and to ease capacity constraints. In a meeting held on 14th and 15th September, the committee members expressed their anger and frustration on the reluctance of NHS England and government to fund pharmacy sustainably. The meeting was held to consider practical steps to ease the pressures on the community pharmacy sector, and to oversee the progress of negotiations on the Community Pharmacy Contractual Framework (CPCF) and other work. Committee members, as pharmacy contractors, shared their experiences of the current pressures on all contractors, including the inability to deliver some services and to maintain core service levels; the capacity and workforce crises facing the sector; the critical need for funding support this winter; and the urgent need for Government to adapt the Price Concessions system to meet the needs of contractors. "The Price Concessions system is no longer working for contractors in the current volatile medicine supply environment and PSNC is clear this is not acceptable," said the committee.

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."

The Pharmaceutical Services Negotiating Committee (PSNC) has rejected Department of Health and Social Care (DHSC) and NHS England's proposal on price concessions reform and relief measures to ease pressure on pharmacies. The Committee called the proposal 'insufficient' to meet the sector's needs considering the impact of the current crisis, reflecting on the economic pressures that accelerated through the autumn and winter. The Ministers and other decision-makers have shown their interest in the potential role of community pharmacy, particularly in using a Pharmacy First approach and making use of PGDs and the skills of independent prescribers. But the Committee had made clear to them that without new money this is all a pipedream. "We need an urgent injection of funds into the sector, otherwise we will continue to see a degradation of services and eventual collapse of the network. The Committee is clear that there is no further place for warm words while pharmacy collapses," said PSNC. The Committee reflected that the 5-year CPCF agreement had been based on working together to create the capacity and context necessary to deliver the shift towards greater service delivery. Not only has that capacity-release not happened due to slow progress by Government, but pharmacies have also been burdened with these additional, and insurmountable, challenges.

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."

The Pharmaceutical Services Negotiating Committee (PSNC) has raised concerns over the impact that high medicine price rises are having on contractor. Recently, the Department of Health and Social Care (DHSC) has granted the final list of price concessions for December 2022. The latest additions bring the total number of concessionary prices granted for the month of December to 198, surpassing the previous record of 159 granted in September 2022. PSNC has heard from hundreds of community pharmacy contractors who are paying inflated prices for antibiotics used for the treatment of Strep A and who have rightly been concerned about the lack of certainty around the final reimbursement prices for these medicines. It added: "We welcomed the involvement of the Competition and Markets Authority (CMA) to look into the pricing of antibiotics. But the number of reports we are getting from contractors about medicines price rises are just not acceptable and this goes far beyond the antibiotic crisis."

The PSNC on Friday said it has warned the DHSC about the "very serious impact" of the limited supply of certain antibiotics on pharmacies who are "having to chase stock, purchase without sight of any concession prices, and cope with increasing patient questions and abuse." With higher than usual number of cases of scarlet fever, caused by invasive Group A Streptococci (iGAS) infections, being reported in children across the country, supplies of antibiotics for Group A Strep treatment have seen a surge in demand, leading to limited supply at certain wholesalers and pharmacies. PSNC has urged the DHSC to adopt measures that could help to manage the current crisis, such as allowing pharmacists more freedom to change strengths or formulations without prescriber approval, outside of Serious Shortage Protocols. It has also raised concerns on the significant rise in wholesale prices of many oral antibiotics as a result of the surge in demand and the ongoing supply disruptions. PSNC also said they have received reports of some suppliers putting up their prices for any oral antibiotics they do have in stock.

The Department of Health and Social Care (DHSC) has redetermined the December 2023 concessionary prices for four medicines following requests made by Community Pharmacy England (CPE) on behalf of community pharmacy owners. For Ezetimibe 10mg tablets (pack size 28), the price has been fixed at £17.78, up from £9.44. Other drugs included in the list are Aripiprazole 5mg (£8.52), Digoxin 125microgram (£3.70) and Digoxin 250micrgram (£3.70) tablets. Contractors would be reimbursed at the new prices only for prescriptions submitted for payment for the dispensing month of December 2023. CPE said they are still working with DHSC to agree price concessions for January. Check the final the December 2023 price concessionary here. Additionally, DHSC on Friday confirmed that there's now sufficient stock of Clarithromycin 125mg/5ml oral suspension to meet normal demand, and the Serious Shortage Protocol (SSP), SSP053 for the antibiotic expires on 12 January 2024.

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."

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 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."

Community Pharmacy England (CPE) has explained MPs on instability that puts operational pressures on pharmacies, financial pressures on businesses at a Parliamentary drop-in event held on Monday (10 July). The association has been in Parliament today alongside patient representatives and others to highlight our ongoing concerns about medicines supply to MPs. It said: "Medicines supply remains a critical issue for community pharmacies with disruption causing problems both accessing medicines and procuring them cost effectively." In CPE's recent sector polling, community pharmacy owners rated medicines supply instability as being the most severe pressure facing their businesses. This echoed the results of CPE's Pressures Survey which found 97% of pharmacy owners survey are facing significant increases in wholesaler and medicine supply issues, with 71% saying this was leading to delays in prescriptions being issued. During the Parliamentary drop-in event, CPE talked MPs through the issues and set out what it believe needs to happen to resolve them, calling for- Reform of Serious Shortage Protocols; Allowing generic substitution; An overhaul of the concessions system; and a strategic Government review of medicine supply and pricing with a shift to focusing on how to improve the functioning of the supply chain rather than solely on the drive to depress prices and margins.

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

Leaders from across the pharmacy sector and trade bodies dwelled on the challenges faced by the pharmacists at the Sigma Conference held on Sunday (2 October). "If the cost of carrying out regulation is higher than the benefits, it's time for all the bodies to sit together and talk on what can be adjusted accordingly," said Salim Jetha, Chairman, Avicenna. Jetha highlighted the challenges faced by the independent pharmacy and also raised the concern about the 'level playing field' for pharmacists compared to GPs. He said: "GPs get paid for energy cost, premises cost, the staffing cost. We don't get paid for that. So don't be misled by saying we are being exactly the same. Yes, on paper we are, but in reality we are not. I think also the rules of engagement are different." He called for better collaboration with GPs, and urged PSNC and other trade bodies to ensure a level playing field. Janet Morrison, CEO, Pharmaceutical Services Negotiating Committee(PSNC), warned that the pressure in the sector is building up to a 'breaking point'.

The Pharmaceutical Services Negotiating Committee (PSNC) has urged community pharmacy to plan and ensure patients are able to access their prescription if they have to close in an emergency situation for a short period. It has prepared a guidance which can be undertaken by pharmacy in the event of a closure and the contractor's business can resume easily and effectively once the emergency has passed. In its guidance, PSNC has stated a few actions that can be taken by pharmacy in advance: Plan ahead - be ready before a closure is needed. Don't wait until your pharmacy needs to be closed before you consider how you will manage and what you can put in place to mitigate the impact. Make sure your business continuity plan is up to date and relevant to the current situation. For example, try not to rely on family and friends as part of your plan; if you're having to isolate because of infectious illness, your close contacts may need to do so as well. Ensure your SOPs are accurate, up to date and easy-to-find for someone completely unfamiliar with your pharmacy. Emergency numbers will be crucial. Normal, everyday business continuity issues are still going to arise and anyone on-site needs to know how to address them:

Community Pharmacy England (CPE) is aiming to reach an agreement with the Department of Health and Social Care (DHSC) and NHS England (NHSE) on negotiation with regards to expanded services and payment model in the pharmacy sector. Chief Executive Janet Morrison, said: "We are working at pace in negotiations with DHSC and NHSE. The process remains on track with the Government's original timescale - i.e. aiming for agreement in July, with cross-government clearance later in July, and implementation from July through to September." CPE is involved in working groups on service expansion of Hypertension Case-Finding and the Pharmacy Contraception Scheme and service design for the Common Conditions Service; and are in in-depth negotiations on Payment models. These discussions critically look at the balance between funding core capacity and activity payments, how the funding streams will be distributed and how CPE will measure delivery and impact. NHSE has been leading on the development of the PGD pathways for each of the 7 conditions, with external medical, pharmacy and other experts feeding into the process - pharmacy owners from the Community Pharmacy England Committee have also been involved but the discussions are clinically led to ensure they comply with NICE principles and concur with Antimicrobial Stewardship policy.