Following several weeks of discussion during which Community Pharmacy England made strong representations and put weekly evidence from pharmacy owners to the Department of Health and Social Care (DHSC), late on Monday (July 31st) DHSC announced its final price concessions for July.
Several of the prices announced represented improvements on the original DHSC offers following further representations made by our Dispensing and Supply Team, but it was frustrating that once again some prices were imposed and the decisions came very late in the month and working week.
Below we have set out our next steps – including seeking exceptional back-dated uplifts on some July concession lines, and announcing a concessions webinar to talk to community pharmacy owners directly about this critical issue. DHSC representatives will be invited to join this webinar.
This all builds on the ongoing work we are doing to seek fair concession prices, to improve the concessions system, and to press for wider and critical improvements for community pharmacy including uplifts to core funding and total allowed margin.
We are also deeply concerned about the impact that medicines supply issues are having on pharmacy teams and how this affects patients – in our Pressures Survey earlier this year 94% of pharmacies said patients were being inconvenienced by medicine supply issues on a daily basis.
Pharmacy owners have rightly been deeply concerned and frustrated about Atorvastatin throughout this month, and the breakdown of prices set by DHSC is copied below.
Atorvastatin 10mg tablets (28) – £1.65
Atorvastatin 20mg tablets (28) – £3.38
Atorvastatin 40mg tablets (28) – £2.25
Atorvastatin 80mg tablets (28) – £3.45
Community Pharmacy England submitted price concession requests for Atorvastatin at the start of July and provided DHSC with compelling data throughout the month, consisting of actual purchase prices reported by pharmacy owners and evidence or screenshots of prices/stock available through different suppliers.
Pricing issues are being compounded by ongoing supply issues and given the high volume of this line it is causing many issues for pharmacy teams and patients. DHSC has issued no central communications or Serious Shortage Protocols (SSPs) to help pharmacies better manage this situation – and GPs have not been made aware of the supply issues, which can further compound problems.
The final prices set for 10mg and 40mg by DHSC were high enough to cover the prices being paid by the vast majority of pharmacy owners reporting prices to us.
But despite the improvements, we could not agree the prices for 20mg and 80mg, and these were imposed by DHSC, based on the data they have gathered.
Given the data we have received from pharmacy owners, we have made an exceptional request for a back-dated uplift of the prices for 80mg Atorvastatin and two other concession lines for July.
We do not yet know whether DHSC will grant these exceptional requests, nor when they will respond to us, but we are continuing to press for them alongside work gathering evidence to support our claims for August concessions.
We have pushed DHSC to issue guidance for GPs and patients to explain the supply issues so prescribers can be more accommodating to requests for replacement prescriptions for other available strengths/statins: DHSC are considering our request but are worried that any public guidance may encourage stockpiling or potentially worsen the supply situation.
Community Pharmacy England’s Negotiating Team also met this morning and considered the critical medicines supply situation, thinking about our short and long-term policy asks on this topic.
Those asks include an uplift to the £800m margin that the sector is allowed to earn (alongside an uplift to total community pharmacy funding) – we raised this with MPs at our recent Parliamentary event and will continue to press for this.
Today, we have also announced a webinar on price concessions which we encourage pharmacy owners to attend. At the webinar Committee and Executive Team Members will explain how the concessions system works and what happens when pharmacy owners report increased prices to us, as well as answering your questions and collecting further feedback for DHSC.
Suraj Shah, Drug Tariff and Reimbursement Manager at Community Pharmacy England, said:
“Price concessions are far from a perfect solution to medicines pricing issues but if implemented correctly they are a critical measure to protect pharmacy owners from pricing shocks. Our Dispensing and Supply Team work hard every month to assimilate the evidence from pharmacy owners and ask for appropriate concessions.
Community Pharmacy England’s clear position is that any dispensing at a loss is unacceptable. But DHSC’s objective is to reimburse pharmacy owners fairly overall while also assuring value for money and avoiding driving further price rises. There are a number of wider policy points which further complicate the process and we will cover these in our upcoming webinar.
Last year we drove a six-month review of the concession price system working with DHSC and this resulted in some clear improvements to the price concessions system including removing discount deduction from concession products, allowing a roll-forward for products requested later in the month, and perhaps most importantly, working on a retrospective correction mechanism for prices subsequently demonstrated to be wrong. This was a step in the right direction but more is needed.
And of course these issues not only about money. Further changes are needed to protect patients from the impact of supply problems, and to mitigate the impact that time sourcing medicines is having on pharmacy teams’ workload: we will continue to press for these. Pharmacy teams must be able to access all the medicines that their patients rely on and pharmacy businesses must be reimbursed appropriately for them.”
David Broome, Community Pharmacy England Committee Member, said:
“All pharmacy owners are stuck with the daily headache of trying to obtain medicines affected by supply disruptions or shortages – the impact of this was once again confirmed in our recent sector polling when medicines supply was ranked as the most serious pressure facing pharmacies. And the impact is also playing out on our patients – any delay to receiving life-saving medicines can be both deeply distressing and critical from a clinical perspective.
For many pharmacy owners and their patients the situation is now simply impossible, and it must be resolved.
We are continuing to highlight the very serious impact this issue is having and to call on NHS and Government to take action to steady the UK medicines supply chain, and to protect community pharmacies and their patients from the ongoing volatility in the market. This was the focus of our recent Parliamentary event and we will continue to fight for it through all possible channels.”