HDA UK Media And Political Bulletin – 19 April 2017

Media Summary

Judge dismisses High Court pharmacy cut claims

Chemist and Druggist, Anabelle Collins, 18 May 2017

The National Pharmacy Association’s (NPA) and the Pharmaceutical Services Negotiating Committee’s (PSNC) cases against the funding cuts have been dismissed by a High Court judge. Judge Justice Collins recognised that the evidence presented by the NPA and PSNC suggests there is a “real risk” there will be “less access because of the inability to keep some pharmacies open for as many hours”. One further example given was free delivery services, which may have to cease due to cuts.

Concessions Announcement
PSNC, 17 May 2017

The Department of Health have announced the following price concessions for May 2017:

 

Drug Pack size Price concession
Buspirone 10mg tablets 30 £9.95
Buspirone 5mg tablets 30 £9.95
Clindamycin 150mg capsules 24 £4.85
Dapsone 50mg tablets 28 £46.19
Diamorphine 30mg powder for solution for injection ampoules 5 £16.52
Ethosuximide 250mg/5ml oral solution 200ml £173.00
Exemestane 25mg tablets 30 £12.00
Leflunomide 10mg tablets 30 £8.50
Leflunomide 20mg tablets 30 £8.50
Mefenamic acid 500mg tablets 28 £59.99
Mirtazapine 15mg tablets 28 £3.00
Mirtazapine 45mg tablets 28 £3.00
Nitrofurantoin 100mg tablets 28 £11.93
Nitrofurantoin 50mg tablets 28 £20.50
Oxazepam 10mg tablets 28 £7.97
Oxazepam 15mg tablets 28 £7.97
Pramipexole 88microgram tablets 30 £11.24
Ropinirole 5mg tablets 84 £165.00
Sodium cromoglicate 2% eye drops 13.5ml £5.99
Spironolactone 50mg tablets 28 £5.20
Tranexamic acid 500mg tablets 60 £11.50
Valsartan 160mg capsules 28 £17.10
Valsartan 40mg capsules 28 £8.80
Valsartan 80mg capsules 28 £11.43
Zolmitriptan 2.5mg orodispersible tablets sugar free 6 £15.22
Zolmitriptan 2.5mg tablets 6 £14.99

No endorsements are required as these prices will automatically be applied to this month’s prescriptions.

When any NCSO or price concession announcements are made, these appear on the Generic Shortages page (psnc.org.uk/ncso) and are emailed to those subscribed to this mailing list.

Parliamentary Coverage

There is no Parliamentary Coverage

Full Coverage

There is no full coverage.

April 2017 Price Concessions
PSNC, 12 April 2017

The Department of Health have granted the following price concessions for April 2017:

Drug Pack size Price concession
Amitriptyline 50mg tablets 28 £3.50
Buspirone 10mg tablets 30 £9.57
Buspirone 5mg tablets 30 £16.50
Dapsone 50mg tablets 28 £46.19
Diamorphine 30mg powder for solution for injection ampoules 5 £16.52
Ethosuximide 250mg/5ml oral solution 200ml £173.00
Exemestane 25mg tablets 30 £11.50
Leflunomide 10mg tablets 30 £7.76
Lorazepam 1mg tablets 28 £6.00
Mirtazapine 15mg tablets 28 £3.00
Mirtazapine 30mg tablets 28 £1.40
Mirtazapine 45mg tablets 28 £3.00
Naratriptan 2.5mg tablets 6 £23.00
Nitrofurantoin 100mg tablets 28 £11.20
Nitrofurantoin 50mg tablets 28 £20.50
Oxazepam 10mg tablets 28 £7.97
Oxazepam 15mg tablets 28 £7.97
Pramipexole 88microgram tablets 30 £8.50
Ropinirole 5mg tablets 84 £165.00
Spironolactone 50mg tablets 28 £5.20
Valsartan 160mg capsules 28 £17.25
Valsartan 40mg capsules 28 £8.95
Valsartan 80mg capsules 28 £11.50
Zolmitriptan 2.5mg orodispersible tablets sugar free 6 £15.22
Zolmitriptan 2.5mg tablets 6 £15.30

No endorsements are required as these prices will automatically be applied to this month’s prescriptions.

When any NCSO or price concession announcements are made, these appear on the Generic Shortages page (psnc.org.uk/ncso) and are emailed to those subscribed to this mailing list.

Losing GSi – MHRA emails are changing
MHRA Blog, Mark Birse, 10 April 2017

The MHRA is removing .gsi from its email addresses, so emails will now come from @mhra.gov.uk. The new email addresses will be more secure and the new system guards against anyone trying to forge the MHRA’s domain name. The MHRA recommends that email contacts are updated accordingly.

Parliamentary Coverage

There is no Parliamentary Coverage.

Full Coverage

Losing GSi – MHRA emails are changing
MHRA Blog, Mark Birse, 10 April 2017

From 10 April, we are removing .gsi from our email addresses.

Launched in 1996, the Government Secure Intranet (GSi) has been used until now to guarantee the security of emails sent by Government agencies and Arms Length Bodies. Technology has changed a lot since 1996 and the GSi is now being phased out across Government.

What’s changing?

From 10 April 2017 we are removing .gsi from our mhra email addresses.  So info@mhra.gsi.gov.uk will now be info@mhra.gov.uk.

Our new email addresses will be more secure, and the new system will protect against anyone trying to forge our domain name (the @mhra bit) and sending emails that claim to be from MHRA.

What do I need to do?

Update your MHRA email contacts and remove .gsi from our email addresses.  Update any tools that use MHRA email addresses.

Emails sent to email addresses including the .gsi will continue to be forwarded until further notice.

If you have any questions about this change or require more information please contact us on info@mhra.gov.uk.

This change only affects email addresses ending in mhra.gsi.gov.uk –all email addresses ending in nibsc.org will remain the same.

Media Summary

March concessionary prices updated
Chemist and Druggist, Grace Lewis, 24 March 2017

The Department of Health and National Assembly for Wales have agreed further concessionary prices for the following items for March 2017 prescriptions:

Drug Strength Form Price
Buspirone 5mg Tablets (30) £16.50
Leflunomide 10mg Tablets (30) £7.76
Leflunomide 20mg Tablets (30) £8.90
Nitrofurantoin 100mg Tablets (28) £11.20

Will the NHS force doctors to prescribe biosimilars?
Pharma Phorum, Richard Staines, 23 March 2017

The Medicines for Europe biosimilars conference in London demonstrated concerns that there is a lack of incentives for hospitals to switch to cheaper biosimilar alternatives, proving a major barrier to their uptake. Discussing biosimilar use across Europe, Steinar Madsen, medical director of the Norwegian Medicines Agency, said Denmark has been one of the leaders in using biosimilars and Danish authorities have threatened doctors with cuts to staffing and services if they do not use biosimilars.

Parliamentary Coverage

There is no Parliamentary Coverage.

Full Coverage

Will the NHS force doctors to prescribe biosimilars?
Pharma Phorum, Richard Staines, 23 March 2017

NHS authorities could begin to use the reimbursement system as a “stick” to ensure doctors prescribe cheaper biosimilar medicines amid varied uptake in different regions.

The Medicines for Europe biosimilars conference in London heard that it is not concerns about the science that is an issue for NHS, but a lack of incentives for hospitals to switch to the cheaper alternatives that is a major barrier to their uptake.

In England, the NHS is split into “purchasers” of healthcare and “providers” – and finding ways to share the savings generated by biosimilars is proving to be an obstacle.

The answer in many cases has been “gainshare” agreements, where savings generated by biosimilars are spread between the Clinical Commissioning Group (CCG) purchasing the service and the hospital providing it.

But in some cases the CCGs and hospitals have been unable to agree on these gainshare agreements despite the dire financial situation in the health service.

Typically “gainshare” involve a 50-50 split of the savings, plus an initial investment to reconfigure services around the biosimilar.

And it’s these areas without gainshare where biosimilars are not being used, according to Maggie Dolan, regional pharmacy procurement specialist at NHS Commercial Solutions Surrey.

She told the conference: “In some trusts you have no uptake, in some trusts you have 100% uptake.”

Southampton hospital is often cited as an exemplar, where use of biosimilar infliximab – a near copy of MSD’s Remicade – in its gastroenterological use has shaved almost a million pounds from the hospital’s annual budget.

Southampton was able to implement use of biosimilar infliximab through coordinated working between patient groups, the manufacturer and commissioners.

But in the trusts where biosimilars are not being used, NHS authorities may choose to try and use the reimbursement system to force doctors to prescribe them.

Stick, not carrot

In the near future, drugs will be reimbursed at the price of the biosimilar – meaning that using the branded drug would quickly lead to hospitals racking up large debts, according to Dolan.

This will reflect very badly on them at a time when the NHS is under intense pressure politically to balance the books.

Maggie Dolan

Dolan said: “I think we are not very far away from seeing examples of just that kind of pressure being put on doctors.”

“We know the financial situation of the NHS and we will see quite quickly a move towards the ‘stick’ more than the ‘carrot’”.

The changes are unlikely to happen overnight, but over the next year or so as funding arrangements are reviewed on a piecemeal basis across the country.

Dolan added that uptake of biosimilar rituximab may be affected by a decision by NHS England to eschew a national gainshare agreement.

Reimbursement arrangements are national and NHS England has opted to give a refund to hospitals achieving usage goals under so-called CQUIN targets, Dolan noted.

Fighting talk from Denmark

Giving an update about biosimilar use across Europe, Steinar Madsen, medical director of the Norwegian Medicines Agency said Denmark has been one of the leaders in using biosimilars and nearly all hospitals use the cheaper near-copy.

Danish authorities have been “brutal”, threatening doctors with cuts to staffing and services if they do not use biosimilars, said Madsen.

Peter Jorgensen, director of the Danish generics and biosimilars industry body, IGL, said the Danish system is best described as “efficient”.

He predicted that AbbVie’s Humira (adalimumab) will also disappear from the Danish market once the biosimilar is available, possibly next year when its European patent expires.

He said: “Humira will be whipped off the planet in Denmark. AbbVie had their time, now it is time for somebody else to do the job.”

Media Summary

March 2017 Price Concessions
PSNC, 15 March 2017

The Department of Health have granted the following price concessions for March 2017:

Drug Pack size Price concession
Amitriptyline 50mg tablets 28 £3.50
Dapsone 50mg tablets 28 £46.19
Exemestane 25mg tablets 30 £12.60
Flecainide 100mg  tablets 60 £16.53
Flecainide 50mg  tablets 60 £11.57
Glibenclamide 5mg tablets 28 £2.49
Lorazepam 1mg tablets 28 £6.00
Mirtazapine 15mg tablets 28 £5.95
Mirtazapine 30mg tablets 28 £1.61
Mirtazapine 45mg tablets 28 £5.95
Naratriptan 2.5mg tablets 6 £23.00
Nitrofurantoin 50mg tablets 28 £20.50
Oxazepam 10mg tablets 28 £7.97
Oxazepam 15mg tablets 28 £7.75
Ropinirole 1mg tablets 84 £56.71
Ropinirole 5mg tablets 84 £165.00
Spironolactone 50mg tablets 28 £5.20
Valsartan 160mg capsules 28 £17.65
Valsartan 40mg capsules 28 £8.95
Valsartan 80mg capsules 28 £11.99
Zolmitriptan 2.5mg orodispersible tablets sugar free 6 £15.22
Zolmitriptan 2.5mg tablets 6 £15.30

No endorsements are required as these prices will automatically be applied to this month’s prescriptions.

New UK drug cost rules leave companies fuming
Reuters, Ben Hirschler, 15 March 2017

British drug-makers have said the government is breaking a manifesto commitment to improve access to new medicines, following approval of new cost rules that take effect on April 1. The changes are meant to introduce a new fast-track option for appraising treatments which offer exceptional value for money. Some charities also expressed concern that the measures could mean delays for people with serious conditions in getting new treatments. Drug companies are already concerned that Brexit could make Britain a less attractive market. However, the National Institute for Health and Care Excellence (NICE) and NHS England say the new procedures will fast-track the availability of drugs that offer exceptional value. Significantly, the new rules apply only to England, leaving a different system in place for Scotland.

The European Pharmaceutical Review also reports on the new fast-track option.

Parliamentary Coverage

There is no Parliamentary Coverage.

Full Coverage

New UK drug cost rules leave companies fuming
Reuters, Ben Hirschler, 15 March 2017

British drugmakers on Wednesday accused Theresa May’s Conservative government of breaking a manifesto commitment to improve access to new medicines, following approval of new cost rules that take effect on April 1.

The angry response from both Big Pharma and biotech firms comes despite a concession by government in the latest version of the scheme, which increases the cost threshold for certain drugs for rare diseases from the previously planned level.

Some charities, including the Alzheimer’s Society, also expressed concern that the measures could mean delays for people with serious conditions in getting new treatments.

The row comes at a sensitive time for the government, which is about to trigger proceedings to leave the European Union but wants to encourage investment by strategic industries, including the high-tech pharmaceuticals sector.

Drug companies are already concerned that Brexit could make Britain a less attractive market, especially if the country ends up outside the current EU-wide system for drug licensing.

The National Institute for Health and Care Excellence (NICE), which determines the cost-effectiveness of new drugs, and NHS England say their new procedures will fast-track the availability of drugs that offer exceptional value.

Media Summary

February Concessionary Prices Updated

Chemist and Druggist, Thomas Cox, 21 February 2017

The Department of Health and National Assembly for Wales have agreed further concessionary prices for the following items for February 2017 prescriptions, as follows:

Drug Strength Form Price
Buspirone 5mg tablets (30) £17.50
Leflunomide 10mg tablets (30) £7.79
Leflunomide 20mg tablets (30) £9.03
Valsartan 40mg capsules (28) £4.72
Valsartan 80mg capsules (28) £5.55

Initial concessionary prices were announced earlier this month.

Delivering sustainability and transformation plans

The King’s Fund, Chris Ham, Hugh Alderwick, Phoebe Dunn, Helen McKenna, 21 February 2017

The King’s Fund has published its report examining the content of the 44 sustainability and transformation plans (STPs) which constitute the main vehicle for transforming health and care services in England, in line with the NHS five year forward view. The report looks at challenges and opportunities that come with implementing STPs. In terms of policy, the proposals in STPs now need to be developed into credible plans, with clarity about the priorities in each footprint. Changes to the law are also needed to amend aspects of the Health and Social Care Act 2012 that are not aligned with the Forward View, particularly in relation to market regulation.

Parliamentary Coverage

Lords Second Reading – European Union (Notification of Withdrawal) Bill (Day 1)

HDA briefed the Lib Dem Health Spokesperson after the Financial Times letter from Martin Sawer. An extract from Baroness Walmsley’s speech can be found below.

Baroness Walmsley (LD):

As your Lordships will be aware, I speak for these Benches on health and social care. There are three main healthcare reasons why I believe the Bill should be amended. They boil down to: people, healthcare and Donald Trump. There are tens of thousands of EU citizens working in our health and care system and the Government are using their future, and the future of those they care for, as a pawn in a misguided game of cat and mouse with the other 27 countries. Without them, the staff shortages we are already experiencing will be a lot worse and patients will suffer. 1 am pleased there has been a cross-party outcry from your Lordships about this, so I hope all will vote for an end to that foolishness.

Secondly, the businesses which provide the drugs, medical devices and treatments that British people need will be badly affected by a hard Brexit. That is why I support access to the single market rather than just waving a white flag and not even trying. The pharmaceutical products most of us depend on are developed by research by networks of scientists working together across Europe. These networks are already suffering and the massive EU funding from which they benefit is being put at risk. Clinical trials taking place here in the UK are at risk. UK patients get access to new and cutting-edge treatments because of them. The UK has played an enormous role in the regulation and licensing of medicines for the whole EU. Indeed, much of the expertise is here. It makes no sense to develop our own system. We could lose a lot of that expertise.

Companies will always develop products for big markets where the profits are. Why would they want to develop a product to satisfy the regulations in a market of 68 million people when they could sell to a market of 400 million? Medicine distributors warn of cost increases, decreased access and even shortages. Harmonised regulation is not a burden. It gives us the freedom to sell and the confidence to buy. Why throw it away? Medcare products frequently cross borders in the course of their manufacture, packaging and labelling. Having tariffs imposed on them will increase their costs and decrease their competitiveness. So, for the sake of UK patients and their access to affordable and cutting-edge medicines and treatments, I will be supporting an amendment to give us continued access to the single market and the customs union.

Then there is Donald Trump. Our NHS is probably our most valuable asset. Already a lot of American healthcare companies are sniffing around to see what they can pick up. We all heard what Trump said about trade deals putting America first—America first, not the UK first. So anyone who thinks a trade deal with the USA will not result in a lot of our health services being run by American companies must be completely mad.

Finally, I will be supporting an amendment to ensure the approval of the British people for the deal put before them by the Government. All those who are most affected should have a say, including those who were denied one in the last referendum with its gerrymandered electorate, such as: citizens of other EU countries who live here; British citizens who have lived for many years in other EU countries; and 16 to 18 year-olds whose future study and work opportunities will be damaged by Brexit.

Media Summary

February 2017 Price Concessions

PSNC, February 2017

The Department of Health have granted the price concessions for February 2017. No endorsements are required as these prices will automatically be applied to this month’s prescriptions. NCSO or price concession announcements appear on the Generic Shortages page (psnc.org.uk/ncso) and are emailed to those subscribed to this mailing list. A full list of this month’s price concessions can be found here.

Drug Pack size Price concession
Amitriptyline 50mg tablets 28 £3.50
Candesartan 2mg tablets 7 £2.25
Dapsone 50mg tablets 28 £46.19
Exemestane 25mg tablets 30 £12.60
Flecainide 100mg tablets 60 £16.53
Flecainide 50mg tablets 60 £11.57
Glibenclamide 5mg tablets 28 £2.49
Lorazepam 1mg tablets 28 £5.71
Mirtazapine 15mg tablets 28 £5.45
Mirtazapine 30mg tablets 28 £1.61
Mirtazapine 45mg tablets 28 £5.95
Naratriptan 2.5mg tablets 6 £23.00
Nitrofurantoin 100mg tablets 28 £16.80
Nitrofurantoin 50mg tablets 28 £17.50
Oxazepam 10mg tablets 28 £7.97
Oxazepam 15mg tablets 28 £7.97
Ropinirole 0.5mg tablets 28 £15.50
Ropinirole 1mg tablets 84 £56.71
Ropinirole 2mg tablets 28 £22.25
Ropinirole 5mg tablets 84 £165.00
Spironolactone 50mg tablets 28 £5.20
Valsartan 160mg capsules 28 £5.20
Zolmitriptan 2.5mg tablets 6 £15.30

Parliamentary Coverage

There is no Parliamentary Coverage.

Media Summary

Exiting the EU Committee report: ABPI response

ABPI, 14 January 2017

The Association of the British Pharmaceutical Industry (ABPI) has published its response to the Exiting the EU Select Committee report. The ABPI argues that alignment with EU medicines regulation is key and the UK should look to maintain as much harmonisation of medicine regulation as possible. The ABPI supports the focus on transitional arrangements and the UK’s future partnerships with European regulatory agencies and bodies.

January 2017 Price Concessions

Pharmaceutical Services Negotiating Committee, 13 January 2017 

The Department of Health have granted the following price concessions for January 2017:

Drug

Pack size

Price concession

Amitriptyline 50mg tablets

28

£3.40

Buspirone 5mg tablets

30

£19.54

Candesartan 2mg tablets

7

£2.25

Dapsone 50mg tablets

28

£46.19

Exemestane 25mg tablets

30

£9.60

Flecainide 100mg tablets

60

£13.50

Flecainide 50mg tablets

60

£11.25

Lorazepam 1mg tablets

28

£6.05

Mirtazapine 15mg tablets

28

£5.95

Mirtazapine 30mg tablets

28

£1.61

Mirtazapine 45mg tablets

28

£5.95

Naratriptan 2.5mg tablets

6

£24.55

Nitrofurantoin 100mg tablets

28

£14.50

Nitrofurantoin 50mg tablets

28

£17.50

Quinagolide 75microgram tablets

30

£64.97

Ropinirole 0.5mg tablets

28

£16.32

Ropinirole 1mg tablets

84

£56.71

Ropinirole 5mg tablets

84

£165.00

Valsartan 160mg capsules

28

£5.20

Valsartan 40mg capsules

28

£4.72

Valsartan 80mg capsules

28

£5.55

Zolmitriptan 2.5mg tablets

6

£15.30

No endorsements are required as these prices will automatically be applied to this month’s prescriptions.

When any NCSO or price concession announcements are made, these appear on the Generic Shortages page (psnc.org.uk/ncso) and are emailed to those subscribed to this mailing list.

Parliamentary Coverage

There is no parliamentary coverage.

Full Coverage

Exiting the EU Committee report: ABPI response

ABPI, 14 January 2017

The Association of the British Pharmaceutical Industry (ABPI) has responded to today’s publication of the Exiting the EU Committee report into the process for exiting the European Union and the Government’s negotiating objectives.

​​​In December, Dr Virginia Acha, ABPI Executive Director – Research, Medical & Innovation gave evidence to the Exiting the EU Committee stating that a primary objective for Government in Brexit negotiations should be to secure alignment and cooperation with EU medicines regulation.

​The UK is currently part of the European Medicines Agency (EMA), a network that facilitates the harmonisation of medicines regulation for more than 25% of global pharmaceutical market and over 500m patients. This includes EU member states, and non-EU members of the European Economic Area (EEA), Iceland, Liechtenstein and Norway.

Robust and internationally aligned medicines regulation, has been essential for protecting and improving the health of patients, has ensured effectiveness and safety, and has brought forward advances in medical innovation to large patient populations in a way that minimises delays and cost.

The UK having an aligned framework in place for medicines regulation ‘from day one’ of leaving the EU would be important for maintaining drugs availability and supply.

Upon reviewing the Committee’s report published today​, the ABPI welcomes their explicit focus on the importance of transitional arrangements and the UK’s future relationships with regulatory agencies and bodies.

Mike Thompson, ABPI, Chief Executive ​commented:

“We welcome the Committee’s focus on the importance of getting medicine regulation right from day one of the UK leaving the European Union.

Securing continued regulatory cooperation and alignment with the EU for medicines will be in the best interests of the UK Government, EU member states and patients.

Big pharma braces for further bruising publicity over drug prices

Financial Times, David Crow, 18 December 2016

 

The Financial Times reports on the issue of high drug prices in the US. Theoretically, the pharma industry was relieved by the election of Donald Trump over fears that Hilary Clinton would implement strict policies to curb the cost of medicines. However, this approach could be short-sighted and the issue of drug prices remains high on the agenda with increasing public scrutiny expected in 2017.  Brent Saunders, chief executive of Allergan, the first company to publish a “social contract” with patients, urges the industry to self-regulate.

 

Wholesalers’ Christmas delivery information

DDA, Ailsa Colquhoun, 20 December 2016

 

The three mainline wholesalers have supplied their Christmas delivery information. Please download the information you require to ensure your supplies to patients.

 

AAH

England, Wales and NI

Scotland

Alliance Healthcare

All

Phoenix

England Wales & NI

Scotland

 

December concessionary prices announced

Chemist and Druggist, Thomas Cox, 20 December 2016

 

The Department of Health and National Assembly for Wales have agreed concessionary prices for the following items for December 2016 prescriptions.

 

Drug  Strength Form Price
Amitriptyline 50mg tablets (28) £3.05
Bumetanide 1mg tablets (28) £1.75
Candesartan 2mg tablets (7) £2.25
Dapsone 50mg tablets (28) £46.19
Exemestane 25mg tablets (30) £9.60
Flecainide 50mg tablets (60) £11.25
Fludroxycortide 4mcg/sg tape 7.5cm (20) £12.49
Lorazepam 1mg tablets (28) £6.05
Lorazepam 2.5mg tablets (28) £12.50
Metronidazole 400mg tablets (21) £7.88
Mirtazapine 15mg tablets (28) £5.95
Mirtazapine 30mg tablets (28) £1.55
Mirtazapine 45mg tablets (28) £5.95
Naratriptan 2.5mg tablets (6) £24.55
Nitrofurantoin 100mg tablets (28) £14.05
Nitrofurantoin 50mg tablets (28) £17.50
Quinagolide 75mcg tablets (30) £49.50
Ropinirole 0.25mg tablets (12) £5.70
Ropinirole 0.5mg tablets (28) £18.15
Ropinirole 1mg tablets (84) £56.71
Ropinirole 2mg tablets (28) £31.51
Ropinirole 5mg tablets (84) £165.00
Valsartan 160mg capsules (28) £5.20
Valsartan 40mg capsules (28) £4.17
Valsartan 80mg capsules (28) £4.17
Zolmitriptan 2.5mg sugar-free
orodispersible tablets (6)
£23.99

 

 

Parliamentary Coverage

House of Commons Oral Answers, 20 December 2016, Community Pharmacies

 

Lyn Brown (West Ham) (Lab)

 

7. What steps his Department is taking to work with community pharmacies to reduce (a) waste and (b) the cost of medicines.

 

The Parliamentary Under-Secretary of State for Health (David Mowat)

NHS England has a range of initiatives for waste and medicine cost reduction. We estimate that there is a prize of up £150 million a year to be realised across the system on waste. Community pharmacies have a significant role to play in that, partly through their existing duty to review prescriptions when repeat dispensing and partly through the separately commissioned medicine use reviews.

 

Lyn Brown

The Minister is absolutely right to say that community pharmacies have an important role to play. On 17 October, he told the House:

“We do not believe that any community pharmacies will necessarily close as a result of these cuts.”—[Official Report, 17 October 2016; Vol. 615, c. 597.]

However, the impact assessment published by his Department just two days later described a possible scenario in which 1,000 pharmacies close. Will the Minister confirm that nobody in Britain will have to travel further to get to a chemist as a result of his cuts?

 

David Mowat

The impact assessment set out an upper range, which we do not believe represents an accurate reflection of what will happen. The facts of the matter are that we need our community pharmacy network to move towards services and away from dispensing. Paying every community pharmacy in the country, or 91% of them, £25,000 just for having an establishment does not achieve—[Interruption.]

 

Mr Speaker

Order. The hon. Member for West Ham (Lyn Brown) should not chunter from a sedentary position in an attempt to hector the Minister, who should glide seamlessly above the attempted provocation. Minister, continue.

 

David Mowat

The Minister has finished.

 

Mr Speaker

He has finished his answer. Very well; I call Alistair Burt.

 

Alistair Burt (North East Bedfordshire) (Con)

To ensure not only that unnecessary costs are reduced, but that the best community pharmacy services are provided, will the Minister do all that he can to make sure that clinical commissioning groups engage as effectively as possible with pharmacies? Preferably, that would be by getting more people on CCG boards to ensure that the crucial connection between the provision of health services and pharmacy is absolutely at the heart of what we do.

 

David Mowat

My right hon. Friend is right; CCGs are variable in the extent to which they commission pharmacy services. However, we have set out the minor ailments scheme, it will be rolled out nationally by April 2018 and we expect every CCG to take a part in it.

 

Sir Kevin Barron (Rother Valley) (Lab)

As chair of the all-party group on pharmacy, I have seen many examples of drugs that have been prescribed and not used, as I am sure we all have. Should we not renegotiate the national contract, which currently pays community pharmacies more than 90% of their income through prescribing? Surely we can do things differently.

 

David Mowat

The right hon. Gentleman rightly says that we must change the contract to move away from 90% of the income coming from dispensing. Far more must come from services, which are separately commissioned by CCGs and others. The Murray review, which he will be aware of from his work on the all-party group, sets out a road map for that, and NHS England is determined to implement it.

 

Mr Stewart Jackson (Peterborough) (Con)

May I pay tribute to the excellent work of pharmacies in my constituency? Last night, “Look East” demonstrated the pressure that urgent care centres in the east are under because of extra patient footfall. Will the Minister give me an undertaking that he will put in place guidelines to CCGs to encourage them to work much more closely with pharmacies to reduce that footfall?

 

David Mowat

My hon. Friend raises an important point, and he is right to say that we must move the community pharmacy network away from just dispensing and into services, which will include minor ailments and repeat prescriptions. I will be encouraging CCGs to do that.

 

Martyn Day (Linlithgow and East Falkirk) (SNP)

Community pharmacies, which were developed in Scotland 10 years ago, are there for minor ailment, chronic medication and public health services. Although the Minister has expressed admiration for the Scottish system, does he not recognise the need to work with the pharmacy profession to develop the full potential within community services?

 

David Mowat

I have mentioned on previous occasions that Scotland has, in some respects, gone further and faster than we have in England so far on community pharmacies. The £300 million that we have set aside in the integration fund for the rest of this Parliament is going to be used to do just the things that the hon. Gentleman has mentioned, in terms of minor ailments and repeat prescriptions. We are determined to make that happen.

 

Julie Cooper (Burnley) (Lab)

Over the festive period, in every town and city in the UK, community pharmacies will be open to dispense emergency prescriptions, and to provide specialist services and professional advice. Does the Minister appreciate that service, which not only helps the public, but takes pressure off other parts of the NHS? Will he join me in thanking community pharmacies and their staff for the work they do? Will he commit to reconsider budget cuts that will lead to a reduction of this valuable service, and instead meet the Royal Pharmaceutical Society and the National Pharmacy Association to discuss extending the role of community pharmacies, to deliver savings for the NHS?

 

David Mowat

I have met the royal college of pharmacies on a number of occasions, and indeed it has worked with us on the Murray review, which is an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well. I agree with the hon. Lady that the 11,000 community pharmacies across the country all provide excellent services, and we expect that to continue.

 

Full Coverage

Big pharma braces for further bruising publicity over drug prices

Financial Times, David Crow, 18 December 2016

 

Pharmaceutical executives are steeling themselves for 2017 to be another year defined by public outcry over the price of drugs, even as some investors bask in Donald Trump’s election victory.

 

The issue of high drug prices was never far from the headlines during the presidential campaign and shareholders had feared a victorious Hillary Clinton would implement policies to curb the cost of medicines.

 

Price controls would have crimped industry profits in the US, the world’s largest and most profitable healthcare market: Mrs Clinton’s loss was pharma’s gain or so the theory went.

 

But some executives insist it is too soon for relief and many are predicting another 12 months of bruising publicity over the price of medicines.

 

“I don’t think this election changes a thing,” says Dr Steve Miller, chief medical officer of Express Scripts, a pharmacy benefits manager that negotiates drug prices on behalf of US employers and health insurers.

 

“Trump has been a populist — if a company does something irresponsible, I don’t think he’s going to stand on the sidelines,” adds Dr Miller. “It is premature for the industry to relax and celebrate because drug prices are still going to be an enormous issue next year.”

 

Mr Trump has pledged to lower the price of medicines. “I’m going to bring down drug prices,” he told Time earlier this month, as the magazine named him person of the year. “I don’t like what’s happened with drug prices.”

 

His comments knocked roughly 3 per cent off biotech stocks, but they recovered in the following days, in a sign that investors are relatively sanguine about the threat.

 

Brent Saunders, chief executive of Allergan, best known for its Botox wrinkle treatment, says Republican dominance in Washington augurs well for the sector because the party is less inclined to introduce new regulations.

 

But he warns it would be foolish for pharma companies to cling to the pricing policies that landed the industry with such a toxic reputation. “We shouldn’t make the mistake of believing they will allow egregious behaviour to continue.”

 

Rather, he urges rival executives to use Mr Trump’s victory as an opportunity to police themselves. “I think if we self-regulate and stop doing these big double-digit price increases, we will be in a much stronger position.”

 

In September, Allergan became the first company to publish what it called a social contract with its patients, pledging to refrain from raising prices more than once a year and to limit any increases to low, single-digit percentages.

 

Since then, others have followed suit. Novo Nordisk, the diabetes specialist, said it would not increase its prices by more than 10 per cent a year.

 

Last week, Eli Lilly launched a scheme to shield some diabetes patients from high prices. It said it would discount the list price of its insulins by up to 40 per cent for those who have to pay for drugs out of their own pocket.

 

The Eli Lilly scheme is designed to tackle a flaw in the way US drugs are priced.

 

Although list prices are continuing to rise sharply, pharmacy benefit managers have started to extract larger discounts and rebates, meaning the real price received by the manufacturer is lower.

 

In 2016, the list price of drugs rose by between 6 and 7 per cent, but net price inflation — after all the discounts were subtracted — was lower, at between 2 and 3 per cent, according to QuintilesIMS, the research group.

 

On the face of it, the market is functioning as it should. Pharmacy benefit managers amass big groups of patients — 85m in the case of Express Scripts — and use their clout to extract large savings from drug companies, which they pass on to their clients: employers and health insurers.

 

 

Theoretically, it should result in lower premiums for consumers.

 

But in fact it has resulted in much higher costs for patients because their “out-of-pocket” expense is still calculated using the list price, rather than the net price.

 

This is particularly hard on those without insurance who buy their medication with cash and those with “high-deductible” policies, who have to shell out thousands of dollars on medicines before their insurer picks up the burden.

 

An increasing number of Americans fall into this trap, either because they have bought cheaper policies on the Obamacare exchanges or because their employers have switched them to less generous plans to save costs.

 

Ronny Gal, analyst at Bernstein, estimates that roughly 50 per cent of US patients will be exposed to a high-deductible plan in 2017.

 

Most high-deductible plans have a set amount — $5,000, for instance — that a patient must pay for medicines before their insurance kicks in. In the majority of cases the threshold is reset in January, meaning many families are about to see a big spike in their drug costs.

 

Soaring family bills will only deepen anger against the drugs industry, and politicians and reporters are ready to pounce on any egregious examples.

 

“With the media’s attention on this topic primed from 2016, [a pharma company] will likely end up in the wood-chipper,” predicts Mr Gal.

 

The potential time-bomb explains the trickle of drugmakers putting policies in place to defend themselves against accusations of price gouging.

 

Yet there is disagreement within the industry over whether specific policies and promises are the best way to deal with the debate over pricing. Merck, the third-largest US drugmaker by market value, has declined to publish its own pledge.

 

“We’ve had a very disciplined approach to pricing for years,” says Ken Frazier, chief executive of Merck. “We haven’t decided to come out with a big PR blitz. I think actions speak louder than words in this area and Merck has a track record of trying to be a responsible company.”

 

Mr Frazier wants to shift the focus from the price of drugs to the ballooning cost of healthcare in general. He cites Keytruda, his company’s revolutionary “immunotherapy” drug, which can significantly extend the lives of some of the sickest cancer patients. It costs roughly $150,000 a year.

 

“If you take a 45-year-old diagnosed with lung cancer, how much is that going to cost society from that point until a person dies?” he asks, pointing to the huge expenses associated with hospitalisation and end-of-life care.

 

“It’s going to be a lot more than this drug,” he says.

 

Generic drug prices under the microscope

 

The best tonic for the soaring price of prescription medicines is generic drugs. When a branded medicine loses patent protection, cheaper copycat versions are supposed to flood the market and reduce the price of a pill to just a few pennies.

 

However, drugmakers are facing accusations that they are manipulating the generics market to keep prices artificially high. On Friday, Actavis was accused of charging the NHS “excessive” price increases for generic hydrocortisone tablets.

 

The UK Competition and Markets Authority said the company, owned by Teva, the world’s largest generic drugmaker by volume, had raised the price of the tablets by more than 12,000 per cent since 2008, from 70p to £88.

 

It comes just a week after Pfizer was fined a record £84m for charging excessive prices for a drug to treat epilepsy. As with Actavis, the CMA said Pfizer had exploited a loophole for generic treatments, which are not subject to price regulation in the UK.

 

In the US, the majority of generic drugmakers are co-operating with a federal investigation into whether they colluded to keep prices high. Last week, the first criminal charges were brought against former executives at a relatively small drugmaker, Heritage Pharmaceuticals.

 

Larger names, such as Teva and Mylan, are still co-operating with the antitrust probe. And last week 20 states filed a lawsuit accusing Teva and Mylan — and four other generic drugmakers — of illegally fixing prices.

Lib Dems slam pharmacy cuts and call for cross-party commission

15 November 2016, Pharmacy Business, Neil Trainis

 

A Liberal Democrat MP, Tom Brake, led a public meeting of constituents where he called for a cross-party commission to ensure the NHS is properly funded. Tom Brake made it clear that although the pharmacy funding cuts are designed to generate efficiency savings within the NHS, the cuts will only add to the burden of the health service during the winter period. Dr Brendan Hudson, Chair of Sutton Clinical Commissioning Group, made it clear that he agrees with the rhetoric of Liberal Democrat Health Spokesperson, Norman Lamb who also believes the NHS needs to be stabilised by a cross- party commission to prevent it being used for political gain.

 

UK drug funding framework needs an overhaul to ensure the right areas are being prioritised

15 November 2016, The Pharmaceutical Journal, David Webb & Ken Paterson

 

David Webb, President of the British Pharmaceutical Society and Ken Paterson, Former Chair of the Scottish Medicines Consortium, have expressed their belief that it is time to review the current drug funding framework due to the rising cost of medicines in the pipeline coupled with increasing financial pressure on the NHS. They believe that it is important to include the wider UK public in discussion around the future priorities for the NHS. They warn that with the 20th anniversary of NICE conducting health technology assessments approaching it is time for the UK’s healthcare funding bodies to make a collective and informed decision about which health problems to prioritise based on what the UK population values.

 

November 2016 Price Concessions/NCSO

15 November 2016, PSNC

The Department of Health have granted the following price concessions for November 2016:

Drug Pack size Price concession
Amitriptyline 50mg tablets 28 £3.25
Bumetanide 1mg tablets 28 £1.95
Candesartan 2mg tablets 7 £2.25
Dapsone 50mg tablets 28 £46.19
Desmopressin 10micrograms/dose nasal spray 60 dose £23.49
Exemestane 25mg tablets 30 £9.60
Flecainide 100mg  tablets 60 £10.93
Flecainide 50mg  tablets 60 £10.70
Fludroxycortide 4mcg/sq cm tape 7.5cm 20 £12.49
Leflunomide 20mg tablets 30 £10.99
Lorazepam 1mg tablets 28 £6.05
Lorazepam 2.5mg tablets 28 £12.50
Metronidazole 400mg tablets 21 £7.88
Naratriptan 2.5mg tablets 6 £24.55
Nitrofurantoin 100mg tablets 28 £14.02
Nitrofurantoin 50mg tablets 28 £16.00
Ropinirole 0.25mg tablets 12 £4.50
Ropinirole 0.5mg tablets 28 £14.85
Ropinirole 1mg tablets 84 £56.71
Ropinirole 2mg tablets 28 £31.51
Trospium Chloride 20mg tablets 60 £15.47
Valsartan 160mg capsules 28 £5.30

No endorsements are required as these prices will automatically be applied to this month’s prescriptions.

 

When any NCSO or price concession announcements are made, these appear on the Generic Shortages page (psnc.org.uk/ncso) and are emailed to those subscribed to this mailing list.

 

Parliamentary Coverage

House of Commons Tabled Written Questions, Department of Health, 15 November 2016

Health

 

Crispin Blunt: To ask the Secretary of State for Health, what discussions he has had on enhancing consultation with and involvement of Pharmaceutical Price Regulation in the preparation and conduct of the forthcoming negotiations on the next such Scheme, in particular industry bodies representing companies directly affected through their participation in the Scheme.

 

###

 

Jonathan Ashworth: To ask the Secretary of State for Health, what assessment he has made of the effect of recent currency exchange rate changes on the import costs of (a) medicines and (b) equipment for the NHS.

 

###

 

Jim Shannon: To ask the Secretary of State for Health, how much the NHS spent on branded drugs after the rebate from the Pharmaceutical Price Regulation Scheme as a proportion of total expenditure in (a) 2010-11 and (b) 2015-16.

 

Full Coverage

Lib Dems slam pharmacy cuts and call for cross-party commission

15 November 2016, Pharmacy Business, Neil Trainis

 

The Liberal Democrats added their voice to the growing swell of discontent at the government’s decision to cut community pharmacy’s funding during a public meeting of constituents which produced strong condemnation of the measures.

 

The meeting was led by Tom Brake, the Lib Dem MP for Carshalton and Wallington, who accused the Conservatives of being “happy to cut off their nose to spite their face” over cuts which are designed to generate efficiency savings in the NHS but which the pharmacy profession feels will only add to the burden faced by a health service under extreme pressure.

 

Brake also called for the establishment of a cross-party commission to ensure the NHS is properly funded.

 

Local residents expressed their feelings about the cuts during the meeting which was also attended by Councillor Simon Wales, the deputy leader of Sutton Council, Dr Brendan Hudson, chair of Sutton Clinical Commissioning Group and Renna Barai, an award-winning pharmacist who runs a pharmacy in Sutton.

 

“These changes are nothing more than a backdoor health cut from the government. We must stand up and let the Conservative government know that these pharmacies provide a vital service in our community and we will not allow them to be heartlessly cut,” Brake said.

 

“The cuts are due to be made right at the start of winter, at a time when doctors surgeries will already be feeling the strain. The Conservatives are happy to cut off their nose to spite their face and are showing no regard for the kind of joined-up thinking that our NHS needs.

 

“In fact, the government has not carried out an impact assessment, so the government is ordering funding cuts, without knowing which pharmacies may close, how many patients will be affected or the number of people who will lose their jobs.

 

“I am in agreement with Liberal Democrat Health Spokesperson Norman Lamb when he says that we need a new deal for the NHS. It is time to stop using our health service as a political football and to establish a cross-party commission to ensure the NHS gets the funding it needs.”

 

Barai said: “It won’t be big businesses that feel these cuts the hardest – it will be small businesses in our area; businesses that will no longer be able to afford the same level of highly-skilled staff, or that will have to start finding other ways to cope, which can only mean a reduced service for patients.

 

“Community pharmacies are a local lifeline in the NHS yet the Department of Health has made it clear that they do not see this value.

 

“These plans will increase pressure on already-overburdened NHS services locally and with GP surgeries, doctors and nurses and A&E departments all overstretched, we surely should not be closing our pharmacies but rather using them more than ever.”

 

The cuts, due to start on December 1, could force many community pharmacies, including those in Sutton which contains areas of deprivation, to cut back on their services and staff and even close.

 

UK drug funding framework needs an overhaul to ensure the right areas are being prioritised

15 November 2016, The Pharmaceutical Journal, David Webb & Ken Paterson

 

If the NHS is to get value for money from medicines, it needs to consider what the UK population values and where its priorities lie.

 

The National Institute for Health and Care Excellence (NICE) in England, the Scottish Medicines Consortium (SMC) and the All-Wales Medicines Strategy Group (AWMSG) are each charged with making recommendations on which new medicines to fund in their respective countries. Many experienced pharmacists, doctors and other healthcare professionals are involved in and commit time to these processes. All three bodies are highly regarded internationally for the quality and rigour of their work, and all use similar methods to assess the clinical and economic evidence for a medicine in order to reach a conclusion on its value. Yet when these agencies choose not to recommend funding for a medicine, the decision can be met with widespread dissatisfaction from the pharmaceutical industry, healthcare professionals, patient advocacy groups and even politicians. It is obvious that any decision not to fund a new medicine will be unpopular with those directly affected, but the criticism often implies that the fundamental assessment of value is flawed.

 

This is because the underlying decision-making framework is based on many untested assumptions about what members of society value. It is not the exclusive role of clinical experts to set this framework, it is a collective responsibility as citizens and current or future patients. We need to come together for some difficult conversations.

 

Value for money

 

Although often accused of being focused purely on cost-containment and the affordability of new medicines, NICE, the SMC and the AWMSG are, in fact, primarily interested in value-for-money, as opposed to total costs. They weigh up the clinical benefits of new medicines against their costs, assessing their cost effectiveness to make sure that money is spent wisely and efficiently. These decisions are important because annual budgets in the NHS are limited. Any money spent unwisely or inefficiently will lead to other treatments of proven benefit not being provided, known as the opportunity cost of the use of a new medicine. Of course, if the NHS was allocated more money it would be able to make available more options and treatments, but there will always be a budget limit. It will never be possible to fund every treatment and so there will always be a requirement to use funding to the greatest effect.

 

The opportunity cost becomes more of an issue when the total cost of a new medicine is high. Until recently total cost was rarely an issue for the NHS. However, recent examples of medicines to treat hepatitis C and for pre-exposure prophylaxis of HIV infection have created situations where medicines appear to offer value for money but the NHS cannot always afford to pay for all eligible patients to access them. They are cost-effective interventions that may not be affordable. This throws the question of societal values into sharp relief: we must help the NHS decide how to evaluate and where to incur the opportunity costs. Who do we want to benefit from new medicines, and what health benefits are we willing to sacrifice in order to achieve this?

 

Singling out certain diseases

 

NICE, the SMC and the AWMSG work from the principle that UK society wishes to derive benefits from new medicines equally across the population, with no discrimination in favour of, or against, any group of patients. For example, improved health in older patients is valued as much as in younger patients, prevention of illness is as highly valued as its treatment, and no disease areas are regarded as more or less worthy of treatment than others. Although this approach is highly equitable, and completely defensible, it is the very decisions made within this framework that come in for criticism.

 

The framework itself is rarely formally questioned, but some workarounds have arisen that cast doubt on the underlying principles involved. In 2008, the health secretary John Reid asked NICE to adopt a more generous approach to ‘end-of-life’ medicines, implicitly valuing the health benefits of these medicines more highly than similar benefits from medicines used earlier in the course of a disease [1]. The Cancer Drugs Fund in England makes medicines available that have not met the cost-effectiveness criteria during NICE assessment, potentially displacing treatments that are more cost-effective [2]. As the name suggests, it is restricted to cancer medicines, implying that these are a ‘special case’ and worthy of exceptional funding not available in other diseases, even those, such as heart failure, with similarly poor outcomes. The SMC has a Patient and Clinician Engagement process that is applied to medicines for rare diseases (orphan diseases or equivalent), again making these conditions a ‘special case’ [3]. The possible ‘ethical imperative’ of aiming to provide treatment where there are no other options (sometimes known as the ‘rule of rescue’) may come into play in these situations.

 

However, the justification for singling out certain diseases or clinical situations is often not based on a clear rationale. These processes have generally come about because of external pressures on the assessment organisations resulting from adverse publicity that has been triggered by individual decisions. There has been tacit acceptance that the changes made match the views of UK society, yet there has been no exploration of whether that is, in fact, the case. The limited evidence that there is[4] suggests that the general public do not favour cancer over other diseases, end-of-life treatments over other interventions[5],[6], or place a higher value on medicines for rare diseases, but the issues have barely been defined or discussed. NICE has undertaken some work in this area with its Citizens’ Council, looking at, for instance, the issues surrounding medicines for orphan diseases, but no clear conclusions emerged to inform real-life decision-making [7].

 

Review funding framework

 

Newer and more expensive medicines in the pipeline, coupled with increasing financial pressures within the NHS, mean that it’s the right time to look at the fundamentals of decision-making around funding of new medicines. The clinical specialists who participate in the work of NICE, the SMC and the AWMSG are highly skilled and experienced in assessing the clinical value and cost-effectiveness of medicines, but are not well placed to assess the views of UK society on where and how limited resources should be spent. Their assessment skills and real world insights will remain essential, but the final call will be influenced by the decision-making framework in which they operate, a framework that society needs to develop. If the deliberations of NICE, the SMC and the AWMSG lead to decisions that society believes are wrong, then maligning the bodies themselves, or their individual members, will not lead to different outcomes unless the context for their deliberations is altered.

 

There is a need to involve the wider UK public in discussions around priorities for the healthcare system, especially in the field of new medicines. Wider and more detailed research into the preferences of society is needed, with a view to incorporating the outcomes of that research into revised processes for the assessment bodies based on objective evidence of societal views. Approaches such as discrete choice experiments [8], where members of the public are asked to express a preference between two or more options and do this for multiple sets of options, allow assessment of the decision-making framework of each individual, and can be combined to gauge the view of wider society.

 

Other methodologies can be[9], and have been[10], used but none has yet achieved widespread acceptance and all have, to date, had little influence on the decision-making framework of the medicines assessment agencies. The limited experience of NICE’s Citizens’ Council has shown the difficulties that can arise — whether in achieving consensus or even clarity of opinion — but the present situation is far from ideal so new thinking is urgently needed.

 

Rather than expedient workarounds with no evidence base of their impact or societal preference, we need this detailed assessment of the views of the UK public followed by a rational debate about where NHS medicines expenditure should be focused. These will be difficult discussions involving many stakeholders – current patients, the wider public (who are all ‘future patients’), ethicists, academics in social sciences and health economics, clinicians, those actively involved in medicines assessment and the pharmaceutical industry all have legitimate interests and need to participate. As we look ahead to the 20th anniversary of NICE conducting health technology assessments, we must decide collectively which health problems to prioritise in order to provide an evidence base for future decision-making.

The Department of Health has announced a new 2 year funding package for community pharmacy. Read the Government’s full plans here: ‘New plans to modernise community pharmacies’ and here: Community pharmacy reforms.

The parliamentary debate on the announcement can be found here.

Government imposes community pharmacy funding reduction
20 October 2016, PSNC

The Government has announced a 2 year funding package for community pharmacy. The package will see contractors funding cut by 12% from December in comparison to current funding levels. Sue Sharpe, the Chief Executive of PSNC made a statement in response to the announcement. She made it clear that the PSNC could not accept a funding package that had potentially damaging consequences for the sector. Miss Sharpe highlighted that although pharmacy closures will not occur immediately the cuts may result in the reduction of services community pharmacies can offer as owners are forced to reduce costs. The PSNC argues that the NHS relies on community pharmacies to relieve pressure on their services, especially in the winter months. There is now a concern that community pharmacies will no longer have the capacity to provide such services and there will be repercussions for the entire health system.

Why the justification for the cuts is ‘complete nonsense’
20 October 2016, Chemist & Druggist, James Waldron

The Government has announced a funding cuts package for community pharmacy at the same time as announcing a new role for community pharmacy in the emergency supply of medicines. The National Pharmacy Association (NPA) branded the emergency supply care role as a smoke screen for the proposal of the funding cuts. The Department of Health told Chemist & Druggist last week that the funding cuts package should be considered in the context of the Government’s ambition to invest a total of £112 million to create a further 1,500 GP pharmacists by 2020. However, James Waldron, Editor of Chemist & Druggist, highlighted that giving GP’s greater access to pharmacists does not balance out the loss of community pharmacies that will be forced to close across the country as a result of the cuts to funding.

Pharmacy plan ‘could lead to High Street closures’
20 October 2016, BBC News, Nick Triggle

The new pharmacy funding package, due to be implemented from December 2016, places a larger emphasis on performance- related funding than the current system. The pharmacy industry has been lobbying the Government, warning them that the newly announced cuts would be damaging to the capacity of A&E departments and GP surgeries.

NHS pharmacy cuts: Tory ministers accused of piling even more pressure on A&Es
20 October 2016, The Independent, Rob Merrick

Ministers from the Department of Health have been accused of creating more pressure for GP surgeries and A&E departments in England as a result of cuts to community pharmacy. Opposition parties to the cuts have warned that they could result in the closure of hundreds of vital community pharmacies across the country. Norman Lamb, the Liberal Democrat Health Spokesman, has said that the reductions are a false economy as cutting funding for community pharmacies will not improve their efficiency. He stressed that the funding cuts will increase pressure on GP surgeries and hospitals that already have limited resources.

The pharmacy cuts coverage was also reported by the ITV NewsPharmaceutical Journal, the PharmaTimesPharmacy Business and P3 Pharmacy (here and here)

The National Pharmacy Association and the Pharmacy Voice (reported here and here) have commented on the imposition of the cuts.

Establishment payments to plummet 20% from December
20 October 2016, Chemist & Druggist, Annabelle Collins

The Department of Health has announced that established payments for community pharmacies in England will drop by 20% from December. From April 2017 these payments will be reduced by a further 40% from their current levels. Community pharmacies receive established payments if they dispense over 2,500 prescriptions a month, however the Government has announced intentions to phase out these payments over the coming years.

DH publishes pharmacy access scheme details
20 October 2016, Dispensing Doctors Association, Alisa Colquhoun

The Department of Health published the details of the new Pharmacy Access Scheme (PhAS). The PhAS means that pharmacies run by GP practices will receive fewer cuts to their funding. The scheme also means that pharmacies dispensing up to 109,012 prescriptions a year and if they are located at least one mile away from its nearest competition will make a smaller efficiency saving than other pharmacies. These PhAS concessions will continue monthly until the payment for March 2018. NHS community pharmacy funding and PhAS beyond March 2018 will be subject to further consultation. From December 2016 any pharmacies in England that do meet the eligibility criteria for PhAS will be subject to the pharmacy funding cuts announced by the Department of Health on October 20th 2016.

This was also reported by Pharmacy Voice

Brexit will increase drugs shortages and lower value of parallel imports
20 October 2016, Pharmacy Business, Neil Trainis

Rajiv Shah, the Director of Sigma Pharmaceuticals, has warned that one of the implications of Brexit will be a resultant increase in drug shortages in the UK. He explains that Brexit may complicate the process of medicine distribution throughout the UK. He goes on to warn that importation and exportation levies being placed on UK companies will cause inflated drug prices and ultimately increase the likelihood of drug shortages. Shah also explains that a weakened pound will result in a 40-50% drop in the value of parallel imported products.

 

October 2016 Price Concessions

20 October 2016, PSNC

 

The Department of Health has granted the following price concessions for October 2016:

The price concession only applies to the month that it is granted.

Drug Pack size Price concession
Amitriptyline 50mg tablets 28 £3.25
Bumetanide 1mg tablets 28 £2.10
Dapsone 50mg tablets 28 £46.19
Lamotrigine 5mg dispersible tablets sugar free 28 £7.45
Leflunomide 20mg tablets 30 £5.10
Lorazepam 1mg tablets 28 £6.25
Metronidazole 400mg tablets 21 £8.00
Naratriptan 2.5mg tablets 6 £24.55
Nitrofurantoin 100mg tablets 28 £14.02
Nitrofurantoin 50mg tablets 28 £16.00
Ropinirole 0.5mg tablets 28 £14.85
Ropinirole 1mg tablets 84 £56.71
Valsartan 160mg capsules 28 £5.30
Valsartan 80mg capsules 28 £4.14
Valsartan 40mg capsules 28 £4.90

Please note negotiations are still ongoing regarding a number of products.

No endorsements are required as these prices will automatically be applied to this month’s prescriptions.

When any NCSO or price concession announcements are made, these appear on the Generic Shortages page (psnc.org.uk/ncso) and are emailed to those subscribed to this mailing list.

 

Parliamentary Coverage

 

The Government has announced a new 2 year funding package for community pharamcy. Read the Government’s full plans here: ‘New plans to modernise community pharmacies’ and here: Community pharmacy reforms

The parliamentary debate on the announcement can be found here.

House of Commons Written Questions; Pharmacy: Finance, 20 October 2016
Health

Ben Howlett: 
What assessment he has made of the potential effect of reductions in pharmacy funding on the availability of essential medicines.

Department of Health

David Mowat:

The Government’s proposals for community pharmacy in 2016/17 and beyond, on which we have consulted, are being considered against the public sector equality duty, the family test and the relevant duties of my Rt. hon. Friend, the Secretary of State for Health, under the National Health Service Act 2006.

Our assessments include consideration of the potential impacts on the adequate provision of NHS pharmaceutical services, including the dispensing of prescriptions and supply of medicines.

An impact assessment will be completed to inform final decisions and published in due course.

Our proposals are about improving services for patients and the public and securing efficiencies and savings. We believe these efficiencies can be made within community pharmacy without compromising the quality of services or public access to them.

Our aim is to ensure that those community pharmacies upon which people depend continue to thrive. We are consulting on the introduction of a Pharmacy Access Scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population.

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House of Commons Written Questions; Pharmacy: Finance, 20 October 2016
Health

Derek Thomas: 
What estimate he has made of the effect on the number of community pharmacies of proposed changes to pharmacy funding.

Department of Health

David Mowat:

Community pharmacy is a vital part of the National Health Service and can play an even greater role. In the Spending Review the Government re-affirmed the need for the NHS to deliver £22 billion in efficiency savings by 2020/21 as set out in the NHS’s own plan, the Five Year Forward View. Community pharmacy is a core part of NHS primary care and has an important contribution to make as the NHS rises to these challenges. The Government believes efficiencies can be made without compromising the quality of services including public access to medicines. Our aim is to ensure that those community pharmacies upon which people depend continue to thrive and so we have consulted on the introduction of a Pharmacy Access Scheme, which will provide more NHS funds to certain pharmacies compared to others, considering factors such as location and the health needs of the local population.

Our proposals are about improving services for patients and the public and securing efficiencies and savings. A consequence may be the closure of some pharmacies but that is not our aim.

 

Full Coverage

 

Government imposes community pharmacy funding reduction

20 October 2016, PSNC

The Government has imposed a two-year funding package on community pharmacy, with a £113 million reduction in funding in 2016/17.

This will take total funding to £2.687 billion for this financial year. This is a reduction of 4% compared with last year, but it will mean that contractors will see their funding for December 2016 to March 2017 fall by an average of 12% compared with current levels.

This will be followed by a reduction in 2017/18 to £2.592 billion for the financial year, which will see funding levels from April 2017 drop by around 7.5% compared with current levels.

Read the Government documents outlining the package, including their impact assessment and a list of pharmacies eligible for the Pharmacy Access Scheme, here.

PSNC has published indicative income tables to help contractors to predict the impact on their businesses.

As part of the package the Department of Health (DH) will make changes to the way in which funding is distributed, introducing quality payments and a Pharmacy Access Scheme (PhAS).

Further information on these and on which pharmacies will be eligible for the payments is outlined in PSNC Briefing 057/16: Information for Contractors.

The Government has also recently announced a pharmacy urgent repeat medicines supply pilot along with plans to refer NHS 111 callers with minor ailments to pharmacies. The service specification for this is still under discussion but further details are also available in PSNC Briefing 057/16: Information for Contractors.

The imposition, which was announced by minister David Mowat in Parliament today (October 20th), comes after PSNC unanimously rejected the package last week.

Statement from PSNC Chief Executive Sue Sharpe

Today’s news is extremely disappointing but does not come as a surprise; it became apparent some time ago that the Government was unshaken in its determination to make a massive cut to community pharmacy funding by reducing fees and allowances. Indeed, it has been clear in both the wording of the original letter sent on December 17th and in our discussions with the Government and NHS since then that there was to be no genuine consultation on the total funding sum.

PSNC could not accept a funding offer which was damaging to the sector and which will adversely affect the ability of pharmacies to provide patient care.

In response to the consultation on changes to community pharmacy, PSNC set out the need for the Government to make decisions about community pharmacy services based on a number of principles that put the needs of patients and communities, as well as evidence, at the heart of the process.

Sadly, this has not been the case, and we are instead now seeing the implementation of a decision for which no evidence has been produced and which many people, including patient and GP groups, have warned will have a detrimental effect on patient care and lead to further pressure on other healthcare services. This is a short-sighted and ill-judged approach to take, particularly when alternative constructive proposals that would address the need for the NHS to make cash savings have been put forward by PSNC.

It is a sad reflection on the NHS on which we all rely to see it taking such a rash decision with so little justification. But this is not the first time that we have seen decisions that do not seem to be in the best interest of patients or the NHS being made. NHS England’s decision to walk away from commissioning a Minor Ailments Advice Service last summer was damaging to the NHS and to patients. Such decisions call into question the judgement of those in control of community pharmacy policy.

In the past PSNC was able to have constructive negotiations with the NHS based on a mutual desire for community pharmacy to be commissioned and funded to deliver the best possible service for patients and local communities. These conversations were based on trust and respect that we had built up with policy makers over many years. It is very sad that real consultation with us has now been abandoned, and the approach through the last six months has instead been of an entirely different character; “we can do it, so we will do it”, seems to be the mantra. The lack of real consultation and clarity has been a common theme throughout the consultation period.

PSNC will study the Government’s decision carefully to inform our own decisions about next steps.

The funding cut, combined with the previously announced reductions to Category M prices following a significant over-delivery of margin last year, will have a significant and negative impact on contractors’ businesses. We would strongly advise contractors to make whatever provisions they can for the funding reductions. These will be very challenging times.

PSNC remains keen to work with the NHS on changes to the Community Pharmacy Contractual Framework that will allow the development of clinical community pharmacy services so that patients and the NHS can get the most benefit and best value from community pharmacy.
Pharmacy closures

Although we are unlikely to see pharmacies closing immediately, we expect that pharmacy owners will be forced to take steps to reduce costs. These are likely to include reducing opening hours and staffing, and stopping the provision of services which they are not obliged to provide, such as home delivery of medicines and the supply of medicines in compliance aids. We are very concerned about the impact that this will have on patients.

We will encourage LPCs and contractors to get together to consider how they can ensure vital local services are maintained. They may need to approach local commissioners to seek funding for services where they are not able to cover their costs.

Impact on patients

Pharmacies have always met demands for help from their patients, particularly in the winter, acting to relieve pressure on other NHS providers. They have done this readily and willingly, but as they are forced to review their operating costs and consider staff cuts, patients may find that they have to wait longer to receive advice that would previously have been readily available. The NHS must recognise this as winter pressures set in and it turns as usual to pharmacy for help.

The Pharmacy Integration Fund

While we are pleased that NHS England has been able to find £42 million over the next two years to support integration, we strongly believe that this should be spent on supporting national community pharmacy services that will better help patients and reduce demand elsewhere on the NHS and will be seeking clarity about how it will be allocated.

Impact on other NHS services

Lots of big policies could be railroaded by these community pharmacy proposals, for instance if social care cannot cope with the increase in people left without support, there could for example, be a rise in hospital admissions. The removal of Establishment Payments will target for the greatest cuts the low dispensing volume pharmacies in areas with the highest health needs. They would see fee income reduced by around 20% next year, at a time when the NHS has said that efficiency targets of 4% are too high to be achievable, and has reduced targets to 2%.

Why the justification for the cuts is ‘complete nonsense’
20 October 2016, Chemist & Druggist, James Waldron

James Waldron questions if any scheme to promote community pharmacy’s emergency supply role will be undermined by the cuts.

They say a week is a long time in politics, but recently it’s felt like that’s just as true for pharmacy.

A quick recap for those of you who haven’t been glued to the C+D website over the last 10 days: On October 13, pharmacy minister David Mowat announced schemes to promote the sector’s urgent repeat supply and minor ailments roles. But community pharmacists barely had time to react before the Pharmaceutical Services Negotiating Committee dropped the bombshell everyone was fearing: the government is planning to bulldoze ahead with its funding cut in England – which will now amount to a 12% drop for December to March, followed by a further cut for 2017-18.

As I write this, official details of how this funding plan will be implemented remain scarce. But a leaked document suggests a promised “access fund” – designed to offer protection from the cuts for the most-needed pharmacies – will benefit just one in 10 businesses.

The only glimmer of hope: the Department of Health (DH) has exclusively told C+D that a “final decision” on the cuts has still not been made. This lent an added urgency to attempts by pharmacy’s political champions to press the minister to reconsider. But in an autumn that has already seen both Mr Mowat and NHS England chief executive Simon Stevens insist the sector must share the burden of the health service’s £22 billion savings, the outlook is bleak.

A deeper concern is the lack of a coherent policy behind these announcements. Surely any scheme to promote community pharmacy’s emergency supply role – which the National Pharmacy Association rightly branded a “smoke screen” for the cuts – will be undermined if pharmacies are forced to close?

If alarm bells weren’t already ringing, the DH told C+D last week that the funding cut should be seen in the context of its ambition to “invest £112 million to deliver a further 1,500 pharmacists in general practice by 2020”. In the words of one C+D reader, this justification is “complete nonsense”. While there are many benefits to giving GP practices greater access to pharmacists’ expertise, even its most vocal proponents have not suggested that this scheme would be a replacement for community pharmacies closing across the country.

Either the government doesn’t understand the difference, or it doesn’t care. At this stage, I honestly don’t know what is more worrying.

Pharmacy plan ‘could lead to High Street closures’
20 October 2016, BBC News, Nick Triggle

Thousands of High Street pharmacies in England could face closure after ministers confirmed plans to alter the funding system and make cuts.

The Department of Health said it wanted to reduce the £2.8bn a year pharmacy bill by more than £200m over the next two years.

It has been suggested cuts on this scale could lead to up to 3,000 of the 11,700 pharmacies being closed.

Currently, the average pharmacy receives £220,000 a year from the NHS.

This accounts for between 80% and 90% of their income and includes a flat rate of £25,000, which nearly all pharmacies receive.

The changes being announced scrap that and put much more emphasis on performance-related funding, with ministers understood to see the current system as outdated and inefficient.

‘Damaging cuts’

Figures previously provided by the Department of Health – it has been looking into the issue for some months – suggested the number of pharmacies had increased by a fifth in the past 12 years.

And it has said about 40% of community pharmacies are found in clusters – with three or more within 10 minutes’ walk of each other.

The pharmacy industry has been lobbying ministers in recent months, warning the move could put more pressure on GPs and accident and emergency departments, as pharmacists provide advice and support to patients.

But Health Minister David Mowat said the government had decided to press on despite these protests, as the current system was not the best use of “valuable” NHS resources.

“Far from jeopardising services, our modernisation package will help improve them,” he added.

He said special funds would be set up to support pharmacies in isolated areas and to help set up more in GP surgeries and hospitals, which would be “more convenient” for patients.

Ministers believe these two measures will help offset the closure of High Street pharmacies – it expects another 1,500 GP surgeries will have in-house pharmacists by 2020. These are much cheaper to run.

But Sandra Gidley, of the Royal Pharmaceutical Society, said she was “deeply disappointed”.

“We fear for patients, the public and pharmacists who may be significantly affected by changes in opening hours and staffing levels in community pharmacy, as well as the knock on impact on already pressured GP and A&E NHS care.”

And Shadow Health Secretary Barbara Keeley said the move would be “damaging” and lead to increased demand on the health service as well as pharmacies.

“The government’s plans are not only deeply unpopular, they are short-sighted and they will hit areas with the greatest health inequalities hardest,” she added.

NHS pharmacy cuts: Tory ministers accused of piling even more pressure on A&Es
20 October 2016, The Independent, Rob Merrick

Ministers were accused of piling more pressure on overcrowded GP surgeries and A&E departments after announcing cuts to pharmacies.

Opposition parties attacked the announcement that more than seven per cent will be slashed from funding for community pharmacies over the next two years, after weeks of speculation.

They said the reductions could trigger the closure of hundreds, if not thousands, of badly-needed high street pharmacies and were a “false economy”.

There was also anger that health minister David Mowat was unable to say how many would be sent to the wall – even claiming it was possible that none would shut.

Norman Lamb, the Liberal Democrat health spokesman, said: “The Government’s belief that cutting funding for community pharmacies will improve efficiency in the NHS is a complete false economy.

“These myopic plans will further increase pressure on GP surgeries and hospitals that are already buckling under the strain of limited resources and unprecedented demand for services.

“More people will be forced to take unnecessary trips to their GP and even A&E, which is completely counter to NHS England’s vision.”

The Government has previously suggested that up to 3,000 pharmacies could close as a result of funding cuts.

But, today, Mr Mowat accused critics of “scaremongering”, saying: “It’s possible that none will close, I do not believe 3,000 will close.

“But I would say this – the average operating margin that a pharmacy makes is 15 per cent. That is after salaries and after rent.

“The cuts we’re making, or the efficiencies we’re asking for, is significantly lower than that.”

The announcement will see chemists will lose four per cent of their funding in 2016-17 and a further 3.4 per cent in 2017-18.

Former Conservative minister Michael Gove said: “Can I congratulate the minister for recognising what Labour failed to – that NHS money is taxpayers’ money and the priority should always be patient care, not the profits of private equity firms.”

Establishment payments to plummet 20% from December
20 October 2016, Chemist & Druggist, Annabelle Collins

Establishment payments for pharmacies in England will drop 20% from December, the government has announced.

This will amount to £419 less a month for pharmacies which currently receive the highest monthly payment of £2,092, the Department of Health (DH) said in a document released today (October 20).

The payments will fall by a further 40% on current levels from April 2017 – down to £1,255 a month for these pharmacies, it said.

All community pharmacies which dispense more than 2,500 items a month currently receive an establishment payment, but the DH reaffirmed that these payments will be “phased out” entirely over “a number of years”.

The DH’s document was timed to coincide with confirmation from pharmacy minister David Mowat that the 12% cut to the global sum would go ahead in December as planned.

Despite the DH telling C+D last week that no final decision had been made on the cut, Mr Mowat laid out the plans in the House of Commons today.

Mr Mowat confirmed the Pharmaceutical Services Negotiating Committee’s (PSNC) announcement last week that funding would drop by 7.4% on current levels for 2017-18, bringing the global sum down to £2.592bn.

Mr Mowat insisted the government “appreciates the value” of the pharmacy sector. But he stressed the current system does not do enough to “promote efficiency or quality”.

The DH also released an impact assessment of the funding plan today, which confirms “there is no reliable way of estimating the number of pharmacies that may close as a result of this policy”.

PSNC “unanimously” rejected the funding package last week.

£42m integration fund announced

Following Mr Mowat’s announcement, NHS England published details of its promised £42m ‘pharmacy integration fund’.

This will support pharmacy to “develop new clinical pharmacy services, working practices and digital platforms”, and result in “more integrated and effective NHS primary care for patients”, it added.

“Wholly unacceptable”

Pharmacy Voice described the government’s plans for significant pharmacy funding cuts as “incoherent, self-defeating and whole unacceptable”.

Chief executive Rob Darracott said the government appears “hell-bent on pressing ahead” with its policy and has “replaced warm words with increasingly aggressive rhetoric.

DH publishes pharmacy access scheme details
20 October 2016, Dispensing Doctors Association, Alisa Colquhoun

GP run pharmacies are on the list of English pharmacies that will see fewer cuts to their funding, according to the details of the pharmacy access scheme published today.

Jeremy Hunt told dispensing GPs of the publication of the details of the scheme today at the Dispensing Doctors’ Association 2016 annual conference, in a speech promising GPs financial and logistical support with developing out of hospital care and workforce development. Details of this speech will appear in our conference news section within a week.

In the pharmacy access scheme (PhAS) pharmacies dispensing up to 109, 012 prescriptions a year (around 9, 084 per month) and located a mile or more from another pharmacy will make a smaller efficiency saving than other pharmacies: 1 per cent in 2016/17 and 3 per cent in 2017/18. According to the DH, 1,356 pharmacies are named on this list, which can be downloaded here.

Pharmacies do not need to apply to the scheme to be eligible; eligibility has been calculated nationally, based on data relating to how many prescription items a pharmacy dispensed in 2015/16, and data relating to the distances between pharmacies.

Eligibility criteria include:

  • The pharmacy is more than a mile away from its nearest pharmacy (measured by road distance)
  • The pharmacy is on the pharmaceutical list as at 1 September 2016
  • The pharmacy is not in the top 25% largest pharmacies by dispensing volume.

Other important details of the scheme include:

  • Eligible pharmacies will see the PhAS concession take effect for prescriptions dispensed in December 2016. These payments will continue monthly until the payment for March 2018
  • If a qualifying PhAS pharmacy subsequently increases the volume of prescription items
  • If a new pharmacy opens very close to a pharmacy receiving the PhAS, the PhAS pharmacy will not lose entitlement, nor will the new pharmacy be eligible for the PhAS
  • The scheme applies in England only, and will run from 1 December 2016 to 31 March 2018. This is in keeping with the overall two year settlement for pharmacies – see below

NHS Community pharmaceutical services funding levels and the PhAS beyond March 2018 will be subject to further consultation, which will include reviewing the PhAS and its effectiveness.

From December 1, 2016, pharmacies not eligible for the PhAS will be hit with a 4 per cent reduction in funding in 2016/17 and a further 3.4 per cent reduction in 2017/18. This equates to funding cuts of £113 million in 2016/17 and takes total funding to £2.687 billion for this financial year. According to PSNC, contractors will see funding for December 2016 to March 2017 fall by an average of 12 per cent compared with current levels.

This will be followed by a reduction in 2017/18 to £2.592 billion for the financial year, which will see funding levels from April 2017 drop by around 7.5 per cent compared with current levels. Dispensing GPs are not affected by the funding cuts, nor are their dispensaries included in the PhAS

From Factory to Pharmacy

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