Proposed reforms for English NHS prescription reimbursement ‘could generate winners and losers at individual pharmacy level’, the Government has admitted.
The reforms include changes to how drug tariff Categories A, C and M prices are set and to the reimbursement and procurement of unlicensed medicines, as well as splitting the discount deduction scale into one for generics and one for brands.
The Government is also proposing to include more products prescribed for medicinal purposes like food supplements in part VIIIA of the drug tariff and to use the manufacturer’s price list for reimbursing non-part VIIIA products rather than the supplier’s.
The aims of the proposals include ensuring contractors have equal access to margin and improving contractors’ cashflow, according to a consultation document published yesterday (23 July) by the Department of Health and Social Care (DHSC).
However, the consultation’s impact assessment says that while the changes are designed to have a ‘net zero impact’ on the sector due to the redistribution of margin, they ‘could generate winners and losers’ depending on the proportion of drugs from each category a contractor dispenses.
It says: ‘This could generate winners and losers at individual pharmacy level if propensity to dispense these products is uneven.
‘Some pharmacies that dispense a higher proportion of the new higher medicine margin products will gain, whilst those who dispense a higher proportion of the new lower medicine margin products may lose out.’
When it is ‘not possible or practical’ to include a drug in part VIII of the tariff, it is proposed that reimbursement prices will be based on the manufacturer’s listed price for single-source drugs, whereas they will be based on the average weighted list prices of suppliers for multi-source drugs.
However, the impact assessment says: ‘As the weighted average prices on the dictionary of medicines and devices (dm+d) will not be knowable in advance, there is a risk that pharmacy contractors may have less certainty over reimbursement prices than under current arrangements.
‘There is a risk that this may make it harder for pharmacies to manage and forecast their cashflow, which could also affect their purchasing decisions.’
The proposal to publish the weighted average of the previous month’s supplier’s list prices aims to ‘mitigate this risk’ by providing an indicative reimbursement price to contractors, the impact assessment says.
The DHSC plans to introduce the reforms from April 2020, according to the consultation.
Further consultation on the details of the new reimbursement mechanisms will be held with PSNC following the public stage of the consultation, which closes on 17 September, the DHSC said.