The price concessions system is ‘no longer working for contractors in the current volatile medicine supply environment’, PSNC has said, condemning the situation as ‘not acceptable’.

PSNC chief executive Janet Morrison said at a meeting of community pharmacy contractors and representatives last week that ‘the anger and frustration that is being felt across the sector.’

‘Pharmacies stepped up during the pandemic to deliver all that the Government and NHS needed, yet you are now struggling to keep afloat while those same two organisations allow Drug Tariff and concession price issues, spiralling costs, and other pressures to decimate your businesses,’ she said.

‘This is not acceptable to us, it is not acceptable to NHS patients, and it won’t be acceptable to the public: PSNC is clear that policy-makers must be held to account for it.’

Ms Morrison said the PSNC was ‘continuing to take a very hard line on all of these issues, alongside ramping up our influencing and data-gathering work as we seek short-term solutions for all contractors.’

‘During the pandemic we and the wider the sector fought very hard for contractors’ Covid costs to be covered and that is what we will do again now, with energy prices, with price concessions, and with overall funding levels.

‘Thank you once again to all those contractors who have contacted us about these issues and for all the evidence you provide on an ongoing basis – we will be needing more of this soon,’ she said.

Pharmacists complain of dispensing ‘at a loss’

A record 138 price concessions were requested by the PSNC this August, of which more than a quarter were granted at prices imposed by the DHSC rather than the price suggested by the PSNC.

Earlier this month, Ashely Cohen, managing director or Pharm-Assist (Healthcare) Ltd, told The Pharmacist that he couldn’t ‘keep up’ with the fluctuating price of aripiprazole, used to treat symptoms of conditions including schizophrenia and bipolar disorder.

He shared that the recent price concessions set by the DHSC had left him ‘considerably short’.

‘We need it 100% confirmed [about] how concessions are priced and feel frustrated when prices from the Department of Health and Social Care are imposed. No other contractor would be expected to provide a service at a loss,’ he commented.

Mr Cohen also said that it was taking hours each day to source alternative products. ‘This is not reflected in our contract of the costs involved in additional communication and time. Patients are anxious, confused and some are angry,’ he added.

‘Our terms of service say we should supply within ‘reasonable promptness’ so a blanket ‘can’t or won’t supply’ is not an option. However, if the dispensing at a loss continues in this current climate, I am sure there will be contractors finding creative ways not to dispense, but this may simply pass the problem on to other contractors,’ he warned.

‘We need a uniform agreement across all contractors on how we will work in these situations.’

Mr Cohen also said that he would like to ‘a stronger response’ from the PSNC and the NPA, as well as a ‘clear steer to contractors on what to do’.

‘Our funding has been eroded for eight years, and with pressure on staffing costs, utilities, delivery costs etc, we should not be left several hundred pounds a month below what it costs us.’

A Department of Health and Social Care spokesperson said: 'The UK has some of the cheapest generic medicines in Europe, and suppliers are given freedom of pricing to ensure we maintain continuity of supply despite increasing prices within the global market.

'We continue to work with the Pharmaceutical Services Negotiating Committee to ensure that pharmacy contractors are paid fairly when prices increase.'

What steps can contractors take?

PSNC recently hosted a webinar to help contractors understand the price concessions system. During the webinar, PSNC said that the number of price concessions requested had increased month on month over the last year, based on its own data reported by contractors. In the case of aripiprazole, PSNC said that the cost of the drug had increased throughout the month, and that the August price concession imposed by the DHSC was an example of where ‘the imposed prices do not reflect market availability’.

It also said that if contractors had no option but to supply a branded product rather than a generic, they should try to get the script amended to ensure that they would be reimbursed at the branded price. The PSNC has provided more information and advice for pharmacy teams on its website.

Following the webinar, Mike Dent, PSNC's director of pharmacy funding, that the PSNC was ‘acutely aware’ of ‘the growing number of medicine pricing and supply issues that are taking up a significant amount of pharmacy teams' time that could be better used elsewhere’.

‘We have been working to support contractors by sharing practical steps, developing a patient information leaflet, and providing more detail on how the price concessions system works.

‘Our key recommendations include making use of cascade systems or buying portals to assist in shopping around for stock, reporting generic drugs over Drug Tariff price to PSNC, and contacting prescribers to request a prescription for an alternative drug.

‘Meanwhile, PSNC has already begun engaging with the new team at DHSC to address many urgent issues, including that of medicines supply. DHSC need to recognise the additional time being spent by pharmacy teams as it conflicts with their wider policy objectives of making dispensing more efficient.’