PSNC must take tougher stance on price concessions, urge contractors

Contractors have called on PSNC to take a tougher stance with the Department of Health and Social Care (DHSC), so they no longer need to ‘subsidise’ the cost of some medicines.

Last week, contractors told The Pharmacist that rising prices were now affecting ‘bread and butter lines’ of drugs, ‘where we dispense hundreds if not thousands of packs each month.’

Some have now suggested that the sector’s negotiating body needs to coordinate action on a national level for contractors to refuse to dispense items above the drug tariff.

‘I think something's going to have to be done from the PSNC side’ said contractor Sri Kanaparthy. ‘They are currently acting as a messenger to the contractors rather than a negotiator because they're just coming back and saying, Department of Health and Social Care has imposed a price.’

‘I think PSNC need to take a tougher stance and say look: it's not reasonable. We have adequate evidence. We can't accept the contractors subsidising the costs for NHS all the time,’ he added.

‘No community pharmacists want the patient to suffer. So the ballot doesn't have to be for total closure of pharmacy or denial of service’, he explained, suggesting that instead community pharmacies could ‘restrict what we're doing’.

‘Say for example, if you just stick to the basic dispensing activity and stop providing free health advice and everything that we're currently providing for free, that would show up in the next channels like GPs, hospitals, A&Es, and that is when the Department of Health will actually take any notice of what our community pharmacy has been shouting for nearly a decade.

‘Because the minute they're just asking us to do more and more with no additional reimbursement. And what we are getting paid is also getting squeezed day after day.’

Ashley Cohen, who owns a group of pharmacies in York and Leeds, said in a tweet that the situation ‘would be solved in days’ if pharmacy leadership bodies instructed contractors ‘to stop dispensing these products at losses.’

It would be solved in days If @PSNCNews @NPA1921 @AIMpharmacies @CCApharmacy told us to STOP dispensing these products at losses. We also have NLW increases ~10% which could bankrupt many more pharmacies @DHSCgovuk you are sleepwalking to oblivion

— Ashley Cohen (@ashleydcohen) November 19, 2022

He added that he thought that the Department of Health was ‘sleepwalking to oblivion’, warning that additional pressures like the recent living wage ‘could bankrupt many more pharmacies’.

In an interview with The Pharmacist last week, PSNC CEO Janet Morrison said that discussing price concessions with the Department of Health was ‘not an easy task’.

In previously unpublished comments from the interview, she said the high wholesale prices of some common medicines, coupled with comparatively low reimbursement prices from the DHSC, risks contractors stopping supplying lines which they are making a loss on, and could impact patient care.

‘It's not good for patients and it's not safe for patients’, she said. ‘Some of the drugs that we've seen on the [price concessions] list, the price concessions that we've asked for haven't been applied. Those are serious drugs that people are very reliant upon.’

Ms Morrison added that she thinks that this is already happening on an informal level, with contractors telling patients that they cannot get hold of medicines and directing patients to other pharmacies.

Ms Morrison also said that a review into the wholesale market might also be needed.

PSNC and DHSC have confirmed that they are working ‘at pace’ to review the price concession system to see what could be improved.

Responding to the contractor’s comments, Ms Morrison said: ‘As well as increasing supply disruptions, 2022 has seen a rise in the number of concessionary prices being imposed by DHSC. Our team works hard to push for a price that we feel is appropriate for contractors but ultimately DHSC can decide to impose a price based on data PSNC has no sight of. This is one of the reasons why we fought for an urgent review of the process. The review is now well underway and so far our meetings with DHSC have been constructive.

‘We hope to provide contractors with further updates as soon as possible, but we have been absolutely clear that pharmacies cannot continue to fund the gap between reimbursement and purchasing prices for some medicines.’

Last month, Community Pharmacy NI (CPNI), which represents hundreds of local pharmacies as the sector’s negotiating body in Northern Ireland, warned that drugs used to treat numerous health conditions including osteoporosis, high blood pressure, insomnia, mental health and coronary conditions, could run out ‘within weeks’, amid exponential rises in wholesale prices and widespread shortages.

DHSC has offered the sector £5.3m to address the situation, but CPNI has said that £20m to £30m is required.

Senior peer Lord Rogan has asked the UK Government to reveal what discussions it is having with CPNI about extra funding for pharmacies in Northern Ireland.

He warned that ‘lives are undoubtedly at risk’ because of the impact of soaring drug wholesale prices, adding that there could be ‘devastating consequences’ if a solution is not swiftly found.