The health and social care secretary should utilise his powers to control ‘excessive’ and ‘unsustainable’ generics prices, the clinical commissioning groups (CCG) representative body NHS Clinical Commissioners (NHSCC) has stressed.

In a letter addressed to Government body the Health and Social Care Committee on 19 July, NHSCC chief executive Julie Wood called on the new health and social care secretary Matt Hancock to ‘utilise his powers under the Health Service Medical Supplies (Costs) Act 2017 to control excessive prices, where appropriate’.

A Department of Health and Social Care (DHSC) spokesperson told The Pharmacist: ‘Our number one priority is to ensure that patients have access to safe and effective medicines.

We have some of the cheapest drug prices in Europe and although the number of concessionary prices increased, the overall spend on generic medicines went down compared to last year.’


‘Unprecedented increase’


In June, Government auditors the National Audit Office (NAO) found that there was an ‘unprecedented rise’ in the number of concessionary prices requests from contractors in 2017/18.

The NAO estimated that CCGs spent £315m on generic drugs in 2017/18, compared to £45m in 2016/17 and £58m in 2015/16, which ‘contributed significantly to the £250.5m overall deficit that CCGs ended the year with’, Ms Wood said.


‘Gaps in care’


Ms Wood wrote: ‘As they attempted to mitigate these cost pressures, CCGs have had to take difficult decisions about the services that they fund to meet the needs of their populations, which will have resulted in reductions in the availability of treatment and services in some areas.

‘In addition to financial pressures, a lack of availability of [short] items impacts upon patients who should be in receipt of them, leaving gaps in their care and potentially compromising the safety and quality of their treatment. Switching patients to alternative medicines can result in anxiety and potentially affect clinical effectiveness.’

Those concerns were previously highlighted in a letter sent to Government auditors the Public Account Committee (PAC) on 26 June, to which the committee is likely to respond in a formal report in the autumn, a PAC spokesperson told The Pharmacist.

NHSCC made the following recommendations:

  • Ensure that prices listed in the Drug Tariff is the lowest price and includes the price of any branded products.
  • Develop a single price for generic medicines based on mg rather than different prices for tablet and capsule forms and agree that pharmacists can substitute tablets for capsules and vice versa without the need for a GP to amend the prescription.
  • Allow pharmacists to substitute alternative strengths of generics without the need for the prescription to be returned to the GP
  • Develop an approval process for reimbursement at branded prices where there are generic stock shortages. This should be administered centrally so it does not require the GP to rewrite the prescription on an individual basis.
  • Allow flexibility in the dispensing process for multiple items on a single prescription, for example, allowing a pharmacist to dispense three out of four available items on a prescription, and then allowing the patient to attend an alternative pharmacist for the remaining item(s).