£1m drugs bill scandal

EXCLUSIVE: MASSIVE differences in the cost of drugs dispensed by some independent pharmacies are landing NHS Oldham with a bill for more than £1m a year.

NHS Oldham has seen the cost of “Special Order Products” — known as specials — soar over the past two years.

Specials are basic drugs ordered as a liquid or spray for patients have difficulty swallowing tablets.

In the first six months of the fincancil year, the primary care trust spent a staggering £613,023 on specials — almost double the bill for the same period the year before.

And between April and June this year it was ranked second biggest spender in the country, forking out an average of £1,411.54 per 1,000 patients.

Pushing up the bill is the massively different costs some independent pharmacies are passing on to NHS Oldham.

But pharmacies across the borough have hit back saying it is unfair to lay the blame with them as they have their hands tied.

Figures disclosed by NHS Oldham reveal that in September this year:

One Oldham pharmacy charged £124 for Omeprazole, used to treat peptic ulcers, while another charged £698, over five and a half times more.

Another pharmacy charged £54 for Amlodipine, a drug used for heart disease, while another charged £523 for exactly the same dose, almost 10 times more.

for the same dose of Colecalciferol, a form of Vitamin D, one pharmacy charged £5 while another charged £161, a 32 times more and a massive 3,120 per cent increase.

Currently, individual chemists buy drugs from suppliers and manufacturers and pass on the bill to the local primary care trust.

As there is no government limit for the cost of specials, primary care trusts must foot the bill no matter how high the charges.

NHS Oldham believes it could cut its annual specials bill by a third through the introduction of a national price cap and better monitoring of pharmacies.

Ian Short, chief officer of Oldham, Tameside & Glossop Local Pharmaceutical Committee (LPC) said manufacturers are responsible for setting the prices of specials.

He said that having obtained them for patients on behalf of the NHS, pharmacists are only entitled to claim back the invoiced price, delivery and other out-of-pocket costs.

He said: “A pharmacist’s number one priority is to get patients the medicines they need, and these sorts of products are usually needed urgently.

“Community pharmacists work every day to source medicines economically, but when the clock is ticking and a patient needs their medicine we don’t have unlimited time to shop around. “What we need to deliver better value here is clear and transparent information about the prices manufacturers are charging for specials, because as we see in Oldham these can vary significantly.

He added: “It’s vital in financial times like these that community pharmacists continue to deliver value for money for the local NHS, which is why we are working with prescribers to ensure that these products are only prescribed when absolutely necessary, working with colleagues to ensure they are sourced as cost-effectively as possible, and working with our representatives nationally to explore developing a tariff to bring consistency to this market.”

Smaller pharmacies across Oldham said they did try to shop around for the best price among licensed manufacturers but could not compete against the buying power of the larger chains.

They said sometimes manufacturers refused to supply independents because of their small size, and cheaper specials deals resulted in delayed delivery.

Mark Ashmore, pharmacist and owner at Butler Green Pharmacy in Chadderton, said: “It is unfair to lay the blame with independent pharmacies.

“We don’t fix the cost of specials, suppliers do.

“It’s the GPs who are prescribing the specials, not the pharmacies and we are working the best we can with GPs and the NHS.

“Major disparities between the cost of specials are few and far between.

“There will always be the odd one but over all, independent pharmacies in Oldham are doing a good job.”

Another pharmacist, who did not want to be named, said: “I’m very surprised that there is such a difference between the costs of specials.

“What would be helpful would be for NHS Oldham to take a bigger role and have a list of manufacturers they could negotiate with, rather than each individual pharmacy having to do it.”

Another said: “Although a GP can look up the cost of a tablet, at no point in the process will they know how much a special will cost.

“Having clear costs would enable them to make a more considerate decision when prescribing and would help keep costs lower.”

Across England, the cost of specials to the NHS has risen from £57m to £160.5m in four years.

A BBC investigation in September found that nearly £72m could be saved if all specials were limited to £75 an item, according to NHS sources.

NHS Oldham said the borough is an area of high health needs and had always had high numbers of prescriptions for low-cost medications.

But it said that did not explain the disparity between prices.

Shauna Dixon, executive director of clinical leadership at NHS Oldham, said: “We want to reassure people that where they need their medicines dispensed in a special way like this it will continue.

“However, at the same time the huge discrepancies in cost between what the NHS locally is charged at one pharmacy and another is not acceptable, and is especially difficult to take in these challenging financial times.

“We have been working closely with GPs and pharmacists to try and make sure medicines are only asked for as specials if they are entirely needed by patients like this.

“And we would ask patients to talk to their GP if they think they may be able to take their medication in the ‘traditional’ way.

“We would also strongly urge the independent pharmacies to work with their manufacturers to deliver the very best value for money they can.

“Money spent on paying the vast variation in cost for the same drugs is money which cannot be spend on other vital services for local people.”




Chief’s reassurance
Shauna Dixon, executive director of clinical leadership at NHS Oldham, said: “We want to reassure people that where they need their medicines dispensed in a special way like this, it will continue.

“At the same time the huge discrepancies in cost between what the NHS locally is charged at one pharmacy and another is not acceptable, and is especially difficult to take in these challenging financial times.

“We have been working closely with GPs and pharmacists to try and make sure medicines are only asked for as specials if they are entirely needed by patients like this.

“And we would ask patients to talk to their GP if they think they may be able to take their medication in the ‘traditional’ way.

“We would also strongly urge the independent pharmacies to work with their manufacturers to deliver the very best value for money they can.

“Money spent on paying the vast variation in cost for the same drugs is money which cannot be spend on other vital services for local people.”