The Pharmaceutical Journal
Vol 268 No 7189 p356
16 March 2002

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Problems with prescription pricing still causing a headache for Wales

The pricing of prescriptions in Wales is expected to be back on target by July. However, community pharmacists are sceptical about this happening. Zoë Gross investigates

The issue that seems to be widely affecting community pharmacies in Wales is that of contractors not being paid on time for items that have been dispensed. A backlog of prescriptions for pricing authorities to process occurred as a result of a short supply of many generic products from the Drug Tariff. It was a problem that affected the whole of the United Kingdom, but has taken longer to resolve in Wales.

Gwyn Phillips, executive director of Bro Taf Health Authority, speaking on behalf of the Welsh prescription pricing authority, Health Solutions Wales, says that the pricing authority's recovery plan for processing prescriptions is on target to be completed by July.

Mr Phillips comments: "We seem to be pulling through what has been a very tough time." He went on to thank those pharmacists in Wales who have been "most understanding" about the difficulties Heath Solutions Wales has had.

Phil Parry, chairman of Community Pharmacy Wales, which represents contractors' interests, reminds The Journal that in 1999, the number of category D items supplied from pharmacies in the UK increased from 15–20 items to 80–90 items. The problem with supplying category D items was that they had to be priced separately and this changed the input data that staff at the pricing authorities had to use, Mr Parry says. There was a dramatic increase in the amount of work carried out by the staff at pricing authorities as a result. Category D has now been discontinued.

He explains that in England, the Prescription Pricing Authority was already "up to speed" at that time. However, Health Solutions Wales was behind schedule with pricing National Health Service prescriptions, for paying contractors, when these extra problems occurred. In Wales, as a consequence, additional staff were required to deal with the increased workload. However, it was not possible to increase the number of staff at the time and a strategy for tackling the problem was agreed between Health Solutions Wales and Community Pharmacy Wales.

From October 1999, about three-quarters of contractors agreed to a system whereby they were paid an estimated amount for items that had been dispensed. A sample of 10 per cent of each contractor's prescriptions was taken each month and the total monthly payment calculated based on this figure. This continued for six months and, to ensure that pharmacists were not out of pocket, an appropriate advance payment was made each month.

Pricing frozen

For contractors who insisted on accurate pricing, the pricing of dispensed items was frozen. These contractors' prescriptions were set aside and not priced for six months. However, each contractor received mon-thly advance payments based on the total number of prescriptions dispensed and the value of a month's items already priced.

Chris Martin, vice-chairman of Community Pharmacy Wales and chairman of Pembrokeshire Pharmacy Forum, says that, as a result of the scheme, contractors were either overpaid or underpaid each month. However, he confirms that by July Health Solutions Wales is expected to be back up to date.

Community Pharmacy Wales has been monitoring the Welsh prescription pricing authority's ability to cope with increased pricing demands. According to Mr Parry, Health Solutions Wales has a recovery plan and is expected to price and pay contractors for prescriptions dispensed in July by October, which is the normal process. Contractors are paid an advance payment of an estimated 80 per cent of the value of the number of prescriptions submitted for pricing the previous month plus the balance from a month's prescriptions already priced, less prescription charges. "From that point on, they will be up to date," he says. Also, from October this year to January next year, prescriptions that were not part of the sampling process will be priced and the other quarter of contractors paid. He adds that to get back on target, the number of staff working at Health Solutions Wales has been increased and the authority has adopted a process which allows staff who have been trained to different levels to do different jobs.

Robert Gartside, North Wales Local Pharmaceutical Committee secretary, says that he finds it difficult to believe that Health Solutions Wales will catch up with pricing prescriptions by July. He also comments that as a result of the situation "contractors in North Wales are being threatened with legal action by the Inland Revenue because they cannot complete accounts for pharmacies that have been closed."

Electronic pricing

As a solution to the problem, Mr Gartside believes that electronic pricing in pharmacies is the way forward. He says that in Dublin, where there were similar problems, an "electronic claiming method" was introduced. Pharmacists are able to send prescribing information electronically to the Irish pricing authority through one of three intermediate firms which process the data before it reaches the pricing authority. Using this system the pricing authority is able to pay contractors by the 15th day of the month, he says. Mr Gartside adds that the service is good because the firms compete with each other. However, issues such as validating computer systems have to be addressed first, he says.

Geraint Davies, member of the National Assembly for Wales and pharmacy proprietor, agrees that electronic prescribing would make a difference. He says that it would also provide up-to-date prescribing figures and data for health authorities that are also losing out. "The sooner we start using electronic prescribing and pricing the better."

Mr Davies comments: "It is tough at the coal face, it is hard." The result of having problems with pricing dispensed prescriptions is making it difficult to run a business efficiently. Also, "you do not know whether your stock control is right or wrong", he says. "Pharmacists have been treated terribly."