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	The Pharmaceutical Journal Vol 268 No 7197 p646-648 11 May 2002	This page Reprint Photocopy
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Pharmacy2U

A matter of concern

From Mr D. R. Kent, MRPharmS

Earlier this year all community pharmacists will have received notification of the availability of Propecia (finasteride 1mg) for the treatment of male pattern baldness. Being listed in Part XVIIIA of the Drug Tariff this product is only available as a prescription-only medicine against a private prescription.

The same mailing was received by general practitioners — with a difference, a most significant and worrying difference. Their mailing included a flyer from Pharmacy2U Ltd promoting the direct purchase from the company at prices significantly below those at which a community pharmacy could economically supply. The postage and packing inclusive price from Pharmacy2U Ltd was £25.30 for a pack of 28; the wholesale list price to community pharmacists is £22.49.

Several issues arise from this. First, why is Merck Sharp & Dohme giving Pharmacy2U Ltd special terms so low that it can supply at this deeply discounted price and then promoting them in an MSD mailing?

Second, why is MSD so insensitive to the commercial viability of the major outlets for its products — community pharmacies?

Third, and with this the previous two questions pale into insignificance, how can we trust a company which is leading an electronic transmission of prescriptions trial of the "push" model when it is already seeking to divert business from community pharmacy and to itself on terms that endanger the viability of community pharmacy?

I have always spoken against the "push" model of ETP, especially the Pharmacy2U model. In this case the patient is asked not only whether they wish to have the prescription sent electronically to a pharmacy of their choice but also whether they wish it to be delivered from a mail-order pharmacy — presumably Pharmacy2U Ltd. The "pushing" of prescriptions to suitably equipped pharmacies is dangerous enough to those without the facility; the inducement to promote mail order may be overwhelming in many cases.

Pharmacy2U Ltd has shown itself to be unworthy of the trust put in it by the Department of Health and should forthwith be excluded from all future work on its ETP model and that any "push" model of ETP is inherently flawed.

ETP is the biggest single threat to community pharmacy that has arisen in recent times. The future consequences may far outweigh the iniquitous recent erosion of fees. It is the smaller pharmacies that will suffer first and most; these are the pharmacies that will not be early adopters of ETP, which may well be beyond their pockets.

MSD and more significantly Pharmacy2U Ltd must explain their actions.

David Kent
Secretary,
Camden and Islington LPC

Dr JULIAN HARRISON, commercial director, Pharmacy2U Ltd, replies:

Pharmacy2U Ltd was established in order to offer outstanding pharmacy care to its customers, and offering outstanding prices is part of that service. As such the commercial decision to offer strong prices on private prescription lines should not come as a surprise. The way Pharmacy2U Ltd is operated allows efficiencies that make prices viable to Pharmacy2U, which other pharmacies may not view as attractive.

The fact that Pharmacy2U Ltd chooses to compete with other pharmacies in this manner bears no relevance to its ability or appropriateness to be part of a consortium piloting the electronic transmission of prescriptions on behalf of the NHS Executive. The analogous argument would be that since Boots or Lloyds pharmacies also compete with other pharmacies in ways that they choose, they too should be deemed as unsuitable to be part of piloting efforts. If this stand were taken, how then would the important principle of ETP be investigated?

It is noteworthy that the Pharmacy2U consortium has been successful in establishing a live pilot for ETP in advance of any other consortium with the considerable effort of all involved. The pilot involves high street pharmacists as well as Pharmacy2U Ltd as dispensing entities. This pilot is run in accordance with close guidance given by an NHS Executive-led ETP project board, and in lines with a proposal accepted by a similar panel. The pharmacy profession was and is represented on these bodies. The project board will ensure that the pilot is conducted in such a way that will advise and instruct how ETP can assist and develop all pharmacy, as envisioned in the NHS document "Pharmacy in the future — implementing the NHS plan". The suitability of the "push" or "pull" model will be determined by the independent, NHS-appointed evaluation team. The Pharmacy2U consortium would not be so presumptuous as to try to pre-empt the findings of this highly qualified team and comment on which model is best for the future roll-out of ETP.

Merck Sharpe & Dohme declined our offer to respond to Mr Kent's letter.
— EDITOR

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