PSNC investigates impact on pharmacy contract of PCT brand prescribing
policies
Figures are being compiled by the Pharmaceutical Services Negotiating Committee to try to find out how local primary care trust prescribing policies are distorting the nationally negotiated pharmacy contract.
Some PCTs and practice-based commissioning (PBC) clusters are recommending
that GPs prescribe specific brands where these are cheaper than the Drug
Tariff Category M generic equivalents in order to achieve local reductions
in prescribing costs.
Kamlesh Upadhyaya, a community pharmacist from Barnet, north London,
said: “Pharmacies who serve PCTs or PBC clusters that have branded
generics policies will lose out disproportionately in relation to other
pharmacies because payments are negotiated globally.”
Mr Upadhyaya, who sits on Barnet PCT’s professional executive committee,
added that this could cause a huge drop in income for local pharmacies
that would take a long time to recover because the Department of Health
cannot know which clusters are switching prescribing in this way.
“The 97 pharmacies in Barnet will get less income than the average
pharmacy across the country,” he said. “It follows that this
practice could lead to some heavy dispensing pharmacies [becoming] non-viable.”
Sudden switches that are made to save money can also lead to problems
with the availability of medicines because manufacturers might not be
able to cope with sudden surges in local demand or pharmacies might not
have what is prescribed in stock.
“Just the other day, I had to ask a patient to come back the next
day to start a course of Keflex because the doctor did not prescribe
generic
cephalexin,” Mr Upadhyaya said.
A Barnet PCT spokesman said that one PBC cluster was piloting work on
commissioning prescribing and had seen that the use of specific brands
could generate substantial savings on the primary care budget.
“PBC clusters have a clear remit to generate savings that will
then be reinvested in services that will bring care closer to patients’ homes
and this is part of that remit,” he said.
Lindsay McClure, head of information services at the PSNC, explained
that local policies of this nature caused variations
in income for pharmacies that resulted in
an unequal geographical distribution of nationally negotiated funding,
although they did not threaten the overall purchase profit guarantee.
Miss McClure said: “This is an issue in approximately 15 PCT areas.
Different PCTs have put in place different local policies. In some cases,
prescribing of certain branded generic medicines is encouraged in others
it is prescribing of off-patent brands.”
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