The Drug Tariff preface contains a wealth of information, not least of which is the advance notice of changes. As the name suggests, this section provides you with information on the following month’s changes, for example, the October 2020 Drug Tariff will list changes to the November 2020 Drug Tariff.
Changes to the Drug Tariff affect your reimbursement, and advance knowledge of a change can help you to plan your dispensary spending, arrange the necessary endorsements/changes to the prescriptions, and budget for changes in reimbursement.
Sections to note, include:
Changes: This section is probably the most important section of the advance notice as it gives you a chance to be ready for possible changes in reimbursement price of a medicine.
The advance changes for November, listed in the October Tariff, are as follows:
Cinacalcet 30mg tablets 28 (Category C Mimpara) will be: Category A
Cinacalcet 60mg tablets 28 (Category C Mimpara) will be: Category A
Cinacalcet 90mg tablets 28 (Category C Mimpara) will be: Category A
Omeprazole 10mg/5ml oral suspension sugar free 75ml (Category C Rosemont Pharmaceuticals Ltd) will be: Category A
Omeprazole 20mg/5ml oral suspension sugar free 75ml (Category C Rosemont Pharmaceuticals Ltd) will be: 75ml Category A
Terazosin 2mg tablets 28 (Category C Hytrin) will be: Category A
Thus, a prescription written for cinacalcet tablets 30mg x 28, currently reimbursed at the Category C brand NHS list price of Mimpara will, from November 1, be reimbursed at the Category A generic price. If this new Category A price is lower than the brand list price of Mimpara, and you dispense Mimpara against this prescription, you will lose money on every one of these prescriptions.
With this notice you should aim to keep your stock of the brand to a minimum, and to look for generic alternatives. The new Drug Tariff is available online three days before the start of the month, at which time you can check the actual new reimbursement price to inform buying/budgeting. If you are purchasing at a price above Drug Tariff you can ensure you re-write the prescription with the relevant brand/wholesaler/supplier to ensure correct reimbursement.
Additions to Part VIIIA (new medicines or pack sizes). If the product is listed generically and you are buying for less than Drug Tariff, you won’t need to prescribe by brand (unless there is a clinical or social reason to do so).
Among the November changes listed in the October preface (advance notice) are:
- Pregabalin 100mg tablets 84 Category A
- Pregabalin 150mg tablets 56 Category A
- Pregabalin 200mg tablets 84 Category A
- Pregabalin 225mg tablets 56 Category A
- Pregabalin 25mg tablets 56 Category A
Deletions: items which are being removed from the Drug Tariff, due to discontinuation, for example. Deleted items dispensed after November 1, 2020 will need to be re-written by brand or wholesaler/supplier in order to be correctly reimbursed.
Examples of November discontinuations listed in the October Drug Tariff include:
- Alprostadil 250microgram urethral sticks 1 Category C
- Muse Dihydrocodeine 10mg/5ml oral solution 150ml Category A
- Flecainide 200mg modified-release capsules 30 Category C Tambocor XL
- Glibenclamide 2.5mg tablets 28 Category A
- Glucosamine sulfate 1.5g oral powder sachets sugar free 30 Category A
Thus, prescriptions for glibenclamide 2.5mg tablets x 28 would need to include endorsement of brand or supplier used so that the submission can be correctly reimbursed.
All relevant staff should be aware of price changes listed in the Tariff and the relevant endorsements/checks to make as a result. Drug Tariffs for England & Wales are available online.