By Alastair Carmichael MRPharmS
As you will be aware the Summer is coming and with Summer comes the rise in hay fever patients presenting at the practice. It seems appropriate to have a look at the cost and profit profile of the main four antihistamines.
Looking at the table below the two which cost least to the NHS are cetirizine and loratadine and these are found on many CCG Formularies:
| Medicine | Drug Tariff Price | Drug Tariff Category |
| Cetirizine 10mg x 30 | £1.17 | M |
| Chlorphenamine 4mg x 30 | £3.07 | A |
| Fexofenadine 120mg x 30 | £2.29 | M |
| Loratadine 10mg x 30 | £1.21 | M |
And whilst NHS England [NHSE] has published guidance around not routinely prescribing certain Over the Counter medicines for conditions such as mild to moderate hay fever/seasonal allergic rhinitis, it may be that where there is no local pharmacy, prescribing [and dispensing] of antihistamines for your patients is essential.
Investigating further it is interesting to note that of the four above three are Category M, meaning their reimbursement price is stable until July 2021 and one is Category A which means the NHS price is based upon a basket of suppliers’ prices.
Moving on to the purchase price of these currently the best prices we have found are as follows:
| Medicine | Best Market Price | Discount |
| Cetirizine 10mg x 30 | £0.24 | 79% |
| Chlorphenamine 4mg x 30 | £0.85 | 72% |
| Fexofenadine 120mg x 30 | £1.01 | 56% |
| Loratadine 10mg x 30 | £0.24 | 80% |
Again, both cetirizine and loratadine have a remarkably similar purchase price, and therefore discount which is your dispensing margin [income]. When we apply clawback to the discounts the final 5 gross profit and Profit per Prescription can be clearly seen:
| Medicine | % Gross Profit | Profit per Prescription |
| Cetirizine 10mg x 30 | 68.31% | £0.80 |
| Chlorphenamine 4mg x 30 | 61.13% | £1.88 |
| Fexofenadine 120mg x 30 | 44.72% | £1.02 |
| Loratadine 10mg x 30 | 68.99% | £0.83 |
Another point to consider is the change in status of medicines moving from POM to GSL, such as has happened with a brand of fexofenadine – more information here. Should patients be self-medicating?
This leaves you to make the decision as to which medicines to use in your first line formulary from a commercial point of view. As a dispensary manager it is essential you let your prescribers make a clear clinical decision first and foremost, and then consider cost to the NHS before looking at the profitability of these medicines.
