From March 1st 2022 there will be a new section in the Drug Tariff, as mentioned in the Preface section of the February 2022 Drug Tariff.
The preface gives dispensing contractors advance notice of changes, and in this case the addition of 47 specials with different formulations to Part VIIID of the March 2022 Drug Tariff.
This new section, Part VIIID, will publish the reimbursement and payment arrangements for specials and imported unlicensed medicines to be paid relative to a specific and identified pack size.
According to the PSNC “This is the first of many changes expected to drug reimbursement following the publication of Department of Health and Social Care’s (DHSC’s) response to the 2019 consultation on community pharmacy drug reimbursement reforms.”
Currently the specials listed in the Drug Tariff Part VIIIB are all non-solid formulations such as liquids, creams and the like. The new Part VIIID section contains mostly unlicensed capsules and tablets with reimbursement prices calculated against an identified pack size.
The pack sizes which are listed are designed to help with claims for Broken Bulk which will be allowable for any specials listed in Part VIIID from March 2022.
Remember that Broken Bulk cannot be claimed for any specials listed in Part VIIIB of the Tariff or for any non-Tariff specials.
I spoke to Alastair Carmichael who stated, “My thoughts are that Dispensing Doctors will have to look more carefully at their purchasing for what are “Special Obtains” where prices can vary dramatically.
Many of the products are prescribed for a specific patient or reason, such as not tolerating the standard original formulation, but they can be very expensive.
There may be incidents of mis-prescribing and patients do not now require one of these products.
It would be a good exercise to review any prescribing and dispensing of any of these listed products – Is there now a more standard alternative which is easy to obtain and cheaper?
There maybe some challenging conversations with any remaining patients taking items such as Co-Proxamol, and benefit versus risk and cost will have to be weighed up.”
Below is a list of most the Part VIIID specials that will be listed with a reimbursement price in the March 2022 Drug Tariff:
| 4.1.2 ADDITION OF PART VIIID – ARRANGEMENTS FOR PAYMENT FOR SPECIALS AND IMPORTED UNLICENSED MEDICINES TO BE PAID RELATIVE TO AN IDENTIFIED PACK SIZE EFFECTIVE FROM 1 MARCH 2022 | ||
| Product | Pack Size | Formulation |
| Albendazole 400mg tablets | 1 | STD |
| Benzbromarone 100mg tablets | 30 | STD, FF, LF, SF |
| Biotin 5mg tablets | 30 | STD |
| Calcium carbonate 300mg tablets | 200 | STD |
| Colecalciferol 10,000unit tablets | 12 | STD |
| Colecalciferol 2,000unit tablets | 28 | STD, SF |
| Colecalciferol 20,000unit tablets | 14 | STD |
| Colecalciferol 3,000unit tablets | 28 | STD |
| Co-phenotrope 2.5mg/0.025mg tablets | 20 | STD |
| Co-Proxamol 32.5mg/325mg tablets | 100 | STD |
| Danazol 100mg capsules | 100 | STD |
| Flunarizine dihydrochloride 10mg tablets | 30 | STD |
| Flunarizine dihydrochloride 5mg capsules | 50 | STD |
| Hydrochlorothiazide 25mg tablets | 28 | STD |
| 100 | STD | |
| Ivermectin 3mg tablets | 4 | STD |
| Levamisole 50mg tablets | 50 | STD |
| Levothyroxine 100microgram capsules | 50 | STD, LF, SF |
| Levothyroxine 25microgram capsules | 28 | STD, LF, SF |
| Levothyroxine 50microgram capsules | 28 | STD, LF, SF |
| Liothyronine 2.5microgram capsules | 100 | STD, SF |
| Magnesium citrate 200mg tablets | 60 | STD |
| Magnesium oxide 160mg capsules | 100 | STD |
| Megestrol 40mg tablets | 100 | STD |
| Melatonin 10mg capsules | 30 | STD, LF, SF |
| 60 | STD, LF, SF | |
| Melatonin 1mg capsules | 60 | STD, LF, SF |
| Melatonin 2.5mg capsules | 60 | STD, LF, SF |
| Melatonin modified-release 3mg capsules | 60 | STD |
| Mepacrine 100mg tablets | 50 | STD, LF |
| Mercaptopurine 10mg capsules | 50 | STD, CF, FF, SF |
| Mercaptopurine 10mg tablets | 100 | STD |
| Metolazone 2.5mg tablets | 4 | STD, LF, SF |
| 100 | STD, LF, SF | |
| Metolazone 5mg tablets | 28 | STD, LF, SF |
| 50 | STD, LF, SF | |
| Nadolol 40mg tablets | 28 | STD, CF, FF |
| 100 | STD, CF, FF | |
| Naltrexone 3mg capsules | 30 | STD, AF, LF, SF |
| Naltrexone 4.5mg capsules | 30 | STD, AF, LF, SF |
| Nicotinamide 250mg tablets | 100 | STD |
| Orphenadrine 50mg tablets | 100 | STD |
| Phenelzine 15mg capsules | 60 | STD, AF, CF, LF, PF, SF |
| Phenelzine 15mg tablets | 60 | STD, LF, SF |
| Phytomenadione 10mg tablets | 30 | STD, SF |
| 50 | STD, SF | |
| Pirenzepine 50mg tablets | 50 | STD |
| Prazosin hydrochloride 2mg tablets | 28 | STD |
| 100 | STD | |
| Probenecid 500mg tablets | 50 | STD, CF, LF, SF |
| Riboflavin 100mg modified-release tablets | 60 | STD |
| Sucralfate 1g tablets | 40 | STD, CF, FF, LF, PF, SF |
| Sultiame 200mg tablets | 50 | STD |
| Trimetazidine hydrochloride 35mg modified-release tablets | 60 | STD |
Formulations:
| STD | Standard formulation including standard flavours |
| SF | Sugar free |
| AF | Alcohol free |
| CF | Colour free |
| FF | Flavour free |
| LF | Lactose free |
| PF | Preservative free |
| NSF | Non standard flavours |
