Despite accounting for less than 1 per cent of the prescription budget, specials raise a number of important issues for contractors. Steve Bremer asks manufacturers for advice on dealing with common problems

Although the introduction of the specials tariff over two years ago has increased pharmacists’ confidence in specials as well as reducing the average cost per item by 25 per cent, some contractors still have concerns about their dealings with specials. Manufacturers are willing and able to help independents to tackle any ongoing issues around these prescriptions.

Pressure from CCGs for GPs to prescribe by brand and/or for the pharmacist to use certain suppliers is reducing fair competition, warns Mark Stephenson, managing director of IPS Specials. But it is also restricting pharmacists’ ability to choose suppliers they trust, have good relations with and who provide the best service for the patient. It can also increase their administration, as they may have to deal with multiple suppliers. Pharmacists are within their rights to choose their own supplier, but in order to maintain good relations with CCGs, they often feel that their hands are tied when trying to serve their patients in the best way they know how.

Understanding whether a special is in the specials tariff or not, which affects endorsement requirements, can be a problem for pharmacists so IPS has not only produced guides for contractors to keep on their walls, but it was also the first company to introduce endorsement stickers on invoices. These contain the information required to endorse a prescription, thus reducing the potential for administrative errors that can result in mispayment.

IPS was also the first company to provide pharmacists with two copies of the CoC/CoA (Certificate of Conformity/Certificate of Analysis), allowing them to send one off as required and keep the other for their records as required.

Technical expertise

If pharmacists are unsure exactly what is required for a particular prescription, they can use the technical expertise of an established company like IPS Specials. This can help them decide on questions like whether a product licensed abroad is preferable to a manufactured special, and which is the best option to improve compliance (eg, flavourings or solution vs suspension, etc).

Keeping on top of the tariff and reimbursement in general are the areas that cause contractors the most problems, says Sharon Griffiths, managing director of The Specials Laboratory. “We have been as helpful as possible to ensure ordering, queries and deliveries are efficient to make life as easy as possible for pharmacists.” To help its pharmacy customers, The Specials Laboratory supplies all the information they need to submit their data through the CoC/CoA and for endorsing scripts to the PPA for reimbursement. It also keeps contractors up-to-date with new tariff updates and has a popular reimbursement guide on its website.

Cost and confidence

Cost and confidence are key issues, particularly in light of the recent press investigations into the market, says Jan Flynn, marketing manager at Rosemont Pharmaceuticals. But she believes that both issues are being addressed through the specials tariff, which saw 51 new products added in November, bringing the total number of tariff specials to 188. Rosemont has always supported transparency of pricing and published a specials price list (available to healthcare professionals on request) to ensure that its pricing policies are open and transparent even before the tariff was introduced.

Every area of expenditure in the NHS is under close scrutiny and specials are no exception. However, high quality specials play an essential role in the delivery of patient care and this fact should not be forgotten, says Ms Flynn. The decision to prescribe a special rests with the prescribing clinician, who takes overall responsibility for the safety of the patient. The General Medical Council recommends prescribing an unlicensed medicine only when “an alternative, licensed medicine would not meet the patient's needs” and it has published guidance (Drug and Therapeutics Bulletin, Oct 2010, vol 48, p112) for both prescribers and pharmacists.

Of particular note in this guidance is the emphasis on the quality of the product, which should be procured “from an appropriate source” and be of “appropriate quality”. This is where the community pharmacist has a key role to play in ensuring the highest quality medicines are dispensed and this is paramount to ensure high standards of patient care, says Ms Flynn.

Knowledge and resource

Lack of in-house knowledge and resource to be able to tackle prescriptions quickly and efficiently is a challenge for pharmacists, says Karen Cole, business account manager for specials at Nova Laboratories. “Many need a specials manufacturer, which effectively acts as an outsourced consultancy on technical issues, as well as a provider of unlicensed medicines to fulfil prescriptions.”

Specials prescriptions can prove an administrative burden on pharmacies, says Ms Cole, especially if prescriptions are less common or familiar to the pharmacists. It is advisable to keep a record of suppliers that are able to fulfil certain prescriptions to avoid having to contact multiple manufacturers each time, she suggests.

Nova has a “dedicated support pharmacist and a highly experienced customer service team” who can advise on any formulation issues and help to resolve any technical problems available “freephone” to all customers. “We are happy to run in-pharmacy or external training sessions at our customers’ request.”

Pharma Nord Specials encourages independents to search for the best prices to provide value for money to the NHS, says Michael Dobson, its commercial manager. The company has many generic preparations available in its own livery, supplied at the “best” price to community pharmacists, “cutting out any possibility” of price inflation.

“We would also encourage pharmacists to question the prescribing of specials to rationalise away from expensive bespoke preparations to standardised wholesale lines available at a fraction of the cost,” says Mr Dobson. Whether this is questioning a specific flavouring request, or a slight quantity variation from a standard line, many commonly prescribed unlicensed medicines are available at fair prices if the patient will accept a standard formula, he says. “There is obviously a clinical need for bespoke lines to be manufactured, but Pharma Nord always encourage the use of standard lines purchased direct from the manufacturer.”

Why choose us?

IPS Specials

IPS’s late cut off time of 5pm with lunchtime next day delivery as standard gives pharmacists peace of mind that they can tell their patients to collect their medicine “tomorrow afternoon”. Pharmacists’ service to their patients is directly linked to the service IPS provides the pharmacist, says Mr Stephenson. “I think IPS are the only specials company to truly believe in and focus on that, maybe because we were founded by independent pharmacists, one of whom still works on-site today.”

Every member of the IPS customer service team has experience of working in pharmacies as well as experience in the laboratories. “This technical knowledge is invaluable when discussing medicines so the pharmacist can rest assured they are speaking to someone who truly understands what is required and the pressures they are under.”

Moorfields Pharmaceuticals

Moorfields Pharmaceuticals was one of the first NHS manufacturers and, as part of the Moorfields Eye Hospital NHS Foundation Trust, specialises only in ophthalmology. It now offers a “unique” service, says Oliver Wooding, marketing executive at Moorfields Pharmaceuticals. “Independent pharmacists can rely on us to provide them with the widest choice of ophthalmic specials and value for money. Our products are made to the highest industry standards and any profits made are invested back into the NHS.”

February this year marked the tenth anniversary of the business moving from the trust premises into its ‘state of the art’ manufacturing facility near to the hospital in Old Street, London. Moorfields says that it is now one of the leading specials manufacturers, offering the widest portfolio of ophthalmic specials in the UK. It has been manufacturing specials for over 50 years, and now employs more than 75 people.

Rosemont Pharmaceuticals

Rosemont Pharmaceuticals recently announced that its range of special liquid medicines will be packaged in cartons (wherever feasible), with a patient information leaflet (PIL) included in the pack.

These new cartons have been “very well received by pharmacists, who particularly like the inclusion of a PIL in the carton”. Rosemont aims to package all its specials with a PIL and as many as possible in cartons. This is a rolling programme with the repackaged products being introduced once the previous batches have been used.

A CoA is available for every Rosemont product, which verifies that the levels of active ingredients and the chemical and microbiological parameters have been retrospectively confirmed by testing a sample of the final product. This differs considerably from a CoC, which is only a signed statement by the manufacturer that they believe the product complies with the purchaser’s specification. The Royal Pharmaceutical Society advises that pharmacists should request a CoA or CoC with every product.

The Specials Laboratory

“We pride ourselves on being an ethical specials supplier and this is becoming increasingly important for pharmacists when it comes to pricing and the quality of products,” says Ms Griffiths. “We will continue to refine and improve the way we work to ensure we are always adding value to customers to continue to help them with the increased administration requirements and the needs of the end patient.”

The Specials Laboratory provides a free clinical support service for pharmacists looking for guidance on specials. Supported by an online technical bulletin service, the helpline is intended to assist pharmacies with questions and queries relating to new formulations, sourcing, product information and expiry dates.

“For over 15 years, The Specials Laboratory has been committed to providing the finest specials service to independent community pharmacists across the UK. We believe our reputation goes before us and reflects how our customers trust we will deliver their patient orders to the highest quality, on time, every time.”