They may only account for 1% of all prescriptions, but they play a vital role in the treatment of varied medical conditions. Victoria Goldman explores what you should expect from your specials supplier.

The specials market is a complex one, but the aim of the Association of Pharmaceutical Specials Manufacturers (APSM) is to provide community pharmacists with support and advice to make it easier.

Specials account for less than 1% of all prescriptions, but they play a vital role in the treatment of varied medical conditions, with more than 75,000 different formulations being prescribed each year. Many of the people requiring specials are the most vulnerable members of society, such as premature babies, people with learning difficulties who won’t take tablets or people with severe skin conditions or allergies who require a preservative-free formulation.

Although wholesale companies can re-sell specials, only a small number of dedicated companies in the UK are licensed to make these bespoke specialist medicines. They must hold a ‘Specials Manufacturer’s Licence’ (issued by the MHRA), and most of these companies are members of the APSM.

APSM membership has strict criteria, with many of the highly specialised firms also operating in the global market place. The APSM has recently set up an Import/ Export Group to reflect its role in sourcing and importing specialist drugs on behalf of its NHS customers as well as exporting members’ own products and expertise. “We have one of the most regulated specials industries in the world,” says APSM chair, Sharon Griffiths. “It’s earned us a reputation as one of the best in the world.”

Key principles

Mike Edge, in-house pharmacist at Nova Laboratories, says there are five key principles to manage specials procurement, to help eliminate risk and save healthcare professionals’ time:

1. Build relations - It’s essential to trust your specials supplier because speed is often of the essence. Be sure to work with a supplier you can rely on.

2. Technical support – Use the technical support available from your specials supplier and speak to their expert
customer service teams and in-house pharmacists for advice and guidance. They will be able to tell you if there’s a licensed option available or recommend adjustments to formulations.

3. Range of products - Keep a record of manufacturers that are able to fulfil certain prescriptions to avoid having to contact multiple manufacturers each time. Try to use a supplier who can cover all bases to save on admin.
4. Quality guarantee and reduce risk – Ask about the end-to-end process. Is the product made and tested in-house? Ask for evidence that the product meets appropriate standards. This will help assure you and the patient that the special is compliant and made to the highest quality.

5. Speed – How quickly can the special be made? If the product is made and tested in-house then the turnaround will be quicker.

Quantum Pharmaceuticals highlights three key areas that pharmacists should look out for too:

1. Compliance – MHRA requires that orders for specials are always confirmed to the supplier in writing as a further means to safeguard the patient and avoid the risk of a transcription error or miscommunication.

2. Quality – Ensure your supplier goes above and beyond when it comes to quality checks to ensure your patients’ safety.
3. Service – Check that your supplier has various ways to order and provide next-day delivery.

BCM Specials recommends that that pharmacists ensure that the specials medicine is competitively priced and represents good value for money. This can be achieved by obtaining quotes from manufacturers, rather than using intermediaries, to:

• avoid excessive handling costs
• avoid higher mark ups
• maintaining high quality standards
• ensure rapid delivery for the patient.