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The pharmacy contractor Ashley Cohen, who sits on the National Pharmacy Association (NPA) board, has said pharmacies in England should stop dispensing medicines they are making a loss on until the Government fixes a “broken” reimbursement system which has left pharmacists continuing to “subsidise the NHS drugs bill”.

Speaking to Independent Community Pharmacist in a personal capacity and not on behalf of the NPA, Cohen (pictured), who runs pharmacies in Leeds and York, insisted contractors are increasingly being forced to pay more money for medicines than they are reimbursed by the NHS and warned the situation is “getting worse”.

He said he has not stopped dispensing any loss-making medicines but insisted he “would be prepared to”. When asked if he knew how many medicines he would no longer be supplying to patients if he decided to stop dispensing those drugs, Cohen said: “Probably most of them. There would be lots of them. I think it would run into three figures.”

I’m fully aware it is a nuclear button

He conceded patient care would be significantly impacted if pharmacies all over England took that measure, describing it as “a nuclear button”, but insisted rising cost pressures were imperilling pharmacies which, in turn, was also threatening to jeopardise the public’s safety.

“My personal view is if we’re not on the high street, if pharmacies are closing because of funding, the contract is not fit for purpose, that’s also going to have an impact on patient care,” he said.

When asked if he had asked the NPA board to put non-dispensing of loss-making medicines to its members, Cohen said: “Everything is on the table to discuss. The NPA want to ensure that pharmacists are reimbursed accurately and transparently and move away from this opaque system.”

He added: “I’m fully aware it is a nuclear button and I’m fully aware that not everyone might align to that but we’ve talked about it for too long and nothing has changed and it’s time for change.”

The NPA told ICP: “We absolutely share the frustration of contractors who are pushed to the edge by an unfair and underfunded system.

“We have been saying for a long time that the NHS should not put pharmacies in a position where they are forced to dispense medication at a loss. This is a scandal and must end.”

Calling for reform of the reimbursement system, the NPA added: “We’ve made it very clear that eliminating dispensing at a loss and reforming the antiquated and broken pharmacy contract is absolutely essential.”

Cost pressures on pharmacies already operating to a collective £2.6 billion funding shortfall across the country are being ramped up because pharmacists have increasingly been unable to source medicines at or below the reimbursement price in the drug tariff.

Supply chain issues and increasing manufacturers’ prices have reportedly seen a rise in price concessions which are designed to ensure pharmacists are not left out of pocket when they have paid more for stock.

However, concessionary prices have often been published late by the Government, leaving pharmacists unable to plan their businesses effectively.

We’ve been told for four or five years that pricing is broken

“We’ve been told for four or five years from Community Pharmacy England and others that the reimbursement system, the concession price system, the remuneration and drug pricing is broken and ‘we’re actively looking at fixing it,’” said Cohen, who has a hospital and prison contract, seven hospice contracts across north and west Yorkshire and serves 50 care homes.

“But five years have passed and it hasn’t been resolved. Concession prices, you could count on one or two hands how many prices (were) outside of the drug tariff. But it’s running into hundreds now. It’s peaked at 200 in a month and it’s not acceptable for us to not know what we getting paid for our services.”

He added: “As a contractor, I want to be able to plan my business and cashflow more than one or two weeks at a time, which is all I’m able to do at the moment. I need to plan my cashflow for six to nine months. I can’t plan it for six to nine days at the moment because of the uncertainty.”

Can’t we be paid based on the cost of the medicine with margin on top?

Cohen also called on the Government to scrap the “opaque system of withheld margin”, currently £900 million, which the independent pharmacy sector feels is not distributed equally.

Urging Labour to move “to a model where we are reimbursed on cost price”, Cohen said: “Nobody’s got an idea of who’s earning the margin. I don’t think any healthcare profession should have to fund the drugs bill from their own back pocket which is what I’m doing.

“Every time I’m dispensing aspirin this month, I’m basically paying, at the moment, £1.60, £1.70 per pack out of my back pocket to fund that patient’s treatment.

“Why can’t we be paid based on the cost of the medicine with a margin included on top of that? It’s quite clear what we’re paying for our medicines, you can see that from our invoices, you can see that from our notifications from our PMR, rather than having to wait until either the last day of the month to find out what you’re being paid for the previous month. It's not transparent, it’s not agreeable.”

Suggesting a nationwide halt to the dispensing of loss-making medicines “might knock some heads together” in Government, Cohen said: “Wouldn’t it be great if a prescription came in for aspirin dispersible that I can’t get hold of and I could change for aspirin enteric coated or aspirin plain that could be cheaper than it is at the moment, not have an issue, not have a £1.50 per pack hole in the price that I’m paying versus the concession price.

“But I can’t do that, I’ve got to go back, get the prescription changed, go back to the prescriber. I want to be operating at the top of my game, I want to have the freedom and flexibility to work at the best of my licence, whether that’s changing capsules to tablets, doubling up on strengths if there’s shortages but I can’t even do that.

"But I can’t even do that, we’re not even trusted to do that.”