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Prescription pricing complexity

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Give three pharmacists acalculator, the drug tariff and a prescription. Ask them how much they will be paid for dispensing theprescription.  I bet you'll get threedifferent answers.

That's no reflection of the incompetenceof pharmacists.  We're meant to be quitegood with numbers given that, in our profession, lives can depend on them.  Instead, it's a reflection of the complexityof prescription pricing.

NHS Business Services (NHSBS) must employ wizards to price prescriptions. Only the tap of a wand can possibly reveal how much a prescription isworth.  But it appears not, as NHSBS don'tseem to know how much prescriptions are worth either.

Is it any wonder?  Consider what makes up a payment (take a deepbreath): there is a professional fee, potentially one of 11 additional fees, apractice payment which includes a payment for complying with the Equality Act, aconsumables & container allowance and the basic price of the medicineprescribed less a deduction based on the total value of medicines dispensed ina given month, unless the medicine is considered non-deductible.  You might also make an out of pocket or brokenbulk claim.

Category M adds furthercomplexity.  Community pharmacy isguaranteed £500m in purchase profit (money made from buying a medicine for lessthan is reimbursed).  It's deliveredthrough quarterly changes in the reimbursement prices of generic drugs.   It's mostly seen as "clawbacks" followingexcessive purchase profit being earned.

The process requires forecastingof expected medicine spend and, later, an assessment of actual spend.  Cat M makes it difficult for contractors tobudget and can cause cash flow worries. The share a pharmacy will receive from the purchase profit pot dependson the mix of drugs they dispense.

It all seems unnecessarilycomplicated.  Why not allocate thepurchase profit proportional to the number of items dispensed?  It's also worth noting that the profit figurewas agreed in 2005 and has not changed. It would need to have increased by around £120m to have kept its valuetoday.

Generally, complexity is used tohide things.  It's why government talksof ‘realignment of service provision to meet future fiscal constraint', ratherthan ‘cost-cutting'.  I'm unsure whetherthe complexity of prescription pricing benefits pharmacy or thegovernment.  I suspect it's the latter.

Either way, a simplified and moretransparent funding arrangement should be the aim.  Let's hope the new pharmacy contract deliversthat.

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