Reforms fail to cut the rising cost of special medicines

Bespoke medicines are costing the NHS more than £10m a month as scrips continue to rise.

Dr Beeby: It will take time for changes to the law and new guidance to affect NHS spending.
Dr Beeby: It will take time for changes to the law and new guidance to affect NHS spending.

Prescribing of expensive bespoke medicines in the NHS has remained high despite changes in the law to cut their use, latest figures show.

Prescriptions for special order medicines in England hit a three-year high in March this year at more than 63,000 items per month, data from NHS Prescription Services show.

Costs have spiralled in recent years, rising to £11m for the month of June this year alone. The rises have continued despite the publication last summer of price lists aimed at cutting spending.

GP revealed earlier this year that rules governing how pharmacists are paid for specials would be overhauled to cut costs. Currently, pharmacists are reimbursed for specials costs without incentives to make prescribing more cost-effective.

'Specials' are prescribed to patients who cannot tolerate a licensed preparation, but may cost hundreds of times more.

The DoH hoped legal changes in August 2010 allowing 'specials' manufacturers to publish price lists would boost competition and cut costs.

Guidance to help GPs cut inappropriate prescribing of specials was released by the National Prescribing Centre (NPC) in March.

GPC prescribing subcommittee chairman Dr Bill Beeby said it was important specials were used 'appropriately and cost-effectively'. But he said it would take time for changes to the law and new guidance to affect NHS spending.

His local PCT, NHS Middlesbrough, has proposed that GPs could prescribe specials from manufacturers who sell the cheapest product. These would be identified by pharmacy advisers.

Dr Beeby said negotiations were ongoing but the proposal was encouraging. But he warned the burden of work in this area should not fall on GPs. 'It would be unreasonable for GPs to do a huge amount of work to save NHS money if not resourced to do it,' he said.

The NPC guidance encourages more appropriate use of specials, and use of lower cost options, such as prescribing crushed tablets.

Latest figures showed quarterly spend on specials reached £31.2m in April-June 2011 - 25% higher than the same period in 2009.

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