The DoH is in talks with the Pharmaceutical Services Negotiating Committee on a new pay deal for 'specials', bespoke medicines for patients who cannot tolerate a licensed preparation. It comes after NHS spend on specials rose 100 per cent in two years, reaching £109 million by 2009.
Meanwhile, the GPC called for central guidance for GPs on the safe modification of licensed drugs, such as grinding tablets for patients with problems swallowing. This can reduce the need for expensive specials but is in decline due to worries over legal liability.
Currently, pharmacists are reimbursed for any specials costs and this expenditure is not tracked in GP prescribing data. A change in the law last August permitted specials manufacturers to issue price lists for the first time, which it was hoped would promote competition and lower costs.
Now the DoH has signalled further reform, although it said progress has been delayed by 'complex' issues.
Specials should only be used after GPs have considered the safe use of licensed medicines in an unlicensed manner, according to the UK Medicines Information service. However, there is no exhaustive list of which drugs may be safely modified.
GPC prescribing subcommittee chairman Dr Bill Beeby said worries over liability meant GPs were 'afraid' of prescribing modifications.
'Doctors are reluctant to write a prescription that includes re-manufacturing a product. But there is leeway in the regulations,' he said.
The Medical Defence Union said GPs might be liable if they prescribe unlicensed medicines that cause harm.
But GMC rules allow prescribing of unlicensed medicines as long as the licensed form is inappropriate for the patient and there is evidence the medication is safe and effective. They must also monitor and follow up patients.
An Association of Commercial Specials Manufacturers spokeswoman said: 'Any initiative to restrict the use of specials needs to be very carefully considered and implemented.'