Community pharmacies ‘footing the bill’ for many NHS drugs

Community pharmacists are under severe financial pressure due to an “utterly broken” payment system, experts have said.

A mismatch between the price of some medicines and the amount that pharmacists are reimbursed by the Government means that many are making a loss, pharmacy leaders said.

The National Pharmacy Association (NPA) said that many community pharmacists are paying out of their own pockets to ensure patients get the medicines they need.

It said that the health system is underpaying pharmacies for medicines by as much as £75 a pack.

One pharmacist described how is can make losses of £1,000 a month due to the mismatch in prices.

The NPA said that pharmacies are closing in “record numbers” due to financial pressures.

Olivier Picard, a pharmacist in Berkshire, told the PA news agency that the discrepancy between the prices “huge”.

“This is affecting us enormously,” he said.

“The number of products that we cannot purchase under the reimbursement price is increasing and increasing, and the prices that we are seeing… the discrepancy is so huge.

“A couple of months ago, we were losing £20 a packet on a medicine for stroke prevention. The next month, we lost money on something that you give as an antidepressant.

“Sometimes it’ll be a few pence, sometimes it’ll be several pounds.

“There are some months where I am out of pocket by £1,000 pounds per pharmacy – I have got four pharmacies.

“It is not a sustainable model. It is not something that I can continue doing.

“Every month we dispense at a loss for dozens of medications.”

The NPA, which represents independent community pharmacies in the UK, said financial pressure on pharmacies has forced 1,500 to have closed permanently in England in the past decade.

The NPA conducted a snapshot survey on October 7 of drug prices from pharmacy wholesalers and compared it to how much pharmacies are reimbursed through the NHS Drug Tariff, funded by the Department of Health and Social Care. The NPA found:

– Amantadine, a drug to treat the symptoms of Parkinson’s, cost pharmacies £94.05 per pack to buy from suppliers, but the drugs tariff pays £18.06 per pack. The NPA said that a pharmacy dispensing this medicine to a patient would lose £75.99 per 56 tablet pack.

– Pharmacies are paid £1.72 to dispense a pack of Escitalopram, a common anti-depressant. But it costs them £9.08 to buy from suppliers.

– Anti-anxiety medication Lorazepam costs £10.75 to buy from a wholesaler but pharmacies are paid £3.16 to dispense it.

– Pharmacies can buy etoricoxib, an anti-inflammatory drug to treat conditions such as rheumatoid arthritis, for £19.47 from their supplier but they only receive £6.75 to dispense the medication.

Pharmacies cannot stop supplying medicines because of cost because this would put them in breach of their contract with the health service, experts said.

Earlier this year an NPA poll revealed that 85% of community pharmacies say that they “often” make a net loss on NHS prescribing.

Meanwhile the survey of around 500 small independent community pharmacies, also found 36% feared they will be forced to close within a year due to financial pressures.

Paul Rees, NPA chief executive, added: “It is nothing short of a national scandal that pharmacies have to dig deep into their own pockets just to cover the cost of basic medicines that they dispense to patients in need of treatment. No other health professional would be asked subsidise a key NHS service.

“The system for funding the medicines upon which millions of patients rely is utterly broken.

“Pharmacists are left tearing their hair out at a system that simply doesn’t cover the cost of medicines they are forced to buy on the open market, which make up the vast majority of their workload.

“This pressure has led pharmacy owners to desperate measures to keep their pharmacies open for their local community, including borrowing from family, raiding pension savings and even in some cases remortgaging their homes.

“We share the Government’s ambitions to expand the role of pharmacies but this cannot happen whilst they are being forced to closing at record numbers by chronic underfunding.

“The Government must step in now to halt pharmacy closures, fix the broken funding system and deliver a new deal for pharmacies which will end the terrible toll of closures and cuts to services.”

Louise Ansari, chief executive of Healthwatch England, said: “These findings are worrying, with community pharmacies already facing multiple challenges, including closures and shortages of prescription medication.

“Community pharmacists provide a lifeline to patients, especially those with chronic health conditions, and play a huge role in alleviating the strain on GPs.

“The more pharmacies that close, the more people will be forced to travel further or risk not getting the advice, care and medications they need, when they need them.

“We have called for a national evaluation of pharmacy funding, and the Government has announced that it will look into this. These findings only underscore why the review needs to happen as soon as possible.”

A Department of Health and Social Care spokesperson said: “This government inherited a broken NHS but is committed to expanding the role of pharmacists, making better use of the skills of pharmacists and pharmacy technicians.

“We already reimburse community pharmacies for what they spend on drugs and provide additional funding for the services they provide. There are also safeguards in place if purchase prices for a given drug increase.”