Price Concessions and NCSO
Price Concessions and NCSO
|BGMA best practice guidelines on notification of medicines shortages|
|Price Concession and NCSO Archive|
|REF: Drug Tariff Part II, Clause 8B and 9C|
The Department of Health has granted the following price concessions for May 2016:
The price concession only applies to the month that it is granted.
|Drug||Pack size||Price concession|
|Bumetanide 1mg tablets||28||£2.05|
|Celiprolol 400mg tablets||28||£39.65|
|Cimetidine 400mg tablets||60||£19.99|
|Desmopressin 10micrograms/dose nasal spray||60 dose||£24.00|
|Flecainide 100mg tablets||60||£10.73|
|Flecainide 50mg tablets||60||£7.50|
|Isosorbide mononitrate 10mg tablets (new)||56||£16.05|
|Isosorbide mononitrate 20mg tablets (new)||56||£10.50|
|Lamotrigine 5mg dispersible tablets sugar free||28||£7.50|
|Lamotrigine 100mg dispersible tablets sugar free||56||£3.60|
|Mefenamic acid 500mg tablets||28||£9.50|
|Nitrofurantoin 100mg tablets||28||£12.25|
|Nitrofurantoin 50mg tablets||28||£11.50|
Please note that PSNC cannot provide details of generic products that are suspected of being affected by generic supply problems unless and until the Department of Health grants a concession.
Updates on price concessions will be shown on this page or you can sign up to receive price concession alerts and updates by email.
All drugs listed in Part VIII of the Drug Tariff are eligible for price concessions and ‘No Cheaper Stock Obtainable’ (NCSO) status.
Occasionally there are shortages of these products, for example, if there are manufacturing problems or a change in demand, resulting in pharmacy contractors having to dispense an equivalent product that is only available above the set Drug Tariff price.
When this happens, PSNC is able to apply to the Department of Health for either a price concession or NCSO status for that particular month.
What is a price concession?
The Department of Health could consider setting a price concession for products listed in Part VIIIA and Part VIIIB where they are available above the set Drug Tariff reimbursement price. Pharmacy contractors will be automatically reimbursed based on the set price rather than the Drug Tariff listed price. There is no need for any endorsement.
Applications are made in month and once the price concession has been announced, it only lasts for the month in which it is granted. Where problems persist into the following month a new application is made. It is possible that a new concession will be granted by the Department of Health for subsequent months; however, these are subject to application and are not guaranteed.
The Department of Health set price concessions using information derived from manufacturers and wholesalers. Where contractors are unable to purchase products at the set prices, they may wish to challenge suppliers for an explanation of why their prices are so high. Where contractors are unable to secure products at or near the concessionary price, PSNC would like to receive copies of invoices for monitoring of prices. Please email these to firstname.lastname@example.org or fax to 0207 278 1127 for the attention of the Dispensing and Supply Team.
Reporting generic supply issues
If you have problems obtaining a Part VIII product at the set Drug Tariff price, please report the issue using our online feedback form. PSNC will investigate the extent of the problem and where necessary discuss the issue with the Department of Health.
Please note, PSNC is unable to provide details of generic products that are suspected of being affected by generic supply problems unless and until the Department of Health grants a concession.
Contractors will be alerted to any updates through our website and via our e-news email. You can subscribe to our mailing list by clicking here.
Sometimes a price concession or NCSO is granted late in the month, this is due to changing stock levels within the month. Contractors are advised to procure as economically as is possible for their individual businesses.
Q. How long do price concessions or NCSOs last?
A. If price concessions or NCSOs are granted, it is valid until the end of the month in which it was granted. PSNC needs to apply/re-apply for concessions on a monthly basis. If there is an on-going supply problem, it is possible that a new concession will be granted by the Department of Health the following month; however, this is not guaranteed.
Q. Why do contractors need to report generic shortages each month? If a price concession or NCSO is granted in one month and is still a problem in the next month why doesn’t the price roll over?
A. Price concessions and NCSOs only apply for the month in which they are granted. Because the market fluctuates on a regular basis in terms of stock levels and prices it would not be appropriate to roll the price over from one month to the next.
PSNC regularly monitors the market through contractor reports and communications with wholesalers. Where appropriate, we apply to the Department of Health for price concessions on products which aren’t available at Drug Tariff price. As stock levels and prices can vary across the country, we rely on contractor reports to help feed into our market surveillance and our discussions with the Department of Health. It is also important to note that the Department may not act on something unless contractors have reported it.
Q. Why aren’t price concessions or NCSOs granted on the first day of each month?
A. If there is a supply issue, PSNC needs to make a fresh concession application at the start of each month. The Department of Health then take time to undertake checks and make a decision. In some cases, there is a need for negotiation between PSNC and the Department of Health on an individual product’s circumstances; this can take time.
PSNC would like to see changes to the arrangements that would allow contractors to have certainty over what they will be reimbursed, much earlier in the month, a point which we have raised with the Department of Health.
Q. If a medicine is granted a price concession or NCSO , are all strengths of the product covered by the price concession or NCSO ?
A. No, concessions are granted to specific strengths of a product so contractors must check the latest list so they know which strengths have been granted a concession.
Q. What happens if a price concession is announced after the date that I have sent my EPS claim message to the Pricing Authority for an EPSR2 prescription?
A. Price concessions, once granted, apply for the whole ‘dispensing month’. For example a price concession announced on August 30th applies to the entirety of your August ‘prescription bundle’.
Your August prescription bundle is made up of all your paper prescriptions which are sent to the Pricing Authority by the 5th September and all the EPS prescriptions which fall into the August dispensing month (see below). Prescriptions for any one dispensing month are not priced until the Pricing Authority receives both the electronic and paper prescriptions as the FP34C submission document is needed from the paper bundle to calculate the advance payment for the contractor.
How a dispensing month is determined for electronic prescriptions is outlined below:
Q. I have received a prescription for ’28 x 5mg tablets’; however, there is currently a supply issue with that strength and we can only purchase it above Drug Tariff price. The 2.5mg strength is available and works out at the same Drug Tariff price so can I dispense ’56 x 2.5mg tablets’ instead?
A. No. Reimbursement will be based on the prescribed strength and quantity (Please note that the ‘PC’ endorsement is not a sufficient endorsement in this situation). If contractors believe it is in the patients best interest to ‘double up’ to support patient care, contractors are advised to return the prescription to the prescriber so they can make a clinical decision and if necessary amend the prescription to ensure correct reimbursement.
Q. I have been told by my wholesaler that a Part VIIIA licensed generic product is unavailable. There is not an alternative proprietary product available but a specials manufacturer can prepare this product for me. Can a price concession or NCSO be requested?
A. No. The Department of Health’s view is that the prescription should be referred back to the prescriber so that they have the opportunity to prescribe an alternative licensed product and/or are aware of the changes in liability caused by an unlicensed product being given to the patient. If the prescriber believes that the product should be specially manufactured, the prescription should be amended to specify “unlicensed special” within the product description. If the prescriber has stated the name of the specials manufacturer, the Pricing Authority will pay based on the endorsed invoice price for the specially manufactured product rather than the Drug Tariff Price. Remember that if the prescriber makes a hand written amendment or includes additional product information that does not appear in the product description (i.e. to provide a certain brand), the prescription must be included in the red separator.
It is helpful to inform the PSNC Dispensing and Supply Team about the shortage. If there is a long term supply problem, PSNC can make an application to the Department of Health to remove the product from the Drug Tariff.
Q. I have been presented with a prescription for a generic product but there is no generic available, only the brand. I have asked the prescriber if they would be prepared to reissue the prescription for the branded product instead but they have refused. Do I have to dispense the brand?
A. Yes, the current Terms of Service require pharmacy contractors to dispense drugs with “reasonable promptness” (see Terms of Service paragraph 5), therefore supply cannot be withheld on cost grounds.
However, where you become aware that a generic is not available to purchase or is not available at the Drug Tariff price, it is essential that you inform PSNC via the online feedback form on our website. Information received from pharmacies helps feed into our market surveillance and subsequent discussions on Drug Tariff changes with the Department of Health. It is imperative that PSNC is kept informed about such pricing anomalies, so that we can act to secure fair reimbursement for contractors.
Q. I have received a prescription for a Part VIIIB unlicensed medicine but cannot obtain it at the Part VIIIB price, what should I do?
A. Unless there are exceptional circumstances pharmacy contractors should be able to purchase the products in Part VIIIB at or below the Drug Tariff price. Pharmacy contractors will need to ensure they have considered a range of suppliers and where they are still having difficulties, pharmacy contractors should contact PSNC who will then be able to investigate the situation and apply to the DH for a price concession or NCSO if appropriate.
What is NCSO status?
No Cheaper Stock Obtainable (NCSO) status, is granted for products listed in Part VIIIA & Part VIIIB of the Drug Tariff where pharmacy contractors have been unable to purchase product at the set Drug Tariff reimbursement price.
Where a NCSO is granted, the reimbursement price is based upon the appropriate prescription endorsement rather than the fixed Drug Tariff price. However, it is essential that contractors endorse the prescription fully.
Applications are made in month and once the NCSO status has been announced, it only lasts for the month in which it is granted. Where problems persist into the following month, a new application may be made. It is possible that a new concession will be granted by the Department of Health for subsequent months; however, these are subject to application and are not guaranteed.
NCSO endorsing guide
Given the number of products in short supply at present, contractors may want to consider undertaking an additional check during their end of month prescription submission process, to ensure that all prescriptions have been endorsed correctly, where necessary. Key things to consider:
- The NCSO is granted at different times during the month; have staff been giving consideration to whether the concession needs to be claimed for all products on the NCSO list?
- Where staff have endorsed to claim the NCSO, does the endorsement include all of the necessary information? In checks PSNC has undertaken on endorsing practice, the most common omission is the initial for the dispenser (any authorised staff member can add the initial, it doesn’t need to be the pharmacist. The initials can be computer generated).
- If the Pricing Authority do not have a price on their system for the endorsed brand or supplier, the endorsement must also include the price paid (before discount and ex VAT). An indication of which suppliers are listed on the NHS RxS system for a particular product is available through the Dictionary of Medicines and Devices browser.
- The Pricing Authority will only reimburse based on an NCSO endorsement where a prescription has been submitted in the month that the NCSO has been granted. Care should be taken to ensure that prescriptions dispensed in a particular month are submitted with that month’s prescription bundle.
For further information, see our guidance on NCSOs: NCSO Endorsement Guidance and FAQs (May 13).
NCSO Endorsement FAQs
Q. Do I need to include the name of the supplier or is just the price acceptable for NCSO endorsements?
A. It is essential to endorse the following:
- Pharmacist initials
- Supplier, manufacturer or brand name;
- Pack size
- Price if appropriate
If this information is missing, even if a price has been endorsed, the NCSO claim will not be accepted by the Pricing Authority.
Q. Does it need to be the pharmacist that initials the NCSO endorsement?
A. No, it can be any staff member who has been authorised by the pharmacy owner. It doesn’t need to be the pharmacist.
Q. Is it acceptable to provide a fully computer-generated NCSO endorsement or do any parts of this endorsement need to be handwritten?
A. It is acceptable for the NCSO endorsement (including the date and initials of the staff member making the endorsement) to be computer-generated.
Q. Can I endorse ‘NCSO’ for any item I am unable to purchase at the Drug Tariff Part VIII price?
A. No. No Cheaper Stock Obtainable (NCSO) products are items for which in the opinion of the Secretary of State for Health and the Welsh Ministers there is no product available to contractors at the price in Part VIII of the Drug Tariff. In this scenario the Pricing Authority will only reimburse based on a full NCSO endorsement against those items which have been granted this status.
Q. Can I endorse that I have given a branded product against a prescription for the Part VIIIA generic item and be reimbursed for doing so?
Contractors will only be reimbursed for a branded equivalent if the NCSO has been granted for that product in that dispensing month, and the prescription has been endorsed fully to claim the concession (see endorsing guidance above).