dr philip koopowitz norfolk dispensing gp dda board member ... · dr philip koopowitz norfolk...

Challenges Facing Dispensing Practices

Dr Philip Koopowitz

Norfolk Dispensing GP

DDA Board member

[email protected]

EPS

Dm+d Browser

Prescribing Smart

Profit

Dispensing Smart

Price Concessions

Ideal Dispensing Purchasing

Generic vs Brand

EPS

• Protecting your practice

• Threat from Internet retail type services

• DDs will need to raise their game

• EPS is currently not available for nomination to dispensing practices

• Dispensing patients can nominate a pharmacy and not lose their dispensing status for the future

EPS

• Do not buy any EPS software yet – even if they claim to be FMD compliant

• Stop the leak of patients to APPs which direct them to pharmacies

• Healthera – bespoke dispensing doctor solution

Profit

Dispensing profit

Accounting profit = Gross dispensing profit

NHSBSA PS payment MINUS Cost of Drugs (after discounts taken off)excluding VAT (except for PAs)

(This excludes staff costs and service charges)

Gross dispensing profit = in £ or % Profit

Accountants normally compare percentage profit across the dispensing doctors they deal with

17/18 tax year -decreases in percentage profit of 4-8%

Decreases in actual profit have been eye watering

Profit

Dispensing profit Vs Profit per dispensing patient

I have seen figures from as low as £30 per dispensing patient and you should be aiming for at least double that and more

Profit

Factors affecting Dispensing Gross Profit – Income

• Dispensing fees and clawback

• Loss of business – to local pharmacy, to internet pharmacy (EPS) *

• Drug tariff prices– Category M

– Price concessions

– CCG pressure

– Script changes *

Profit

Prescribe by Branded Generic or Generic?

Some CCGs push Branded generics which have a lower price than

the Tariff generic


• Branded generics cost the NHS more in the long run, even if in the short term they make savings for your CCG


• Annual Margins Survey for Community Pharmacy Contractual Framework (CPCF)

• Brands and branded generics contribute to Margins Survey

• They are assumed to have lower discounts than Generics, thus decreasing the Profit

Margin throughout Pharmacy


• Margins Survey should deliver Fixed Profit margin across all of Pharmacy

• If Margins survey shows a smaller than expected profit margin, then reimbursement for pharmacy will increase to try balance the

overall Profit Margin


• Pharmacy discount clawback will be decreased, pharmacy fees adjusted upwards to try offset the decreased Profit Margin, thus costing the NHS

more in the long run.


• Net effect is an overall INCREASEin Medicines Management spend

for the whole NHS!


Examples of CCGs directing to prescribe by brand

Prescribe DispenseBasic price Profit

Glucophage SR Tab 500Mg £5.32 £1.37Sukkarto SR 500Mg £3.46 -£0.39Bolamyn 500mg £6.40 £3.69Metformin 500mg MR Bolamyn £5.32 £2.74Metformin 500mg MR Sukkarto £5.32 £1.27


Prescribe Sukkarto – for 50 scriptsImmediately save your CCG £93

Lose your practice £156

Long term Adjustments because Metformin MR

prescribed by brand will increase NHS drug budget by > £93 after Margins Survey


Examples of CCGs directing to prescribe by brand

Prescribe BP Profit

Fenbid £1.50 -£0.14

Ibugel £4.87 £0.04

Ibuleve £6.80 -£0.76

Ibuprofen Alliance £2.26 -£0.25

Phorpain £0.89 -£0.10

Ibuprofen generic £2.34 £1.33


Prescribe Fenbid – for 100 scripts

Immediately save your CCG £82Lose your practice £147

Long term Adjustments because Fenbid prescribed by brand will increase NHS drug budget

by > £82 after Margins Survey

Factors affecting Dispensing Gross Profit – Drug costs• Prescribers

• Practice formulary

• CCG Formulary

• Hospital prescribing

• Discounts

• Generic buying

• Use of PIs

• Ignorance!

Profit

Prescribing Smart

• Generics where possible

• Add generics manufacturer if needed –initial changes

• Class effect – look for win wins

Prescribing Smart

• Review clinical areas

• Clinicians must agree Formulary

• Assess each class of drug for cost effectiveness

Prescribing Smart

• Class Effect – Gliptins

• Linagliptin (Trajenta ®) discount slashed from 1 Oct

• Trajenta® - Basic price = £33.26

• Profit used to be £ 2.93 per pack

• Now make a LOSS of £0.39 per pack

Prescribing Smart

• Alogliptin (Vipidia)® costs the NHS £26.60 -

£6.66 per pack less pm than Trajenta ®

• Alogliptin (Vipidia)®makes the dispensary £7.67 per pack

This is £8.06 better than Trajenta ®

Prescribing Smart

• Case study

– 25 patients on Trajenta ®

– Changing 20 of the patients on Trajenta ® to Vipidia® over 3 months – face to face by Diabetes nurse

– Average increase in profit per patient is £8.06 pm

–£1 934 increase in profit pa

– Average saving for NHS is £6.66 per patient pm

–£1 598 savings for NHS pa

Dispensing Smart

Brand Prescribed

Dispense:

▪UK Brand

▪ Parallel Import

Dispensing Smart

Brand Prescribed

DDs can change script to:

▪ Branded generic (including Generic plus manufacturer)

▪ Different brand

▪ Generic

Dispensing Smart

Generic Prescribed

Dispense:

▪UK Brand

▪PI Brand

▪Branded generic

▪Generic

Dispensing Smart

If you Change script to:

▪ Brand (UK or PI)

▪ Branded generic

▪ Generic plus manufacturer

▪ The doctor MUST initial

all changes

Teva/Actavis etc

Sildenafil 100mg tabs x 28 tabs

Difficulties with purchasing

• Too many ordering portals – solus

• Withdrawal of discounts

• Generic pricing

• Parallel Imports

• Price on the screen may be hiding true price

• Lack of transparency with discounts

– Including or excluding Wholesalers Discount

Not all Zeros are HeroesBP AD WD

ZeroAQS 500g £3.29 15.00%

Zerobase 50g £1.04 15.00%

cream pump 500g £5.26 15.00%

Zerocream500Mg

500g

£4.08 15.00%50g

£1.17 15.00%

Zeroderm 125g £2.41 15.00% 12.00%500g

£4.10 15.00%

Zerodouble 100,475, 500g £4.71 15.00% 12.00%Zeroguent 100g £2.33 15.00%

500g £6.99 15.00%

Zerolatum 500Ml £4.79 15.00%

Price Concessions

• Normally category M prices that have been slashed and manufacturers are unable to provide at such a low cost.

• Concessions are added to Drug Tariff throughout the month (and sometimes later) and will be paid ONLY in the month which the script was sent to NHSBSA.

Price Concessions

• October 2018 –

– 86 generics lines cost more than the Tariff price

– 201 generic lines cost more than Tariff minus Clawback

• Losses range from 1 p to £28.00 - Risperidone 4mg

– DT = £1.95

– Reimbursement price (DT – Clawback) = £1.74

– Purchase price = £ 29.99

Prescribe by Brand/Branded generic or Generic plus manufacturer and ensure any changes to script are made within main body of the script and all endorsements are initialled by the person signing the script – use dm+d to check reimbursement price you will get.

Price Concessions

.

Price Concessions

Risperidone 4mg tabs x 60 tabs

Teva/Accord etc

dm+d Browser

• Drug tariff price

• Brand price

• Branded generics price

• Generics (endorsed) price

• Personally administered items

• Zero-discounted items (for pharmacy)

• Number of prescription charges

• Number of Dispensing fees

• Price drugs not in Drug tariff

VMP vs AMPVMP= Generic name

AMP = Brand or Branded Generic

AMP = Actual Medicinal ProductCategory C - DT

•Brands eg Glucophage SR 1000

•Branded generics eg•Bolamyn SR 1000•Metabet SR 1000•Metformin 1g MR (Actavis)•Metformin 1g MR (AAH

Pharmaceuticals)

VMP = Virtual Medicinal Product

Generics – Drug Tariff price

Metformin 1g MR tablet = October 2018

= £8.52 – Category C – Drugs that are NOT readily available as a generic

Cat C products often have the leading brand name against them and are priced at that brand price.

dm+d Browser

• Drug tariff price –• Product- generic name

•Tick VMP and click Search• In Left hand pane (VMP) click on the [+] of the strength you require

dm+d Browser

• Drug tariff price –• Product- generic name

•Within the (VMPP) box Click on View against the pack size you wish to check and the box below will give you the Drug tariff price.

dm+d Browser

• Brand and Branded generics price –• Product- Brand name

• Tick AMP and click Search

• In Right hand pane (AMP) click on the [+]of the Brand and strength you require

dm+d Browser

• Brand and Branded generics price –• Product- Brand name

• Within the (AMPP) box Click on View against the pack size you wish to check and the Product Information box below will give you:

• The Basic Price (exl Clawback)• Number of Prescription charges• Number of Dispensing Fees• Attracts an Administration Fee – PA• Discount Not Deducted – ZD (for pharmacy)

Prostap

Elleste duet

Scholl stockings x 2

Drugs not in Drug tariff

dm+d Browser

•https://apps.nhsbsa.nhs.uk/DMDBrowser/DMDBrowser.do#product

https://apps.nhsbsa.nhs.uk/DMDBrowser/DMDBrowser.do#product


✓Transparency

✓ Single ordering portal

✓The price you see is the price you pay

✓Best possible generic pricing across basket of generics


✓Use PIs – but only where they are more profitable than UK brands

✓Block OOS products going to Second and Third Line to avoid low cost surcharge

✓Avoid rogue ordering


✓Discount off invoice

✓Find an easy way of keeping up to date with all new discounts

✓Find an easy way of keeping up to date with all withdrawn or decreased discounts

✓Comparisons of alternatives when discounts withdrawn or decreased


✓Monthly updates on which Generics are obtainable at greater than tariff price

✓Monthly updates on different drug groups and their profitability


• Utopia is within reach, but requires YOU to do something about it

• Take action and start looking after your dispensary, because it is looking after you!

??QUESTIONS??

Thank You

dr philip koopowitz norfolk dispensing gp dda board member ... · dr philip koopowitz norfolk...

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