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Welcome to our second edition of our new and improved quarterly bulletin. So much has happened in the last quarter both industry wide

and here at Forte, meaning that this edition is packed to the rafters with updates and information.

Where to start?

No matter on which side of the debate you sit, and where politicians stand on the issues, both FMD and Brexit are looming ominously on the horizon. We and Alliance Healthcare will be offering help and advice in the coming weeks and months to ensure you are all prepared for the eventual launches.

In other news The Department of Health has announced an increase of Category M reimbursement prices from August 2018. Read on for the announcement from the PSNC regarding how this can help you increase your profitability. See more information below.

Speaking of increased profitability,

As of 1 September 2018, we are improving our

membership model. Some of you would have already received letters about this and you will start to receive your enhanced baseline terms from the 1 September without having to lift a finger. We will also be launching a range of new and improved schemes for all your purchases, RWA, specials PIs and generics so make sure you speak to your BDM to take advantage of these exclusive member offers.

Lastly, soon we will be launching our new and improved Forte website, where you will be able to order your OTC purchases online as well as access all your reporting, purchase breakdowns, membership messages and news and views in one place. Your BDM will be in touch to run through improvements once the new site is live.

More exciting membership enhancements to be announced and launched throughout the rest of the year, because ‘your practice matters’.

September 2018

PRACTICE MATTERS

The near death experience that House of Fraser went through last week shows the immense pressures on retail businesses to survive the current change in customer buying habits with the shift to e-commerce. House of Fraser with all its significant heritage of over 169 years of being in business did not invest to defend its business from the disruption caused by the growth of internet shopping.

The internet will continue to cause significant disruption as consumers and patients alike seek an easier way to access goods and services they want. Internet retail sales in the UK now account for 18.2% of all the total sales made - one of the highest in the world, and these sales are growing at over 15% per year. Therefore this shift to e-commerce cannot be ignored.

Turning to the prescription market, it is probably no surprise that biggest pharmacy in England by prescription numbers is Pharmacy2U, it now dispenses over 10 times more prescriptions every month than the second place pharmacy. How has Pharmacy2U been able to build such a huge prescription business? By using the internet has allowed Pharmacy2U to offer its services to patients all across the country. However, the real reason for the

Bricks versus Clicks: How Can Your Practice Keep A Growing Prescription Business

The Forte Team

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growth in distance selling pharmacies has been the uptake of electronic prescribing services (EPS). A recent NHS Digital headline stated that now all the 1,311 eligible GP practices in London are now using the electronic service for prescribing. This growth in practices using EPS is allowing Pharmacy2U to gain over 2,500 new EPS new nominations each week, and now it has amassed over 250,000 patients’ nominations, up from 120 thousand a year ago 1.

We (dispensing doctors) as a health care business provide both prescriptions and patient consultation services, will need to embrace this technology change to make it easier for our patients to access the services they need from us. You are already providing online access to patients for booking appointments and ordering their repeat medications, and in some areas using e-consultations with patients. However the competing pharmacies in addition offer reminder notifications and one click ordering of prescriptions with free delivery of medicines direct to the door.

So what more can you do to ensure that your patients choose their practice to dispense their regular prescriptions?

Firstly, do what a business with a quarter of a million customers can’t do, focus on achieving a quality relationship with your patients. It is key to provide a personal experience where you ensure that you identify and meet your patient’s needs. Online ordering is simple and time efficient for some, but there will be a growing number who will need greater support perhaps telephone ordering, or being part of a dispensary repeat management scheme.

A fundamental for the provision of a quality bespoke service to patients is to invest in good training for all your dispensary staff.

Most dispensing practices will offer a delivery service to patients, and because free delivery is a fundamental part of the offer I believe that all dispensing practices should provide this service. A delivery service could focus on the housebound or for patients who have difficulty getting to the practice when you are open. Above all whether patients require delivery of their medicines or choose to collect them is to ensure their experience of accessing their medicines is simple and trouble free.

Large internet businesses invest in huge advertising campaigns to talk directly to prospective patients, often they selectively target the patients that are most likely to become a regular customer for example diabetics. We should not be afraid of speaking up for our dispensary businesses, messaging patients in waiting rooms, patient newsletters and through word of mouth so patients understand what services we offer. Part of the key messages could be the positives of using local businesses.

The above provides a few ideas on how you can support the continuing growth of your dispensary business. Above all your aim should be to build a quality relationship and provide a bespoke service offer to patients, giving them simple and easy access to their prescriptions medicines.

Mark Stone, Pharmacist Partner Tamar Valley Health, DDA Board Member

1 NHS Digital August 2018

Teva UK Limited Dispensing Doctors Respiratory discount schemeAs Teva UK Limited continue to support our dispensing doctor customers, we are pleased to offer the following discount scheme across branded inhaler purchases.

▸ Available through your preferred wholesaler

▸ Discounts applicable from pack 1

To participate in the scheme and for further support please contact your local Teva representative or alternatively email tevauk.marketinggeneral@tevauk.com

Alternatively contact your wholesaler for further information and direction

Brand Device Generic name Dose Discount from list

Aerivio® Spiromax® salmeterol/fluticasone propionate 50mcg/500mcg per metered dose 30%

DuoResp® Spiromax® budesonide/formoterol fumarate dihydrate 160mcg/4.5mcg per delivered dose 30%

DuoResp® Spiromax® budesonide/formoterol fumarate dihydrate 320mcg/9mcg per delivered dose 30%

Braltus® Zonda tiotropium bromide 10mcg per delivered dose 25%

Qvar® MDI beclometasone dipropionate 50mcg per metered dose 40%

Qvar® MDI beclometasone dipropionate 100mcg per metered dose 40%

Qvar® Easi-Breathe® beclometasone dipropionate 50mcg per metered dose 30%

Qvar® Easi-Breathe® beclometasone dipropionate 100mcg per metered dose 30%

TevaUKLimited,RidingsPoint,WhistlerDrive,Castleford,WF105HXUnitedKingdom. Approval code: UK/RESP/18/0006. Date of preparation: July 2018

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At this time off the year, I am always trying to come up with new ideas and patient groups to include into our DRUM search. That is why when I came across this advice below I thought it would be useful to include patients that are using Paraffin- based emollients into this year’s DRUM review.

This advice posted by the Medicines Healthcare products Regulatory Agency (MHRA) and is for patients using Paraffin- based emollients

Drum Review For Patients Using Paraffin-Based Emollients

Paraffin-based skin emollients on dressings or clothing: fire risk

Skin creams containing paraffin have been linked to dozens of fire deaths across England. Since 2010, 37 deaths have been linked to paraffin-based products but the actual figure is thought to be far more. The products for conditions like eczema and psoriasis can leave people at risk of setting themselves ablaze.

If people use the emollients that contain paraffin regularly but do not often change clothes or bedding, paraffin residue can soak into the fabric, making it flammable.

The medicines regulator has updated its guidance and says all creams containing paraffin should carry a warning.

As healthcare professionals we should:

▸ Advise patients not to smoke; use naked flames (or be near people who are smoking or using naked flames); or go near anything that may cause a fire while emollients are in contact with their medical dressings or clothing.

▸ Change patient clothing and bedding regularly because emollients soak into fabric and can become a fire hazard.

▸ Incidents should be reported to NHS England’s Serious Incident Framework (includes Wales).

What can we do?

▸ Identify patients using paraffin-based products.

▸ Explain the fire risk.

▸ Identify if they are smokers.

▸ Give partial advice to patients who smoke and support to stop smoking.

▸ One the first dispensing of a paraffin-based product we should give advice and counselling the patient and/ carers.

▸ We should also check on any subsequent occasions that this advice has been understood.

▸ Offer an alternative skin treatment if possible where people smoke, and/or have a condition which places them at increased risk of fire such as memory loss, poor concentration or drowsiness.

▸ Advise washing fabrics at the highest temperature possible, this will reduce the paraffin contamination but not totally remove it.

▸ When placing dispensing labels on products, take care not to cover fire safety warning.

Please see below other resources, which dispensaries may find helpful, include:

▸ www.gov.uk GOV UK website about Paraffin-based skin emollients on dressings or clothing: fire risk

https://www.gov.uk/drug-safety-update/paraffin-based-skin-emollients-on-dressings-or-clothing-fire-risk

▸ www.dispensingdoctor.org Dispensing Doctors Association Fire dangers of paraffin-based skincare products

https://www.dispensingdoctor.org/news/fire-dangers-paraffin-based-skincare-products/

By Hazel Harris, Dispensary Manager & Trainer, Wye Surgery

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CATEGORY M REIMBURSEMENT PRICES

The Department of Health has announced an increase of Category M reimbursement prices from August 2018.

Contractor Information

Category M reimbursement prices will increase by £15 million a month from August 2018, the Department of Health and Social Care (DHSC) has confirmed.

The increase is because DHSC has agreed to cease the £15 million per month reduction in prices that had been in place to recover estimated excess margin delivered to pharmacies in 2015/16 and 2016/17.

These reductions had been in place since August 2017 and had been set to continue. This was because the latest Margins Survey results from 2016/17 suggest that there was over-delivery of margin in that financial year, with some excess yet to be recovered by DHSC.

The decision to cease the Category M price reductions to recover margin now was a result of negotiations with PSNC in which we raised concerns about the impact of price reductions on contractors’ cash flow.

However, underlying Category M prices will continue to be based on manufacturers’ data so prices will still reflect the lower purchase prices that led to the additional reduction in prices seen in the July Tariff.

The Category M reimbursement price list for August 2018 can be found here. Prices have been uplifted by an average of 16% which equates to an increase in Average Item Value (AIV) of between 19 and 20 pence per item on all items.

PSNC Director of Pharmacy Funding Mike Dent said:

“The decision to cease margin recovery in the short-term in light of PSNC’s representations about contractors’ cash flow is very positive and reflective of the collaborative relationship that we are trying to rebuild with the DHSC.

PSNC will be working, through the negotiations on funding and in discussions with the Department, to get the best possible deal for contractors and to ensure that any future mechanisms to correct margin delivery are as manageable as possible in terms of cash flow.”

This was discussed at PSNC’s July 2018 meeting. A summary of all the topics discussed at that meeting is available here:

▸ http://psnc.org.uk http://psnc.org.uk/our-news/psnc-july-meeting-summary-for-contractors-now-available/

We are gearing up for FMDFrom 9 February 2019, community pharmacies, hospitals and dispensing medical practices must start authenticating any new packs of prescription medicines that have the safety features, as part of the dispensing process. The European Falsified Medicines Directive aims to reduce the number of potentially falsified medicines entering the European medicines supply chain.

We have produced a comprehensive pack for all dispensing doctors informing them of what FMD means to them, what they need to do to prepare themselves for 9 February.

Find out more about the support we are giving to dispensing doctors.

You can visit the new FMD site here: http://www.alliance-healthcare.co.uk/fmd

We will be regularly updating this site as the FMD programme progresses.  

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FREQUENTLY ASKED QUESTIONSOur Forte Team share their answers to your top questions in this issue.

Q. What is happening to Category M reimbursement prices in August?

A. Category M prices are affected by two factors:

▸ the underlying manufacturers’ data;

▸ and the margin required to make the supply chain work effectively in August. The underlying prices will carry on at levels introduced in the July tariff, but prices will increase because the margin recovery has been removed. Prices will therefore be £15 million higher than they would otherwise have been had Department of Health and Social Care (DHSC) not agreed to suspend the recovery.

Q. For what months will these prices apply?

A. There will be a new Drug Tariff for August which will spread the £15 million uplift (because margins recovery has ceased) across the Category M products. This will apply for September as well.

Q. What will happen to prices from October?

A. In October there will be a new drug tariff based on manufacturers’ data.  At the moment the timing or quantum of any future adjustments are not known.

Q. How much excess margin has still not been recovered by DHSC?

A. The results of the margins surveys for 2016/17 and 2017/18 are still being analysed and discussed with DHSC. The survey for 2017/18 is taking far more work than usual because of the need to deal with the many price concession lines set throughout the year.

Q. Is there any update on the funding negotiations and

how does all this feed into those?

A. There is no update – funding negotiations for 2018/19 have not yet begun. The changes to Category M prices are part of PSNC’s ongoing work to ensure that the full amount of community pharmacy funding is delivered to contractors. You can find out more information here: https://psnc.org.uk/our-news/category-m-reimbursement-prices-to-increase-from-august-2018/

If you have a question contact us:

▸ E: info@forte.uk.com

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MANUFACTURER UPDATE

Astellas PharmaWe are pleased to inform you of changes to the Astellas Pharma Manufacturer’s Discount Scheme.

The table below shows the new dispensing discounts that will be active from 1 August 2018. Please note volume related discounts have been removed for BETMIGATM and VESOMNITM and replaced with flat discounts available on every pack.

From 1 August 2018, these discounts will be applied on invoice and not as a monthly rebate.

Product Pack size Strength List priceDispensing discount %

DTP discount %

Total savings per pack

BETMIGA TM (mirabegron) 30 25mg or 50mg £29.00 3% 8% £3.19

FLOMAXTRA XL TM (Tamsulosin hydrochloride) 30 400mcg £10.47 30% 8% £3.98

VESOMNI TM (Tamsulosin hydrochloride/ solifenacin succinate) 30 400mcg/6mg £27.62 3% 8% £3.04

As shown in the table, all of these products above are also subject to an 8% “Direct to Pharmacy” (DTP) discount through Alliance Healthcare.

These discounts are for dispensing practices who have signed up to the scheme. Astellas Pharma Ltd reserve the right to amend or withdraw the discount scheme at any time without prior notice.

If you would like to discuss this further, or you have any questions regarding this scheme, please contact commercial@astellas.com or speak to your local Astellas representative.

Solaraze Almirall has announced an increase of the discount on both Solaraze 50g and 100g presentations.

The discount will now include 15% discount from 5+ packs from the 1st of May 2018, and an additional 5% discount is also available for a volume purchase of 25% or more between 1st April and 30 September 2018* each month compared to the same period last year. The additional discount will be paid through the MDS on monthly bases as a rebate.

Product PriceWholesale discount

MDSMax total

profit

SOLARAZE 100g £76.60 7.5%1-4 = 12.5%

5+ = 15%£14.49**

SOLARAZE 50g £38.30 7.5%1-4 = 12.5%

5+ = 15%£8.24**

Based on purchasing data in June 2017

**Total profit calculations assume 11.18% clawback and £1.98 prescribing fee and includes MDS and WD

To find out more please contact Forte on 0370 2418717

A representative will be in touch to discuss how you can save money and increase profitability on the Almirall Manufacturer discount scheme.

Sandoz As from the 1st June 2018, Sandoz have discontinued the discount scheme for Reletrans Trans Patches.

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MDS AdditionsSupplier PIP

codeProduct

description Alliance discount

Bayer 031-7081 DIPROBASE CREAM50g 1-4 = 0%5-9 = 14.5%10+ = 27%

Bayer 040-2495 DIPROBASE CREAM 500g 1-4 = 0%5+ = 14.5%

Bayer 040-2503 DIPROBASE OINT 500g 1-4 = 0%5+ = 14.5%

Scope Ophthalmics 407-5099 KETOFALL UD 0.025% 14%

Qdem 404-7502 ZYTRAM TAB 75MG (Tramadol Hydrochloride) Individual discount enquiries@qdem.co.uk

Qdem 404-7510 ZYTRAM TAB 100MG (Tramadol Hydrochloride) Individual discount enquiries@qdem.co.uk

Qdem 404-7528 ZYTRAM TAB 150MG (Tramadol Hydrochloride) Individual discount enquiries@qdem.co.uk

Qdem 404-7536 ZYTRAM TAB 200MG (Tramadol Hydrochloride) Individual discount enquiries@qdem.co.uk

Your Practice Matters MeetingsOur two latest Your Practice Matters meetings took place on 5 June 2018 at Pontlands Park Hotel, Essex and 5 July 2018 at Mercure Hotel, Kent. Richard West, Chairman of the DDA was our main speaker and discussed Future challenges and opportunities for dispensing Doctors. Discussion focussed on the reduced profitability earlier in the year, FMD and Brexit.

Feedback suggested that both these events were a fantastic success with our delegates getting a lot of value from Richards’s talk, and the buffet.

We will be continuing these with a full national roadshow planned for 2018/19 and we will be announcing dates soon.

We’re helping you to save timeWe know your time is precious, that’s why we’re working on ways to reduce call waiting times for you and your dispensing staff, so that you can spend more time helping patients and customers.

It’s quick, easy and secure to order electronically through your PMR system or through Alliance Healthcare Direct, our online ordering platform. Depending on your requirements, PMR ordering can potentially save you money via the correct cascading and purchase options. By ordering online, you’ll get an instant stock response outside of customer service hours and it also helps with our efforts to improve availability of our customer service teams - for when it really matters.

As well as our ongoing service improvement, we’ve also invested time and resource to optimise Alliance Healthcare Direct and can provide accurate and reliable stock status updates every 10 minutes. Just one of the many ways we’re making doing business with us easier. You asked – we’ve delivered.

Visit our website – alliance-healthcare.co.uk/doingthingsdifferently – for more information

We’re doing things differently

T 0370 241 8717

E info@forte.uk.com

W forte.uk.com

Alliance Healthcare (Distribution) Limited trading as Forte A company registered in England and Wales.

Registered Office: 43 Cox Lane, Chessington, Surrey KT9 1SN. Company Registration Number: 4023414