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Category M reimbursements fall £28m, despite 54 products added

Category M reimbursements have fallen almost £28 million over the past three years, according to Sigma Pharmaceuticals.

Speaking at the Avicenna conference in Vietnam yesterday (October 24), Sigma managing director Bharat Shah presented figures compiled by the pharmacy wholesaler, which revealed a 20% reduction in overall category M reimbursements between 2014 and 2017.

This drop had occurred while the total number of products in category M of the drug tariff grew by 54, according to Sigma’s figures, as a result of 83 products being added and 29 removed.

This added a net value of £6.6m to the category, Mr Shah showed delegates.

“Where has the money gone?”

In July 2014, there were 557 products in category M, reimbursed to the value of £140m, Mr Shah pointed out.

By October 2017, this had risen to 611 products – even though total reimbursement for the category had dropped to the current level of £112m.

This shortfall of almost £28m led Mr Shah to ask: “Where has the money gone?”

“It’s gone when [branded] products have come off patent,” he explained. “These products [had] been very profitable for pharmacy businesses.”

Mr Shah pointed to pricing changes prompted by Lyrica losing its patent for neuropathic pain in July 2017, followed by pregabalin entering category M a month later.

This meant contractors “really saw the effect” when “there was £180m taken from the system by the government in one swipe” as part of the category M clawback announced in July.

On Monday (October 23), PSNC referred to drug tariff reductions as one of the reasons it had asked pharmacy minister Steve Brine to agree a 15p rise in advance payments for contractors in November.

Have you noticed a drop in category M reimbursements?

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