Community pharmacy contractors are facing a cash crunch due to atorvastatin shortages, a C+D snapshot poll has revealed.

Of the 182 responses received, 47% said that they were facing losses of over £1,000 from dispensing the medicine in July.

Almost a third (31%) of respondents said that they faced losses of up to £1,000, while 22% said they were not losing money from dispensing atorvastatin.

Read more: Atorvastatin: DH ‘closely monitoring’ situation amid 'supply constraints'

The NHS Business Service Authority’s (NHSBSA) July drug tariff update set out that the Department of Health and Social Care (DH) would reimburse:

• Atorvastatin 10mg tablets 28 at £1.65
• Atorvastatin 20mg tablets 28 at £3.38
• Atorvastatin 40mg tablets 28 at £2.25
• And atorvastatin 80mg tablets 28 at £3.45

However, the cost to contractors for these has been significantly higher than the reimbursement provided by the government.

Atorvastatin is one of the most popular medicines in the UK, with more than five million items prescribed in May 2023, according to Open Prescribing data – a project built by the Bennett Institute for Applied Data Science at the University of Oxford using NHSBSA data.

 

“Sector lost out on millions”

 

Mike Hewitson, an independent contractor, told C+D on Friday (July 28) that at one of his pharmacies, the loss from dispensing atorvastatin would “easily be a four-figure loss” for the month of July.

Mr Hewitson called on the DH to issue a serious shortage protocol (SSP) “today” and said that an investigation should look into “supply chain behaviours”.

Read more: Prescription costs up 8% to over £10 billion in England, NHSBSA reveals

Also speaking to C+D on Friday, superintendent pharmacist at Knights Pharmacy Pete Horrocks estimated that “the sector will have lost out on millions this month on just one drug”.

Mr Horrocks said that the atorvastatin situation was a “nightmare” as the drug was not available to purchase at the concession price.

“The price concession mechanism is broken,” Mr Horrocks told C+D. “Contractors should not be responsible for funding the NHS when supply chain issues occur.”

 

“Workload impact”

 

Mr Hewitson said that the major consequence stemming from the atorvastatin crisis was the “workload impact”.

He said that “hundreds of man hours” had been wasted in July tracking down prescriptions and communicating the problems to patients, instead of providing core services. 

Mr Horrocks faced similar problems, adding that time wasted “trying to obtain stock” means that “pharmacy staff are losing vital time away from dispensing and direct patient care”.

 

Unclaimed scripts

 

Pharmacy contractor Waqas Ahmad highlighted a further issue, pointing out that if atorvastatin is outstanding on a prescription, then “the rest of the script can't be claimed either”.

He told C+D that pharmacists are having to resort to marking scripts as “not dispensed” so that they can claim the rest of the script to avoid “a massive loss”.

Read more: Atorvastatin most-dispensed drug in community for second year running

Mr Hewitson echoed Mr Ahmad’s concerns, saying that along with the “immediate cash loss” on buying atorvastatin for more than the concession price, “we also have the potential for another 1,800 items that won’t be claimable this month”.

He estimated that £15,000 had been supplied for which the pharmacy cannot claim payment – in addition to another “£15,000 outstanding from the previous month” – he added.

 

CPE: Concessions “imposed”

 

It comes as CPE yesterday (August 1) issued a price concessions update for July, in which it described the “very late” publication of the final price concessions, some of which it said were “imposed”, as “frustrating”.

The negotiator said that pharmacy contractors had been “deeply concerned and frustrated” about atorvastatin and that it had submitted price concession requests for the medicine at the start of the month.

Read more: Feeling the pinch: How funding cuts are leaving contractors out of pocket

CPE added that the DH had not issued “central communications or SSPs” that could help pharmacies, nor contacted GPs so that they might prescribe alternatives to atorvastatin.

It conceded that the concessions for atorvastatin 10mg and 40mg were “high enough” to cover costs for “the vast majority of pharmacy owners” that report prices to the negotiator, but said that the concessionary prices for 20mg and 80mg were “imposed” by the DH.

The negotiator said that its “next steps” would include asking for an “exceptional back-dated uplift” on “some July concession lines”.

 

DH: Aware of supply constraints

 

A DH spokesperson told C+D yesterday that concessionary prices “have been granted for all four strengths of atorvastatin for July 2023”.

“We are also working on a package of reforms to further support equitable access to medicine margin for pharmacy contractors while improving value for money for the NHS,” they said.

Read more: PSNC ‘deeply concerned’ as pharmacies contend with record price concessions

And they added that reimbursement arrangements, such as the medicines margin and concessionary prices, are “in place to ensure contractors are paid fairly for the medicines they dispense” and “specifically designed” to avoid them “dispensing at a loss”.

They reiterated that the DH is “closely monitoring” supply issues around atorvastatin, after CPE raised “pricing and availability” concerns.

An SSP was most recently issued for atorvastatin in November 2022, but this was withdrawn on January 27 this year.