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Boots and Alliance deny allegations of colluding on specials prices

Walgreens Boots Alliance said it has met with the DH to discuss specials
Walgreens Boots Alliance said it has met with the DH to discuss specials

Boots and Alliance Healthcare's parent company has “firmly rejected” allegations that both companies colluded to overcharge the NHS for a specific specials product.

According to an investigation by The Times – published on Friday (May 25) – between 2013 and 2017 Boots ordered cocaine mouthwash – used to treat patients with severe sores caused by chemotherapy – “at least five times” from Alliance Healthcare, charging between £1,843 and £3,220 on each occasion.

According to The Times, in 2013 Boots charged the NHS £3,219 for three 200ml bottles, then £3,220 for the same amount on another occasion. Last year, it charged £1,843 for 800ml, then £1,989 for 800ml and £6,374 for 2.6 litres.

Three 200ml bottles had been bought by other pharmacies for as little as £93.42, The Times alleged.

A spokesperson for parent company Walgreens Boots Alliance told C+D this morning (May 29) that it “firmly rejects accusations of overcharging the NHS” and claimed Boots and Alliance Healthcare “fully comply with all applicable legal requirements” in the UK (see their full response below).

Responding to the allegations in The Times, pharmacy minister Steve Brine said: “The British public will take an extremely dim view of any company found to be exploiting our NHS and patients, and we have asked the Competition and Markets Authority (CMA) to consider investigating as a priority.”

The government has recently changed the law “to enable us to place pharmacies and manufacturers under much stronger scrutiny”, Mr Brine added.

“Where there is evidence of collusion between pharmacies and suppliers, swift action will be taken to claw back funds and penalise offenders.”

Watchdog the CMA confirmed to C+D that it had received a complaint regarding the claims and is “considering it”.

Walgreens “welcomes” further discussions

Walgreens Boots Alliance said its senior leaders had recently met with the DH “to discuss the specials products”.

“We would welcome any further conversations with relevant authorities and stakeholders on this matter, including with the CMA,” it added. 

The price of specials reflect the “high overheads” that go into making these “bespoke, unlicensed prescription items”, which are “ordered at short notice”, Walgreens Boots Alliance added.

“Boots UK fulfils prescriptions for specials by ordering and dispensing them to patients as required and specifically detailed on the prescriptions. The decision to request a specials prescription rests with medical professionals, like GPs and hospital consultants,” it said.

22 Comments
Question: 
Do you regularly dispense specials in your pharmacy?

Meera Sharma, Primary care pharmacist

I think this should be looked into further - there are a lot of items that are extornate prices as compared to historical prices. I'm sure we can all draw up this list - it's daylight robbery for the taxpayer, and consititutes waste for the NHS. Here's hoping there's a wider investigation that will come out of this!

Not-So-Lucky Ex-Locum, Superintendent Pharmacist

Lets face it - the whole area of pharmacy specials is a total ripoff for the NHS. I remember the days when we would knock out cream and ointment dilutions on a regular basis for the cost of the ingredients plus a small extemp fee. Then the rules changed, you needed a manufacturing licence to do anything like that and suddenly, that same cream that cost the NHS a few quid was now a few HUNDRED quid because a specials firm said that that was how much it was. 

And what about the 20 quid handling fee? What does that relate to? Everything is automated anyway and given that most of the 'handling' will be done by minimum wage workers, does a special really get 'handled' for two and a half hours before it reaches us?

Jonny Johal, Pharmacy Area manager/ Operations Manager

Sadly, this problem of ripping off the taxpayer is not unique to Boots, and this practice, which I think is unethical, could not have been possible without collusion by pharmacists. What the newspapers did were to shine a light on a very small tip of a very big iceberg.

Today, I have written to my MP, The Sun, and The Times to alert them to another practice which resulted in the taxpayer having to pay more unneccesarily - I am referring to the transfer of prescriptions to appliance contractors when pharmacies can do the dispense themselves. Once again, sadly, this is another practice which required collusion by pharmacists. Perhaps the DoH will be able to recoup some money. 

Dave Downham, Manager

JJ, you haven't told us the financial extent of this "scandal". Surely you must have used at least half a beer mat - do you still get them? - to pad out your letter to the Sun. Are we talking 10s or 100s of pounds here?

Adam Hall, Community pharmacist

I do hope your crusade of rightous idignation includes telling everyone about Dispensing Doctors refusing to dispense any item on which they do not recieve discount.

Not-So-Lucky Ex-Locum, Superintendent Pharmacist

Not true I'm afraid. 

However, the fact that GP dispensaries get a higher dispensing fee plus better discounts from manufacturers IS scandalous. 

Jonny Johal, Pharmacy Area manager/ Operations Manager

We are not here to discuss the GP contract. Professional jealousy. 

Not-So-Lucky Ex-Locum, Superintendent Pharmacist

Not at all. I wear both hats.

Not-So-Lucky Ex-Locum, Superintendent Pharmacist

Don't quite understand why you want to destroy another revenue stream for pharmacies. Don't you think a little kickback after all the cuts is acceptable because I certainly do.

Jonny Johal, Pharmacy Area manager/ Operations Manager

No I don’t, because I think it is the wrong way to go about increasing ones revenue. 

Not-So-Lucky Ex-Locum, Superintendent Pharmacist

Enlighten us with the right way then. 

As far as I'm concerned, if it ain't breaking any laws then it's perfectly fair. It's not as if using appliance contractors is anything new. It's been happening for years. Am I to assume you've never sent a prescription to NWOS or Wardles??

S J- Locum, Locum pharmacist

They are THIEVES. Thieving from the public. Arrest them and LOCK them up. What do they do to  anyone caught cheating or taking from them, even worth pennies?

Who would you arrest and lock up? The superintendant? The pharmacist who placed the orders? 

Remember this isn't illegal, immoral yes, but you can't arrest people for doing something that isn't illegal as far as I'm aware.

The DOH will have to propose legislation to prevent this practice. Ideas such as banning rebates or requiring pharmacies to obtain and document 3 prices from suppliers have been mentioned in the past.

At the moment, it's just naming and shaming. Which I guess does bring the issue to attention and may lead to some sort of change.

A.S. Singh, Community pharmacist

Boots are most definately unscrupulous, but lets not forget the NHS for some reason deduct discounts anywhere between 0-14% from pharmacies and litigation in the NHS far exceeds the drug budget at around £7bn per annum. Logic?

The explanation given by Boots regarding high overheads and short notice is complete rubbish.

The "overheads" for specials in the DT would be the same or very similar as those not in the DT. There may be slightly higher costs if it is an unusual active ingredient but it wouldn't justify the massive price differences. The same principle goes for special obtains, some companies charge a fortune, others less for no apparant reason.

I'm not suggesting Boots are alone in manipulating the system. I would expect the same explanation for the cost of specials from any chain or independant found to be charging a lot. I can get a certain special obtain item for around £25 from one supplier or £235 from another. Thing is, the higher priced company give a large "loyalty rebate" at the end of the month. Same goes for NP8 items, I can get a generic hydrocortisone/cinchocaine ointment and charge the NHS £49.99.

As the law stands the moment, it depends on whether you are comfortable with playing the system or not. Personally, I get specials from oxford pharmacy store, run by an NHS trust, as they seem to be the cheapest (but not the most profitable).

Clive Hodgson, Community pharmacist

And while we are on the subject of (allegedly) blatantly ripping off the NHS and tax payer let’s not forget the ongoing situation with the generic drug market. The sums here dwarf that of ‘specials’.

There is little doubt that the supply and pricing of certain generic drugs has been and is being manipulated with certain entities making £millions at the expense of the NHS and independent pharmacies to say nothing of the resulting problems for patients.

In a C&D article (16/Feb/2018) the BGMA stated: "Concessionary prices are double what is charged by manufacturers". The obvious suggestion has thus been made that certain very large wholesalers, (who also have a high street presence), are perfectly positioned for this manipulation and profiteering. More investigative reporting into this is required methinks.

Paul Samuels, Community pharmacist

Methinks -- the generic market has always been open to manipulation & agree it is widely managed for this purpose.

However sometimes "unavailability" is the veil for increasing prices---specials  (apart from part VIIIB) will always be charged as what suppliers can get away with until put into D.T.

 

 

however 

A Hussain, Senior Management

I don't agree with this kind of behaviour at all, but is Mr Brine not a beneficiary of practices that leave pharmacies out of pocket also.  The concessionary price system will more than recoup any excesses in the specials market even though the price discrepancies aren't as good for headlines.

But as I say, I don't condone these prices that are plucked from the sky.

Ben Merriman, Community pharmacist

How dare you suggest they are just plucked from the sky?!  This isn't DHSC we're dealing with!  I have it on good authority that the mark up formula is:

1, 2, miss a few, 99, 100...

A Hussain, Senior Management

I was talking about specials prices being plucked from the sky, but the same does apply to concessionary prices too.

Seal Patel, Community pharmacist

Its boots they will be let off with slap on the wrist but the community pharmacist would be struck off. Its the pharmacy world we live in, GPHC are spineless and immoral they will look after the big boys while the small independants are held to a different standard. We need new a stronger council

Ben Merriman, Community pharmacist

Before the current specials tariff was in place, I can remember ordering a special for an infant (I think it was spironolactone) on a Friday morning and having it delivered the same day. I did consider making it myself but didn't have the excipients to do so.  I justified the expense (usual price for the liquid plus £80 plus VAT) as it was needed there and then and thechild woould have to have been admitted had the supply not been made.  Back then, any OOP would be reimbursed. 

Given a same day delivery costs £100 (let's be generous and say £100 now due to inflation, etc) and the product should cost £93.42, I cannot think of any circumstance possible (and I am a pretty creative thinker as far as far as Devil's Advocacy goes) where the amounts charged can be at all justified. 

This is not something I say often but, on this occasion, I am happy to be proven wrong. 

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