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PSNC: Pressure wholesalers to reduce pregabalin price

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Pregabalin prices in the drug tariff currently range from £1.87 for a pack of 56 25mg capsules
Pregabalin prices in the drug tariff currently range from £1.87 for a pack of 56 25mg capsules

It is “essential” that contractors “exert maximum pressure” on wholesalers to match the reduction in pregabalin’s reimbursement price, the Pharmaceutical Services Negotiating Committee (PSNC) has said.

Pregabalin entered category M in August, two months after NHS England announced the drug should be prescribed “in accordance with normal practice”.

Pregabalin prices in the drug tariff currently range from £1.87 for a pack of 56 25mg capsules to £4.17 for a pack of 56 300mg capsules. But contractors have told C+D they are being forced to pay almost £20 per pack by wholesalers.

PSNC director of pharmacy funding Mike Dent told C+D that when a category M reimbursement price for a particular product is reduced, it may take time and “sustained pressure from pharmacies for wholesale prices to respond.

“There have been a number of examples where manufacturers' prices were below the drug tariff price, but a product could not be obtained at the drug tariff price from a number of wholesalers,” Mr Dent told C+D today (August 3).

“During this period, it is essential that contractors exert maximum pressure on wholesalers,” Mr Dent said.

“Ridiculous” prices

A Cheshire contractor – who requires “around 200” boxes of pregabalin a month – told C+D he was not able to order any stock last month, as the prices “were ridiculous”.

“Yesterday I bought pregabalin at £19.32 a box. In the drug tariff, the box is £4.17. I’ve just lost £15 on that,” said the contractor, who wishes to remain anonymous.

“All the wholesalers seem to be quoting the same price across the board, it’s so unusual,” he said.

Describing the situation as “totally unsustainable”, the contractor said that as soon as pregabalin went off patent, some wholesalers refused to supply the generic in sufficient quantities.

“When I struggled to get hold of stock, I knew something was up,” he added.

“Contact PSNC immediately”

Numark said it is encouraging its members to “immediately contact PSNC” and alert the negotiator about the raised purchasing price of pregabalin.

“We have picked up news that the price of pregabalin is in some cases higher than the tariff,” Numark marketing director Mandeep Mudhar told C+D.

“This is not unusual with molecules where there is sometimes a shortage in the market – wholesalers have to pay more for a limited amount of stock.”

The drug tariff price “does not quickly respond to pricing fluctuations”, he added.

C+D has approached wholesaler representative body the Healthcare Distribution Association for comment.

9 Comments
Question: 
Have you noticed an increase in pregabalin prices?

Gerry Diamond, Primary care pharmacist

Well I was really grateful having read this article earlier in the week and went straight ahead the following morning and switched all seventy or so patients from alzain to generic pregabalin in the surgery. Our health centre pharmacist never had a clue when I showed them the price in the DT, losing about £17 per item, but at least the practice budget won't get hammered....lolx

Ilove Pharmacy, Non Pharmacist Branch Manager

The whole thing is actually a well run racket for the benefit of the big boys. Nothing will be done as making money is the sole objective. Sometimes patient safety etc... may come into it but in the main moeny is what it's all about. Theis publication can surely attest to that.

A Hussain, Senior Management

Pharmacy chains that own wholesalers can't lose.  If pharmacy loses big on Cat M then they win either bigger. The game is rigged and everyone knows it.

Caring Pharmacist, Community pharmacist

The price of Generic Pregabalin was between the range £2.50 to £5 per pack when the reimbursement price on DT was approx £88. This has been the case for good 12 months.Now the DT price has come down to market price levels ,the wholesalers have started to charge higher than drug tarriff prices. All this pricing of generic drugs is in the hands of National Multiples eg Boots,LLoyds and Well etc.They all have their own shortline divisions to control prices.The Independent Pharmacist suffer as national  shortliners and  main suppliers make margins in wholesale division.These groups are now in a monopoly position and needs to broken up so that a healthy competition exist in the market.The government should immediately step in to stop the wastage of taxpayers money.

Pharma Tron , Community pharmacist

Two things- the drug tariff does respond when the department wants it to; take the mid-month adjustment to atorvastatin as an example so don't be fooled! 

 

Secondly, I was at some relative ease when our GPs changed to Alzain with regards the licensing/ patent debate (NOT with the margin, of course!) but now the paltry prices for generic mean that we are now burdened with (technically, of course) having to find an appropriate product that meets the needs of the patient. I was surprised it didn't go Cat C on Alzain, as this is in effect the NHS and Department mandating in part an illegal supply of a medicine, placing the regulatory burden onto the end supplier- the Pharmacist. Rather than Mike Dent passing the monkey, why aren't the PSNC looking at this counter argument, or at least adding something to fees and allowances for regulatory burden- the mechanisms exist for this, but the DoH aren't going to concede this without it being pointed out. 

 

Just an interesting point, our GPs have refused to change back to generic because, in their words, they want a cut of the savings to administer the switch! So we have our pants down and others will trouser the difference. Plain wrong! 

Shamir Patel, Community pharmacist

Our CCG changed all patients last month to Alzain to save money as tariff was based on Lyrica. Love them to explain why to tax payers why they are paying £25-£40 a box when the tariff is significantly lower. Branded generics gone wrong for a first!!

Farhat Ahmed, Locum pharmacist

Thats a very clever suggestion from Mike Dent, would he like to show how he expects us to "apply sustained pressure" and in the interim period would he like to open his wallet out on the table to reimburse the money that we are losing or alternatively would he like to actually make a feasible suggestion. This whole pregabalin farce shows exactly what the government thinks of pharmacy. Just for the record previously when I have asked PSNC to supply with the names of wholesalers from whom products are readily available at the drug tariff prices, I have been told that competition law does not allow them to divulge such information. Is there any pharmacist out there who has been able to obtain pregabalin, licensed for all indications at the August Tariff prices, you could make yourself a fortune by charging the rest of us for the information. 

 

 

 

Chandra Nathwani, Community pharmacist

Who was supplying pregabalin at the current Cat M price when the drug was selected for entry to Cat M at the end of July and why has that supplier now increased the price?

Over the telephone, and desperate to fill a prescription it is not quite possible to "exert maximum" pressure! And any suggestions of the pressure that can be applied by an independent? 

 In the meantime, is the patient under consideration by anyone other than the pharmacist who stand to lose money just to ensure patient does not suffer. Should this duty of care not extend to all involved in price setting right through to the supply chain? 

Ben Merriman, Community pharmacist

Please report any medicines only available above the tariff price to PSNC using this form: http://psnc.org.uk/dispensing-supply/supply-chain/supply-issues-feedback/problems-with-obtaining-a-generic-medicine/

Don't assume someone else has! The more info and reports of pricing issues PSNC have, the better equipped they are to negotiate a concession with DH.

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