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PSNC announces revised methadone payment structure

Business PSNC has unveiled a revised payment structure for oral liquid methadone, which will slash item fees from £4.05 to £2.50 but introduce a 55p fee for dispensing doses in separate containers.

PSNC has unveiled a revised methadone payment structure that will slash item fees by nearly a third but introduce a 55p fee for dispensing doses in separate containers.

The negotiating body announced yesterday (March 5) that item fees for oral liquid methadone would plummet from £4.05 to £2.50 per prescription from April 1. But, after conducting "extensive modelling" on how pharmacies dispensed methadone, PSNC announced a 55p payment for each additional dose supplied in separate containers. Professional and controlled drugs (CD) fees will remain the same.

The 55p fees will apply regardless of whether the prescriber requests additional containers and will not be payable if pharmacists choose to dispense doses together in a large bottle.

The changes will require contractors to make an endorsement to show that they have supplied individual doses, although details were yet to be finalised with the Department of Health, PSNC said.

"It's like being given a death sentence and then finding it's been moved to life imprisonment" Martin Bennet, Wicker Pharmacy, Sheffield

More on methadone payments

Positive response to revised methadone fee proposals

PSNC sets up committee to review methadone fees

PSNC agrees transitional methadone payments for      hardest hit pharmacies

The payment structure follows a previous shake-up in July last year. Those changes involved a fall in the number of times professional and CD fees were paid for dispensing single doses to patients in bulk, as well as introducing the £4.05 payment per prescription item.

At the time, contractors complained that the changes could cost them thousands annually – and they argued this week that the revised system would fail to bring funding back up to previous levels.

Martin Bennett of Wicker Pharmacy, Sheffield, said the 55p payment for individual containers would make little difference to his estimated losses.

"Rather than losing something like £54,000 a year [under the July 2012 tariff], it looks as if we'll now only lose £50,000," he explained. "It's like being given a death sentence and then finding it's been moved to life imprisonment."

Mr Bennett told C+D that PSNC had held a private meeting with him and other contractors in the area last week to explain the changes.

After calculating the full costs of providing methadone supply service, there was "absolutely no profit or incentive" to continue, Mr Bennett argued. "You've probably had a redesign and lost customers who won't come in because you're dealing with [methadone] patients," he said.

Contractors may decide to discontinue the service as a result, Mr Bennett warned. "The reality is you're never going to get adequate payment for providing the service and I suspect people will stop," he said. "For the time being, we're going to carry on but, if something comes along that could use the space more profitably we might do that instead."

But Mr Bennett welcomed the fee for dispensing methadone in separate containers as a "good clinical move". Dispensing multiple methadone doses in one large bottle would become increasingly risky from April onwards, he said. The NHS Regulations 2013, which were announced by the government last month and come into force in April, will require pharmacists to take responsibility for deciding the most appropriate method of packaging liquid methadone for each patient.

Numark director of pharmacy services Mimi Lau said the fee changes were an improvement on the July 2012 system, but stressed that contractors would still be worse off than they were before then. "Every way you look at it, the reimbursement of methadone has been significantly reduced," she told C+D.

Ms Lau also stressed that endorsing requirements must not be "too onerous" for contractors because supplying methadone already involved a high workload.

In October last year, PSNC proposed introducing a two-tier level of ‘per interaction' methadone payments, which would see contractors paid £4.05 for supplying up to seven days of methadone, and a double fee of £8.10 for supply lasting eight days or longer. But PSNC said it had decided against the proposals because the system announced this week, based on contractor endorsement, was the simplest way of ensuring the work to package doses separately had been completed.

"The PSNC committee is confident that these new arrangements will reflect the cost of supply in all scenarios," said PSNC head of pricing Harpreet Chana.

How the 55p fee will work for a patient collecting three doses on a Friday to cover the weekend

● If the contractor dispenses all three doses together in one container, the contractor would not be eligible to claim for any additional 55p fees.

● If the contractor dispenses the Friday dose as a single dose (eg for supervised consumption) with the Saturday and Sunday doses packaged together in one container the contractor would be eligible for one 55p fee as one separate package was supplied for the Saturday and Sunday doses.

● If the contractor dispenses all three doses in separate containers, the contractor would be eligible for two 55p fees as two separate packages were supplied for the Saturday and the Sunday doses.

● If, because of the volume and the size of available containers, one daily dose is dispensed between two or more containers, the contractor is not eligible for another fee – ie splitting one daily dose into multiple containers does not create eligibility for separate fees.


Methadone facts and figures

£2.50 New item fee per prescription

£4.05 Former item fee per prescription

55p New fee for additional doses supplied in separate containers

April 1 When the new system will come into force  

How will these changes to methadone payments affect your business?

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tim hazelwood, Community pharmacist

Tim Hazelwood Community Pharmacist
No one has mentioned the Elephant in the room. Your PNA will now be used to judge new contract applications. If you drop a service, no matter how obnoxious it is, it provides a gap for the vultures. They have us where they want us and the psnc is not protecting us. Drop methadone supply at your peril.

Parminder Bahia, Superintendent Pharmacist

PSNC claimed this was a cost neutral measure despite not having figures
to back up their case. We are now on version 3.0 (not even windows ever issued
new versions this rapidly) - this clearly shows that this is NOT cost neutral.
Mr Chana and company - at least have the courage to SAY the truth ie the DH dictates
and PSNC doesn't really have a function. It's probably very complicated and we probably won't understand usual.

John Schofield, Locum pharmacist

Due to the global sun and averaging system, there are always going to be winners and losers. Many contractors dispense very little methadone, but are they to be penalised for the benefit of those who practise in areas with social problems.
If methadone payments were ringfenced out of the general dispensing budget, and were paid according to the difficulties some of the recipients cause then there may be a case for complaint.
But as far as I understand they aren't except for supervised payments.
It is the system that's at fault and it has always been inherently unfair, with winners and losers.
There is no South-East loading to account for higher rents, extremely high Uniform business rates and often higher wages.
Those contractors unfortunate to have 56 or 84 day Rxs have always missed out.
It's the whole system that is at fault and has been for decades.
I always envied contractors with low overheads and 28 day Rxs and low NIC.
When I was a contractor I struggled with all of those!

Kassim K, Community pharmacist

Same trend as NMS. Deal us with a big blow initially and then try and look like saviours by offering a little more...along with more work and more consumables expenses which dilutes the 55p down.

M Yang, Community pharmacist

In a way this change makes sense. The usual rhetoric about the positives of methadone continue to be spewed out but everyone knows that it's a failure, the number of people successfully weened off opioids is far outweighed by the number who have been on this for years or even decades (some I've met are old enough to be my father). It may hurt our pockets but it's time pharmacists learned to stop relying so much on this source of income. However the government needs to recognise that reducing payment in one area needs to be compensated by increasing payment elsewhere, otherwise we'll see many good pharmacies going bust.

Amal England, Public Relations

M Yang, treating drug addicts is part of the NHS, if drug addicts are to be left untreated I suggest you go and witness the scenes in countries where addicts are untreated wholesale. Some part of the NHS should be responsible for treating drug addicts, whether they are addicted to methadone, heroin or crack. Pharmacy is best placed to do this job, the government realises this and the government also realises that they can cut remuneration and pharmacists will just sit back soak it up talk talk talk and not take any action. Its not a case of what pharmacy should rely on for income, many of us have done this and then after a few years the government cuts remuneration. Its about providing a necessary service at a reasonable level of payment and then not to be stabbed by the government after months/a few years. Pharmacists need to wake up and see that the NHS is in the hands of doctors and doctors income has risen while pharmacist income has declined. The NHS needs to cut its bill, doctors will be damned if they don't make pharmacists work for scraps, before even remotely thinking of cutting their own income. Pharmacists need to wake up and take united action now to ensure a professional future, that includes those working for the multiples-you are not immune.

Brian Austen, Senior Management

I agree with you that addicts are on methadone for years but having someone on a maintenance dose who is stable is much better than the alternative of hectic and increasing street supply, crime, etc. This is just another example of how poorly pharmacists are consulted and represented and it will also reduce the number of providers of this valuable service.

Sukhminderjit Dhoot, Superintendent Pharmacist

What sort of income do you think we should 'rely on' ?

Sukhminderjit Dhoot, Superintendent Pharmacist

Absolute claptrap! Another kick in the teeth for pharmacy. Tinkering with a bad deal does not make it a good deal...we still lose £1000s. For PSNC hierachy to claim satisfaction with this deal is preposterous...we are not stupid, be honest, it is a rubbish deal ...again!
Chris Hetherington
Community Pharmacist

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