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.

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	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

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