Specials manufacturers have voiced fears that fraud allegations could be fuelling further cuts to NHS spend and specials.  

The Telegraph exposé of underhand rebates had created an "unwelcome ripple through the sector" that had made many local medicines management teams wary of specials at a time when confidence and trust in the drugs had been returning, the Association of Pharmaceutical Specials Manufacturers (APSM) told C+D this month (October 7).  

The article, published in June, accused pharmacists of colluding with specials manufacturers to bill the NHS for a higher price than that paid for the drugs. This undermined some of the trust in specials created by the introduction of fixed prices for the most commonly prescribed specials in November 2011, the APSM said. 

The Telegraph exposé had created an "unwelcome ripple through the sector", the APSM said	More on specials GPhC pledges to investigate Telegraph specials fraud exposé Pharmacists split in response to Telegraph specials fraud exposé Pricing authority should be vigilant for signs of specials fraud, PSNC says
	Last month, the APSM published the results of its June survey, which found half of the 200 pharmacists who responded had been asked by clinical commissioning groups (CCGs) to monitor or reduce their specials dispensing. A quarter of respondents had been asked to reduce spend on specials, compared with 13 per cent in 2012.

The APSM said it was "taking a while" for prescribers to understand the impact of the specials tariff and said the fraud revelations could cause further problems.  

"Any further cost savings to be squeezed out of specials will have a minimal financial impact as the volumes are so small but could potentially have a much more significant impact on quality and patient safety," the association stressed. The NHS calculates that the specials tariff has reduced overall specials costs by 25 per cent since its introduction.  

PSNC told C+D specials were likely to be squeezed further as the NHS faced "unprecedented financial challenges" and many CCGs were exceeding their budgets.  

"PSNC has been making very clear to the NHS that CCGs must not use their new powers to manipulate delivery of community pharmacy funding, but in this sort of climate it would not be a surprise to see CCGs considering a range of options to cut costs," said Komal George, head of support services at PSNC.  

NHS England said ensuring patients received appropriate and effective treatment was the main priority for CCGs. "It is, however, absolutely right that we do this while ensuring we get the best value for the taxpayer," a spokesperson told C+D.  

Specials account for less than 1 per cent of all prescriptions, 96 per cent of spend is accounted for by the top 500 specials and, of these, more than a third are included in the tariff, the APSM said.