FEATURE
The use of specials is an area that is constantly evolving, both with
regard to the products available and the guidance that accompanies
them, and pharmacists are urged to keep themselves abreast of any
changes in these particular areas as and when they occur
provided within the drug tariff. In short however, the price of the dispensed prescription item (which has been sourced from a supplier holding a MHRA specials or importers licence) should be provided on the prescription, after deductions have been made for any applicable discounts or rebates.
Overall, the procedure appears to relatively straightforward at present, but pharmacists are encouraged to continually check for updates to this process due to the potential for claiming payment to become become more complex in the future (perhaps following the processes put in place by the likes of NHS Scotland), and may ultimately lead to them being out of pocket if they do not file claims correctly.
> the incurrence of unnecessary costs. From a pharmacy perspective, there are a number of straightforward actions that we can take to ensure that a special product is provided to a patient only when necessary:
• Informing the prescriber that the prescribed item is a special (in some circumstances, this is not apparent from the prescriber’s computer system, and they may think that the item prescribed is a “normal” item on the drug tariff • Informing the prescriber of the price of the special, particularly in the instance that there is either a cheaper comparable special, or if there is a comparable licensed product available • Suggesting alternative and appropriate approaches that involve the use of licensed products, and which will offer a cost reduction in the patient’s treatment, whilst not affecting their care.
In addition to these practices, pharmacists are also encouraged to make sure that they obtain their specials from the most cost effective source, and that they also maintain regular communication from suppliers, so that they can be made aware when products which were previously specials, have become licensed products which may be available at a fraction of the cost.
Of course, pharmacists are not the lone bastions of money saving via the appropriate use of specials, and a great deal of the responsibility lies at the feet of prescribers. As a result, guidance has been issued to these professionals, including the use of appropriate alternatives where possible. This might include the use of an alternative drug from the same therapeutic class as the initially suggested product, as it may exist in a form which is more suitable for the patient’s needs.
Moreover, some guidance indicates that the “off-label” use of products
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may be suitable – this involves the use of licensed products in an unlicensed way, and can include strategies such as the dispersal of tablets in a suspending medium. These recommendations can vary by location, and can make the provision of medications to patients that bit more complicated. However, pharmacists should ensure that they liaise with the prescriber as much as is necessary, act within the law, and that they are able to advise their patient fully on the product dispensed, particularly if it is a product that the patient may not be expecting(5,6)
!
Special considerations Of course, there will still very often be times where the provision of a special product to a patient is the best option. As with everything else within our profession, we pharmacists have specific responsibilities that we need to adhere to when it comes to the dispensing of special items. Such responsibilities have been detailed by agencies such as the Royal Pharmaceutical Society, and include:
• Ensuring that the patient receives a medication that is appropriate for their condition and clinical circumstances, with and associated minimal clinical risk • Checking that the continued prescription of a special is regularly reviewed and continually justified • Full understanding of other professional responsibilities when ordering a special product, i.e. ensuring that you provide a product of assured quality.
These particular responsibilities seem to be somewhat obvious, but it is always useful for us to remind ourselves about what is expected, and ensure that we take the most appropriate steps we can to ensure the safety of our patients. In addition to these responsibilities, it is also necessary that the appropriate records be kept when these products are
dispensed. The MHRA has issued specific requirements for record keeping around specials, and as a result, it is recommended that the following are maintained for a minimum period of five years:
• A record of the purchase and supply of a Special and the specification of the product agreed with the supplier • Documentation to verify the specifications i.e. certificate of analysis or a certificate of conformity from the manufacturer, should be obtained on delivery and must include the batch number and expiry details of the product; kept on file in the pharmacy • Patient details, such as name and address linked to the special should also be maintained to provide an adequate audit trail • The source of the product i.e. manufacturer details • The quantity of each sale or supply • The batch number and expiry date of the product • If the product is in response to a prescription, the records must also include the patient’s details, prescription details and the date of dispensing. • The date the product was supplied (as may differ from the date of manufacture)
It’s important to note that while the MHRA requires that these records be kept for a minimum of five years, pharmacists may wish to keep these records for a longer period, or indefinitely, as the supplying pharmacy is accountable for the quality of the product, and claims under the Consumer Protection Act may be filed after a longer time period than five years(7)
.
Payment for specials Due to the nature of these products, and the associated cost to the pharmacy to purchase them, it is vitally important that pharmacists are aware how to appropriately claim for specials, with this information being
A special relationship? Ultimately, the dispensing of special products is never going to be a major part of a pharmacist’s day-to- day activities, and indeed, measures are being constantly put in place throughout the UK to ensure that these products are used only when really necessary, further reducing the number of specials prescriptions that pharmacists will have to deal with.
However, as with all such irregular activities, pharmacists are obligated to ensure that they can offer the best service available, and to be aware of any actions that they need to take in order to guarantee the safety and effective treatment of their patients.
Moreover, the use of specials is an area that is constantly evolving, both with regard to the products available and the guidance that accompanies them, and pharmacists are urged to keep themselves abreast of any changes in these particular areas as and when they occur. n
References (1) IPS Specials. About Specials. 2014; Available at:
http://www.ipsspecials.com/specials/about- specials. Accessed 15/02, 2016. (2) Association of Pharmaceutical Specials Manufacturers. The Primary Care Specials Market. 2014; Available at:
http://acsmblog.blogspot.co.uk. Accessed 15/02, 2016. (3) Michele Paduano. Drugs 'specials' cost NHS £160m. 2010; Available at:
http://www.bbc.co.uk/news/uk-england- 11376557. Accessed 15/02, 2016. (4) Association of Pharmaceutical Specials Manufacturers. The Specials Tariff - Two years On. 2013; Available at: http://acsmblog.
blogspot.co.uk. Accessed 15/02, 2016. (5) NHS Fife. Fife Prescribing Update. 2013; Available at:
http://www.communitypharmacy.
scot.nhs.uk/documents/nhs_boards/fife/Fife%20 Prescribing%20Update/Fife_Prescribing_Update _42.pdf. Accessed 15/02, 2016. (6) NHS Kirklees. Community Pharmacy Newsletter. 2010; Available at: http://www.
kirklees.nhs.uk/fileadmin/documents/New/Public _Information/med_mgt/Newsletters/Sept_10_- _Community_Pharmacy_Newsletter.pdf. Accessed 015/02, 2016. (7) The Royal Pharmaceutical Society. Dealing with specials. June 2010; Available at:
http://www.rpharms.com/support- pdfs/ppjune2010-specials-june2011updatefinal. pdf. Accessed 15/02, 2016.
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