SPECIALS
THE USE OF SPECIALS COSTS THE NHS MILLIONS EACH YEAR. SP LOOKS AT HOW, WITH INCREASING DEMANDS ON THE NHS BUDGET, THE MONEY SPENT ON SPECIALS COULD BE BETTER INVESTED IN OTHER AREAS.
SPECIALS: THE BEST POSSIBLE OPTION?
By Gareth McCabe
A special preparation is an unlicensed medicine that needs to be specially manufactured and ordered. They are made to meet the specific needs of an individual patient. The prescribing of unlicensed medication is undertaken in certain clinical situations. This is based on the best available evidence and is judged that a special is in the best interest of the patient.
However, prescribers are advised by the Chief Pharmaceutical Officer that they should not continue to use an unlicensed product, unless there is a specific reason, where there is a licensed product available and has been accepted within NHS Scotland1
or manufacturers that prepare them for you. This article relates primarily to those medicines manufactured outside of the dispensary.
This usually comes at a much higher price and may incur extra out of pocket fees (e.g. handling or delivery fees). Please note that under the terms of the Scottish Drug Tariff, full payment for work undertaken by a third party is not automatically made2
In many cases the patient’s needs could be met with a licensed medicine, or a more competitively priced special could have been sourced elsewhere.
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In the Drug Tariff Part 7S you can find a list of special preparations and set prices beside them. Reimbursement is paid at the price on the list and the prices include a handling fee.
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A special can be extemporaneously prepared, which is more common option for certain creams and ointments. If it is unfeasible, or if the pharmacist chooses not to prepare an unlicensed medicine in the pharmacy, then there are laboratories
It is important to check this list, and the corresponding price, of a special before ordering it in as you will be unable to claim any out-of-pocket expenses; the exception being when prior approval has been sought from the Health Board to cover additional costs arising above the base tariff price1
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LEGAL ISSUES When a prescriber writes a prescription for a licensed product, with the licensed dose and indication, they are protected if any issue regarding adverse effects to a patient occurs. The legal responsibility lies with the pharmaceutical company.
However, for specials, the responsibility lies primarily with the prescriber for any adverse effects to a patient (unless it can be proven that the product was faulty). Pharmacists have a professional responsibility to make prescribers aware of the unlicensed nature of any special before procuring the product. As professionals we have an obligation to the care of our patients. If the special is unsuitable or the directions are off-license (eg, crush tablet, open
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FURTHER REQUIREMENTS WHEN SUPPLYING UNLICENSED MEDICINES:4 As with any prescription there are certain requirements that need to be made regarding record keeping.
Any person selling or supplying a special must:
(a) Keep the following records for at SCOTTISH PHARMACIST - 55
capsule) and we deem the prescription could adversely affect the patient we have a duty to refuse dispensing. It is important to bear in mind that verbal communication from the prescriber requesting dispensing to go ahead regardless may not remove you from legal liability3
‘Altering a licensed medicine by crushing, suspending or dissolving a tablet or opening a capsule, results in the medicine becoming unlicensed. You may become liable for any harm caused as a result of your actions.’ The Human Medicines Regulations 2012
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