PSNC Funding & Contract Subcommittee Agenda€¦ · Web viewApplications for 2 lines were not...

Pharmaceutical Services Negotiating Committee Funding and Contract Subcommittee Agenda

Wednesday 6th February 2019 at 13.30

Aylesbury room, 14 Hosier Lane, London, EC1A 9LQ

Items are confidential where marked.

Members: David Broome, Peter Cattee (Chairman), Tricia Kennerley, Andrew Lane, Margaret MacRury, Has Modi, Garry Myers, Bharat Patel, Adrian Price, Anil Sharma

In attendance: Simon Dukes, Mike Dent, Jack Cresswell, Suraj Shah, Komal George

1. Welcome from Chair

2. Apologies for absence

3. Declarations or conflicts of interest

4. Minutes of last meeting (Confidential Appendix FCS 01/01/19) and Matters Arising

ACTION

5. Work plan for 2019 (Confidential Appendix FCS 02/01/19)

6. Remuneration

a. 2018/19 contract sum forecast (Confidential Appendix FCS 03/01/19) b. 2018/19 fee rates (Confidential Appendix FCS 04/01/19) c. VAT – a verbal update will be given at the meeting

7. Reimbursement

a. Retained margins 2017/18 (Confidential Appendix FCS 05/01/19) b. Margins survey methodology 2018/19 (Confidential Appendix FCS 06/01/19) c. Retained margins forecast 2018/19 (Confidential Appendix FCS 07/01/19) d. Work with GPC / DDA (Confidential Appendix FCS 08/01/19)

8. EPS implementation A verbal update will be given at the meeting.

FunCon Agenda February 2019

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9. Price concessions

a. November 18 price concessions (Confidential Appendix FCS 09/01/19) b. Price concession system (Confidential Appendix FCS 10/01/19)

10. DHSC proposals

a. Late batches (Confidential Appendix FCS 11/01/19) b. Changes to FP10 form – exemptions (Confidential Appendix FCS 12/01/19)

REPORT

11. General funding update (Appendix FCS 13/01/19) 12. Statistics (Appendix FCS 14/01/19)

13. Any Other Business


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Appendix FCS 13/01/19

Subject General funding update

Date of meeting 6th February 2019

Committee/Subcommittee FunCon

Status Not confidential

Overview General update on various issues including QPS, closures, concessions and supply issues, branded generics, VAT

Proposed action(s) No action required

Author(s) of the paper PSNC Pharmacy Funding TeamPSNC Dispensing and Supply Team


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General funding update

The following items are matters of report:

Quality paymentsThe latest declarations data published by NHSBSA was for the June 2018 QPS claim period. As previously reported PSNC verified the June 2018 payments against the claims data and found no anomalies.

The next QPS claim point occurs in February 2019. Payment for the February 2019 review point will be paid as part of the full payment for the March 2019 submission to the Pricing Authority (which contractors will receive at the end of May / start of June). When the payment and declarations data is published PSNC will validate this.

Closures

Methodology

We used pharmacy edispensary data from NHS Digital to analyse how many closures have occurred from October 2016 to November 2018.

The data contains a marker for any pharmacy which closes and gives the date of closure.

In many cases we found that where a certain F-code was flagged as a closure, another pharmacy / F-code would then begin operating from the same address as the closed pharmacy. This indicates that those ‘closures’ are in reality sales of pharmacies, with a new F-code being granted when the new owner takes over.

We therefore scrutinised each pharmacy closure that occurred between October 2016 and November 2018, to identify where pharmacies closed but another pharmacy did not subsequently open in the same location. This will be much closer to the true number of closures.

The main characteristics of the closed pharmacies were then analysed.

Results

The graph below shows the number of closures that occurred each month between Oct 2016 and November 2018 (total 177)


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The closures were spread out across the country but slightly more clustered around London, Birmingham, Liverpool, Manchester and Leeds:

Not all closures were low volume pharmacies:

Blue = less than 5,000 items - 144Green = 5,000 - 10,000 items - 30Red = more than 10,000 items - 3

Most were urban with a mixed ownership profile:


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13 Rural pharmacies, 149 Urban, 15 unclassified60 independent CPs, 105 multiples, 12 IM

Openings

As well as considering closures, we have also begun to investigate openings (unrelated to purchase of an existing pharmacy) in order to understand the net decrease in pharmacies.

Using LPC level data indicates that the net decrease in pharmacy numbers since the beginning of 2016 stands at around 100.


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Price concessions – October 2018

PSNC applied for a total of 45 price concessions in October 2018. 28 price concession were agreed between DHSC and PSNC, 17 products had prices that were not

agreed by PSNC and were imposed. DHSC wrote to PSNC on 01/11/18 with the final prices. Risperidone 2mg tablets price was originally imposed at £1.80. Following representations from PSNC,

the Department increased the October price concession for risperidone 2mg tablets to £20.00

Price concessions – November 2018

PSNC applied for a total of 72 price concessions in November 2018. 39 price concessions were agreed between DHSC and PSNC, 33 products had prices that were not

agreed by PSNC and were imposed. DHSC wrote to PSNC on 30/11/18 with the final prices. There was an increase in the number of price concessions due to the decrease to Cat M prices. PSNC

also found that a number of fast-moving lines such as Naproxen and Losartan entered the price concession list.

Price concessions – December 2018

PSNC applied for a total of 87 price concessions in December 2018. 55 price concessions were agreed between DHSC and PSNC, 30 products had prices that were not

agreed by PSNC and were imposed. Applications for 2 lines were not granted. DHSC wrote to PSNC on 20/12/18 with the final prices.

Problems with Naproxen 250mg, 500mg, GR 250mg and GR 500mg tablets continued this month. DHSC and PSNC were unable to reach an agreement on the prices for all four Naproxen products and the final prices were imposed by Ministers.

DHSC were keen to conclude negotiations by 20th December due to absences during the Christmas break.

Price concessions – January 2019

The PSNC applied for a total of 82 price concessions in January 2019. As of 23rd January 2019, the DHSC had granted 49 granted price concessions for January and

a further 33 products had prices that have not been agreed by PSNC.

Price concession summary


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Apr-17

May-17Jun-17

Jul-17

Aug-17

Sep-17Oct-17

Nov-17

Dec-17Jan-18

Feb-18

Mar-18Apr-18

May-18Jun-18

Jul-18

Aug-18

Sep-18Oct-18

Nov-18

Dec-18

0

20

40

60

80

100

120

Number of price concessions agreed, imposed or not granted

Agreed Imposed No PC granted

Apr-17

May-17Jun-17

Jul-17

Aug-17

Sep-17Oct-17

Nov-17

Dec-17Jan-18

Feb-18

Mar-18Apr-18

May-18Jun-18

Jul-18

Aug-18

Sep-18Oct-18

Nov-18

Dec-18

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of price concessions agreed, imposed or not granted

Agreed Imposed No PC granted

Market movements with implications for supply

Naproxen – DHSC has confirmed that there is an issue with Naproxen 500mg and 250mg due to issues in producing the API. They believe further stock will be made available to the UK market over the coming weeks.

Valsartan – There was a class 2 MHRA medicines recall for Valsartan containing products by Teva and Mylan. This has continued to cause issues for Valsartan. The Valsartan shortage appears to have triggered price fluctuations in the other ‘sartans’ for which concessions have been granted.


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Reimbursement

PSNC is working with representatives of the GPC and DDA on how to improve the reimbursement system.

Prescription charge exemptions and Switching webinar

PSNC and NHSBSA held a Prescription charge exemptions and Switching Webinar on 22nd January, co-presented by Suraj Shah and Mitesh Bhudia from PSNC, and Alison O’Brien from NHSBSA. 377 people attended the webinar, out of 1049 registered (a conversion rate of 36%, deemed a strong result by industry experts).

A feedback survey found that 97% of attendees thought the webinar was useful and 87% would recommend watching it to others.

The on-demand version was made available the day after the live webinar, along with a copy of the slide pack. This can be watched at psnc.org.uk/webinar

A total of 102 questions were sent in through the actual webinar platform and the survey afterwards. The Dispensing and supply team and NHSBSA will work together to respond to each question raised during the webinar within 2 weeks.

The Dispensing and Supply team plan to deliver other useful or suggested webinar topics during 2019. Below is some of the feedback from webinar participants:

- “First webinar I’ve attended. Clear delivery and great as more convenient than face to face sessions”

- “Excellent balance of content, questions etc. Thank you”- “You do excellent webinars so thank you and well done”- “Excellent webinar and very useful”


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Appendix FCS 14/01/19

Subject Statistics

Date of meeting 6th February 2019

Committee/Subcommittee FunCon

Status Not confidential

Overview Latest statistics for information

Proposed action(s) No action required

Author(s) of the paper PSNC Pharmacy Funding Team


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Statistics

Latest Pharmacy growth figures

· 11,589 community pharmacies open in Oct-18· Over the last 12 months average monthly growth has been -0.06% · Over the previous 24 months average growth was 0.01%

-0.30%

-0.20%

-0.10%

0.00%

0.10%

0.20%

0.30%

11,58011,59011,60011,61011,62011,63011,64011,65011,66011,67011,68011,69011,70011,710

No of CPs Growth % Poly. (Growth %)

Latest item volumes and growth rates

12 month prescription volume now 1.033 billion items

Current annual growth rate 0.12%

· Total items for 17/18 was1.030 billion-0.40%

-0.15%0.10%0.35%0.60%0.85%1.10%1.35%1.60%1.85%2.10%2.35%2.60%

1,016 1,018 1,020 1,022 1,024 1,026 1,028 1,030 1,032 1,034 1,036

Apr-1

6

Jun-16

Aug-16

Oct-16

Dec-16

Feb-17

Apr-1

7

Jun-17

Aug-17

Oct-17

Dec-17

Feb-18

Apr-1

8

Jun-18

Aug-18

Oct-18

Millions

Rolling 12 month items Annual growth %

Latest items per trading day figures Oct- 18 total items per month was 89.3m, over 27 dispensing days, (3.3m items per day)

Below peak volume of 91.1m in Mar- 17 79,000,000

80,200,00081,400,00082,600,00083,800,00085,000,00086,200,00087,400,00088,600,00089,800,00091,000,000

3,200,0003,250,0003,300,0003,350,0003,400,0003,450,0003,500,0003,550,0003,600,0003,650,000

Apr-16

Jun-16

Aug-16

Oct-16

Dec-16

Feb-17

Apr-17

Jun-17

Aug-17

Oct-17

Dec-17

Feb-18

Apr-18

Jun-18

Aug-18

Oct-18

Items per mon

th

Items per da

y

Total Items and items dispensed per trading day

Items / day Items per month


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Latest concession items volume Oct- 18 concession items increased to 4.9million Comprising 3.13% of all items dispensed

LatestNMS volume

Sep - 18 NMS volume was 62.9k, claimed by

7,212 CPs

The volume trend shows flat growth

Total spend for 17/18 was£22.9m

Latest MUR volume

Aug- 18 MUR volume was 269k, claimed by10,090 CPs

Aug- 18 is -2.09% lower than Aug- 17

The overall volume trend shows growth

Total spend for 17/18 was £94.1m

6,500

6,700

6,900

7,100

7,300

7,500

7,700

7,900

59,50062,20064,90067,60070,30073,00075,70078,40081,10083,80086,50089,20091,900

Apr-1

6

Jun-16

Aug-16

Oct-16

Dec-16

Feb-17

Apr-1

7

Jun-17

Aug-17

Oct-17

Dec-17

Feb-18

Apr-1

8

Jun-18

Aug-18

No of NMS No. pharmacies claiming Poly. (No of NMS)

8,000

8,500

9,000

9,500

10,000

10,500

160,000

180,000

200,000

220,000

240,000

260,000

280,000

300,000

320,000

340,000Ap

r-15

Jul-1

5

Oct-15

Jan-16

Apr-1

6

Jul-1

6

Oct-16

Jan-17

Apr-1

7

Jul-1

7

Oct-17

Jan-18

Apr-1

8

Jul-1

8

No of MURs No. pharmacies claiming Poly. (No of MURs)

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

10.00%

100,000

1,100,000

2,100,000

3,100,000

4,100,000

5,100,000

6,100,000

7,100,000

8,100,000

Apr-1

6

Jun-16

Aug-16

Oct-16

Dec-16

Feb-17

Apr-1

7

Jun-17

Aug-17

Oct-17

Dec-17

Feb-18

Apr-1

8

Jun-18

Aug-18

Oct-18

Concession item % Concession items


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Latest figures for 18/ 19 Q2 remuneration Fees per item remained at£1.66 Reimbursement per item (after cb) increased to £6.93

Community Pharmacy vs Dispensing Doctors reimbursement over 24 months

(Figures from PCA analysis)

Current AIV is £8.59

Belowpeak AIV of £10.14in Q2 1112

(Figures from NHSBSA payment data)

5.30

5.70

6.10

6.50

6.90

7.30

7.70

8.10

8.50

8.90

9.30

Nov-16

Jan-17

Mar-17

May-17

Jul-1

7

Sep-17

Nov-17

Jan-18

Mar-18

May-18

Jul-1

8

Sep-18

CP DD

5.30

5.70

6.10

6.50

6.90

7.30

7.70

8.10

8.50

8.90

9.30Nov-16

Jan-17

Mar-17

May-17

Jul-1

7

Sep-17

Nov-17

Jan-18

Mar-18

May-18

Jul-1

8

Sep-18

Ingredientcost

Ingredientcost lessdiscount

Ingredientcost lessdiscountplus fees

1.551.601.651.701.751.801.851.901.952.002.05

7.40

7.50

7.60

7.70

7.80

7.90

8.00

8.10

8.20

8.30

Fees

(£)

NIC

(£)

Fees/item NIC/item

£4.30

£4.35

£4.40

£4.45

£4.50

£4.55

£4.60

£2.75£2.85£2.95£3.05£3.15£3.25£3.35£3.45£3.55

Q1 1516

Q2 1516

Q3 1516

Q4 1516

Q1 1617

Q2 1617

Q3 1617

Q4 1617

Q1 1718

Q2 1718

Q3 1718

Q4 1718

Q1 1819

Q2 1819

Bran

d AIV contribu

tion

Generic AIV contribu

tion

G vs B AIV Variance

Contribution of Generic to AIV Contribution of Brand to AIV

£8.50

£8.65

£8.80

£8.95

£9.10

£9.25

£9.40

£9.55

1415 Q1

1415 Q3

1516 Q1

1516 Q3

1617 Q1

1617 Q3

1718 Q1

1718 Q3

1819 Q1

AIV


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Category MBiggest Movers (excluding new additions)

Nov-18 Cat M value* £336,814,196 per quarterDrug Name

Pack Size

Jan-19 DT (£)

Nov-18 DT (£)

change (£)

% change

Jan-19 Cat M value* £327,564,546 per quarter Risperidone_Tab 4mg 60 13.86 1.76 £12.10 688% Latanoprost_Eye Dps 50mcg/ml 2.5 5.89 1.53 £4.36 285%Movement* -£9,249,651 per quarter Ramipril_Tab 5mg 28 2.92 0.78 £2.14 274%

Ramipril_Tab 10mg 28 2.63 0.95 £1.68 177%Amisulpride_Tab 50mg 60 6.56 2.46 £4.10 167%

● 252 increases Tolterodine_Tab 2mg 56 2.38 2.78 -£0.40 -14%● 341 decreases Glimepiride_Tab 1mg 30 1.56 1.82 -£0.26 -14%● 28 no change Flecainide Acet_Tab 100mg 60 5.2 6.05 -£0.85 -14%● 3 new products Paroxetine HCl_Tab 20mg 30 1.04 1.21 -£0.17 -14%

Gliclazide_Tab 40mg 28 1.58 1.83 -£0.25 -14%

*excluding new additions to Cat M. Indicative figures based on Jul-18 to Sep-18 vols with estimated growth factor


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