Cost

Unlicensed medicines, or ‘Specials’, account for less than 1% of the NHS prescriptions budget. The amount being spent on ‘Specials’ is estimated to have risen from £57 million to £160 million between 2007 and 201064. However, the costs for liquid ‘Specials’ in England appear to have dropped more recently between 2010/11 and 2011/1265.

Cost of liquid ‘Specials’ in England (net ingredient cost)65

  • 2005/06
  • £9,213,488
  • 2006/07
  • £10,779,319
  • 2007/08
  • £27,619,254
  • 2008/09
  • £49,903,641
  • 2009/10
  • £87,595,020
  • 2010/11
  • £88,075,613
  • 2011/12
  • £59,842,220

Concerns regarding the cost of ‘Specials’ to the NHS is compounded by a wide variation in cost for the same medicines. Data supplied by NHS Business services Authority Prescription Services shows net ingredient cost for same strength, volume and quantity of unlicensed omeprazole liquid have ranged from £112.98 to £1113.13, and for hypromellose eye drops from £38.70 to £2882.1063.

To address this variability, the Department of Health allowed 'Specials' manufacturers to publish their price lists in August 2010 and introduced new arrangements for the reimbursement of ‘Specials’ in November 2011. This means that certain products formerly categorised as Special Order Products will now be categorised as Drug Tariff Special Order Products with pharmacists now being reimbursed a fixed amount for the most commonly prescribed ‘Specials’. The ‘Specials’ Tariff will have its prices updated quarterly and prescribing data will be examined every six months to allow products to enter and exit the list. Where a ‘Special’ becomes available as a licensed product outside of these reviews, the Drug Tariff will be updated to reflect the introduction of the licensed product.

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Resources

  • Prescribing ‘Specials’ – Five guiding principles for prescribers. NPC.
  • Dealing with ‘Specials’. RPSGB.
  • Information and guidance on the prescribing and use of unlicensed pharmaceutical specials. East of England NHS Collaborative Procurement Hub.
  • Association of Pharmaceutical Specials Manufacturers
  • Manufacturer’s and wholesale dealer’s licences. MHRA.
  • Introduction of a 'Specials' tariff. NHS Prescription Services.