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Clopidogrel 75mg tablets to move to Part VIII Category A in December
Generic Clopidogrel tablets are currently available in the UK based on the besilate and hydrochloride salts. Clopidogrel based on the Hydrogen Sulphate salt is only available as a branded medicine, Plavix. Clopidogrel 75mg tablets are currently listed in Part VIII of the Drug Tariff with the reimbursement price based on the list price of the brand, Plavix.
At present, open prescriptions for Clopidogrel 75mg tablets and prescriptions which specify one of the Clopidogrel salts (i.e. Besilate, Hydrochloride or Hydrogen Sulphate) will be reimbursed based on the set Drug Tariff price.
The Department of Health has confirmed that Clopidogrel 75mg tablets will be moved to Category A of the Drug Tariff with effect 1st December 2009.
From 1st December, the Part VIII reference price of Clopidogrel will be the weighted average of the prices for generic Clopidogrel listed by the following suppliers and manufacturers; AAH, Alliance Healthcare, Teva and Activas. Where a prescription is received for Clopidogrel, pharmacies can fulfill the prescription by supplying any salt, but regardless of which product they supply they will only be paid the category A reference price.
However, where a prescription is received for Clopidogrel 75mg Hydrogen Sulphate, pharmacies must legally and ethically dispense a product based on this salt. The brand, Plavix is currently the only product available in the UK that matches this description. The Department of Health have agreed that where ‘Clopidogrel 75mg Hydrogen Sulphate’ is prescribed on a prescription, the prescription will be treated as a ‘non-Part VIII generic’. The pharmacy must endorse the prescription stating that the brand Plavix has been dispensed and reimbursement will be based on the Plavix list price instead of the Drug Tariff reimbursement price. Where there is no endorsement, prescriptions for ‘Clopidogrel 75mg Hydrogen Sulphate’ will be returned for clarification on what has been dispensed.
PSNC has written to all pharmacy system suppliers to alert them to this change.
Summary of Endorsing Guidance (from December 2009)
| Drug | Reimbursement based on: | Endorsement required: |
| Clopidogrel Tablets 75mg | Part VIII price | No |
| Clopidogrel Besilate Tablets 75mg | Part VIII price | No |
| Clopidogrel Hydrochloride Tablets 75mg | Part VIII price | No |
| Clopidogrel Hydrogen Sulphate Tablets 75mg | Contractor’s Endorsement | Yes, endorse details of product supplied |
Frequently Asked Question
Why is Clopidogrel listed in the Drug Tariff and on dm+d without a salt identifier?
The editorial policy of the NHS Dictionary of Medicines and Devices (dm+d) states that where a virtual medicinal product is available in one form as two or more salts and the BP monograph or the MHRA has determined that products are clinically equivalent, the dm+d ‘virtual’ description for the product does not need to include the salt identifier.
Products are listed in Part VIII of the Drug Tariff using the products dm+d ‘virtual’ description. Also products are prescribed via the Electronic Prescription Service using a product’s dm+d code and description.
Posted 3 November 2009