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Medicine Shortages
Generic Medicines & the NCSO Concession: When stock of a product in Part VIII of the Drug Tariff has gone short in the market or the product has been discontinued by the manufacturer, and there is a more expensive alternative product available in the market, it is possible to apply to the Department of Health to grant the NCSO ('No Cheaper Stock Obtainable') concession which will allow contractors to dispense a more expensive alternative product, and be paid on their endorsement. To see more details on the NCSO concession, and to see what products have currently been granted NCSO, click here.
What is the Impact of Stock Shortages?
From a patient perspective, stock shortages can lead to delays in patient care and can result in increased visits to pharmacies to collect supplies of medicines when the full prescribed order is not initially available. Evidence from the US shows that stock shortages can also lead to increased adverse reactions, for example when alternatives are prescribed and can cause confusion and decreased compliance.
From the NHS perspective, shortages can also be very costly. As well as the increased costs of sourcing alternatives, the unavailability of a key medicine or decreasing a patient's compliance with their medication regimen can lead to the exacerbation of a patient's medical condition, increasing hospital admissions and treatment costs.
Although the impact of stock shortages on patient care is widely acknowledged, when a medicine goes into short supply, it can also have a major impact on community pharmacists. For example, shortages inevitably lead to increased time spent in sourcing products, discussing alternatives with prescribers and counselling patients. Shortages can mean ‘double dispensing', for example if patients have to return to the pharmacy at a later date with an owing note and it can increase conflict between the patient and the pharmacist and the pharmacist and the prescriber, for example if there are misconceptions that the problem is due to the pharmacy's stock management rather than a genuine supply problem. Evidence from the US also suggests that the risk of medication errors increase when alternatives are prescribed, for example if the prescriber and pharmacist are less familiar with the alternative.
Stock shortages can also have an adverse financial impact on pharmacies, as well as increased costs caused by the increased burden on pharmacists, there may also be increased costs in procuring medicines which are not always reimbursable.
Stock Shortage Notification Schemes
The Department of Health, the Association of the British Pharmaceutical Industry and the British Generics Manufacturers Association developed guidelines on the notification and management of stock shortages. These were launched in January 2007. PSNC has welcomed this guidance and believes that it is a positive step in improving the monitoring of potential supply problems. Click on the links below for more information:
Department of Health and ABPI guidance
Department of Health and BGMA Guidance
Frequently Asked Questions
I have problems obtaining a Part VIII Product, what should I do?
If you have problems obtaining a Part VIII product or problems obtaining the product at the set Drug Tariff price, please contact the PSNC Information Team (01296 432823).
PSNC will then contact the main wholesalers to establish the extent of the problem and if necessary make an application for the product to be given NCSO Status. We will keep you informed throughout the process. NCSO status only lasts until the end of the month that the application was made. If at the beginning of the following month, the problem is still not resolved, a new application for NCSO status is made.
I have received a prescription for '28 x 5mg tablets'. As this strength is unavailable, can I dispense '56 x 2.5mg tablets'?
Reimbursement will be based on the prescribed strength and quantity so if contractors do ‘double up' to support patient care, they are advised to return the prescription to the prescriber for amendment to ensure correct payment. Please note that the 'PC' endorsement is not sufficient in this situation. This also applies when the product has been granted the NCSO Concession.
I have been told by my wholesaler that a Part VIII product is unavailable. There is not an alternative proprietary product available but a specials manufacturer can prepare this product for me. Can NCSO be requested?
No. The Department of Health view is that the prescription should be referred back to the prescriber so that they have the opportunity to prescribe an alternative licensed product and/or are aware of the changes in liability caused by an unlicensed product being given to the patient. If the prescriber believes that the product should be specially manufactured, the prescription should be amended to specify a manufacturer within the product description. If the prescriber has stated the name of the specials manufacturer, NHS Prescription Services will pay based on the endorsed invoice price for the specially manufactured product rather than the Drug Tariff Price.
It is helpful to inform the PSNC Information Team about the shortage. If there is a long term supply problem, PSNC can make an application to the Department of Health to remove the product from the Drug Tariff.
More information on the dispensing of unlicensed medicines is available in the RPSGB Fact Sheet on The Use of Unlicensed Medicines in Pharmacy (PDF Format).
Can I endorse ‘DNG' to claim exemption from discount deduction when an item has been granted the NCSO Concession?
When a product is considered NCSO and the prescription has been fully endorsed, the prescription is priced based on the endorsed brand/supplier. If the endorsed product is on the list of ‘drugs for which discount is not deducted' then the item would automatically be exempt from discount deduction. Contractors can only endorse ‘DNG' to claim exemption for discount deduction on prescriptions for Specials and unlicensed medicines that have been obtained without any discount.
Can I endorse a prescription ‘NCSO’ in advance of the NCSO Concession being agreed by the Department of Health?
Yes, where a Part VIII product cannot be obtained at the Drug Tariff price because of a supply problem and a more expensive product has had to be dispensed, the prescription could be endorsed in anticipation of the NCSO Concession being granted. The full endorsement required is the initials, ‘NCSO’, full details of the product dispensed and the endorsement must be initialled and dated. NHS Prescription Services will reimburse based on the standard Part VIII price where the product was not been granted the NCSO Concession in the month concerned.
Can I claim 'out of pocket expenses' incurred in obtaining the brand?
Out of Pocket Expenses (OOP) can be claimed in exceptional circumstances on all medicines except products in Category A or M of Part VIII of the Drug Tariff. If a Part VIII Category A or M product has been granted NCSO Status and the prescription has been fully endorsed, the prescription will be processed based on the dispensed item so out of pocket expenses claimed will be reimbursed. Please note that if the prescription has no NCSO endorsement the contractor will be paid for the Part VIII item and Out of Pocket Expenses will not be paid.
I have received an FP10 prescription for a generic item but can only obtain the branded equivalent, at higher than the Part VIII Drug Tariff price. If I endorse the branded product was dispensed will I be reimbursed for it?
Where a generic product is listed in Part VIII of the Drug Tariff and you receive an FP10 prescription requesting the generic, you will only be reimbursed for a more expensive branded equivalent if the NCSO concession (No Cheaper Stock Obtainable) has been granted for that dispensing month and the prescription has been endorsed fully to claim the concession.
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