1 e f forte.uk.com t January 2018

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1 t e info@forte.uk.com f forte.uk.com January 2018 In July 2017, the NHS England Board approved consultation on a set of proposals to limit the primary care prescribing of 18 products - costing a total of 141 million per year. In total, over 5,500 responses were received by NHS England on the proposals to restrict prescribing of the 18 so described low value medicines. The proposals were discussed at the NHSE board meeting on Monday 30 November 2017,,, and the board decided that a number of the 18 medicines will enter the Drug Tariff Black List - items would not be remunerated on a NHS FP10. This change will take time as the Secretary of State will need to consult on these recommendations, however, there is a risk that without comprehensive communications to patients about the change, patients take out their frustrations on staff in general practice and Proposed Black List Medicines Co-proxamol Glucosamine and Chondroitin Herbal Treatments Homeopathy pharmacies. The other medicines that are going to have strict restrictions placed upon them are dosulepin, doxazosin, oxycodone and naloxone,paracetamol and tramadol, perindopril arginine, tadalafil (5mg o n c e d a i l y ), a n d Lutein and Antioxidants trimepramine. These medicines CCGs will be Omega-3 Fatty Acid advised to stop new Compounds prescriptions bei ng Rubefacients (excluding topical NSAIDS) initiated in primary care, and that current patients w h o r e c e i v e t h e medicines are reviewed and de-prescribed. The only real changes from the consultation was that liothyronine can still be prescribed but only by a NHS endocrinologist, and lidocaine patches and immediate release fentanyl can be used in select conditions. Again these changes will require direct communication to patients as there will be a number of confused and concerned patients who would otherwise seek advice, and probably alternatives form their GPs. The final and I feel most controversial proposal was the idea to restrict prescriptions for 3,200 medicines that can be purchased over the counter. The NHS England (NHSE) board considered this proposals that would potentially save around 190 million per year, stating: As feedback from the consultation was broadly supportive, we now believe that it is appropriate for NHS England to work with partners to develop formal and far more detailed guidance to CCGs. Firstly, this was an interesting statement as actually only 44% of all the respondents agreed the change, 66% responded with either disagreed, neither agree nor disagree or were unsure, but these were conveniently omitted in the headline figure. You can understand why the NHSE board are railroading through any proposals that will save money, as the recent autumn budget yielded less than half of the required investment of 1.6 billion (Simon Stevens had asked for 4 billion additional funds). The main concern is that again without a direct to patient, fully comprehensive communications plan, general practice and pharmacies will be caught in the middle, having to spend time allaying patient concerns and recommending alternatives. So in essence there is a big risk that while NHSE saves money, we gain additional workload and costs when we are struggling with current patient demands. Message from Mark Stone, Consultant Pharmacist Partner, I recently spent time looking at the NHSE Board meeting minutes and the consultation proposals for OTC medicines. 1

2 t e info@forte.uk.com f forte.uk.com January 2018 Firstly, it is interesting to see in the paper the boards opinions on the 'success' of the consultation on OTC medications detailed in the minutes, which reads: 49. As feedback from the consultation was broadly supportive, we now believe that it is appropriate for NHS England to work with partners to develop formal and far more detailed guidance to CCGs. Now please consider the way they presented the responses! 65% of the responses agreed with the proposal, when really it was only 44% - less than half! There is going to be a consultation on an extended grouping of conditions that should not be treated under the NHS - I feel these will be a fait accompli with regard to the NHSE board comments on the low budget funding. Others things of note from the consultation, many medicines will join the Drug Tariff Blacklist (which will mean we can sell them! In reality most are POMs): Co-proxamol Glucosamine and Chondroitin Herbal Treatments Homeopathy Lutein and Antioxidants Omega-3 Fatty Acid Compounds Rubefacients (excluding topical NSAIDS) We will need to get NHSE to recognise that the restrictions on OTC products will detriment access to care to rural patients, in the full consultation (due in early 2018). OTC Proposal: Indicative conditions or items for which prescribing could be restricted: 1. Probiotics 2. Vitamins and minerals 3. Acute Sore Throat 4. Cold Sores 5. Conjunctivitis 6. Coughs and colds and nasal congestion 7. Cradle Cap (Seborrhoeic dermatitis infants) 8. Haemorrhoids 9. Infant Colic 10. Contact Dermatitis 11. Dandruff 12. Diarrhoea 13. Dry Eyes/Sore (tired) Eyes 14. Earwax 15. Excessive sweating (Hyperhidrosis) 16. Indigestion and Heartburn 17. Insect bites and stings 18. Malaria prevention 19. Mild Acne 20. Mild Dry Skin/Sunburn 21. Mild to Moderate Hay fever/allergic Rhinitis 22. Mild Migraine 23. Minor burns and scalds 24. Minor conditions associated with pain, discomfort and/fever. (eg aches and sprains, headache, period pain, back pain) 25. Mouth ulcers 26. Nappy Rash 27. Oral Thrush 28. Prevention of dental caries 29. Ringworm/Athletes foot 30. Scabies/ Head Lice 31. Simple Constipation 32. Teething/Mild toothache 33. Threadworms 34. Travel Sickness 35. Vaginal Thrush 36. Warts and Verrucae By Mark Stone Pharmacist Partner, Tamar Valley Health, DDA Board 2

3 We are pleased to announce that, as of 1 December 2017, Alliance Healthcare, including NWOS, will enter into an exclusive wholesaler distribution agreement to supply Covalon Technologies (Europe) Ltd to all pharmacies and dispensing doctors in England, Scotland and Wales and Northern Ireland. Pip code Product name Item size Colvan product code CovaWound Silicone Foam 5 x 5 cm CovaWound Silicone Foam 10 x 10 cm CovaWound Silicone Foam 10 x 20 cm CovaWound Silicone Foam 15 x 15 cm CovaWound Silicone Foam 20 x 20 cm CovaWound Silicone Foam with Border 10 x 10 cm CovaWound Silicone Foam with Border 10 x 20 cm CovaWound Silicone Foam with Border 15 x 15 cm CovaWound Silicone Foam with Border 7.5 x 7.5 cm CovaWound Silicone Foam with Border Lite 5 x 5 cm CovaWound Silicone Foam with Border Lite 10 x 10 cm CovaWound Silicone Foam with Border Lite 10 x 20 cm CovaWound Silicone Foam with Border Lite 15 x 15 cm CovaWound Silicone Foam with Border Lite 7.5 x 7.5 cm CovaWound Silicone Foam Lite 10 x 10 cm CovaWound Silicone Foam Lite 10 x 20 cm CovaWound Silicone Foam Lite 15 x 15 cm CovaWound Silicone Foam Lite 7.5 x 7.5 cm CovaWound Alginate Rope 2 x 30cm CovaWound Alginate 5 x 5cm CovaWound Alginate 10 x 10cm CovaWound Alginate 10 x 20cm CovaWound Alginate 15 x 20cm CovaWound Hydrocolloid 10 x 10cm CovaWound Hydrocolloid 15 x 15cm CovaWound Hydrocolloid 20 x 20cm CovaWound Hydrocolloid Thin/Transparent 10 x 10cm CovaWound Hydrocolloid Thin/Transparent 10 x 15cm CovaWound Hydrocolloid Thin/Transparent 15 x 15cm As part of this new agreement, the discount available for eligible products will be 10 per cent. This will be invoiced at drug tariff price, with any applicable discounts applied on your statement at the end of the month. 3

4 We are pleased to announce that, as of 1 February 2018, Alliance Healthcare UK will become the only selected wholesaler to supply Grunenthal s product portfolio to pharmacies, hospitals and dispensing doctors in England, Scotland, Wales and Northern Ireland. For your convenience, the full information of Grunenthal s product portfolio can be found on our website at Purchases of Grunenthal lines will arrive as part of your usual Alliance Healthcare delivery available on a same day delivery service. If you already hold an Alliance Healthcare account, there is no need for you to take any further action. Please note that Qutenza will remain on a next day delivery service. In order to receive Grunenthal lines from 1 February 2018, you can simply order from Alliance Healthcare in your usual manner. Purchases of Grunenthal s products will not be subject to Alliance Healthcare s low spend surcharge, if purchased in isolation. A discount of 5% will be available on eligible lines for downstream customers. To set up an Alliance Healthcare account, please visit our website at Should you have any questions in relation to Grunenthal s product portfolio, please contact Grunenthal on: PALEXIA 100MG PR TABLETS A 56 GBR PALEXIA 150MG PR TABLETS A 56 GBR PALEXIA 200MG PR TABLETS A 56 GBR PALEXIA 250MG PR TABLETS A 56 GBR PALEXIA 50MG IR TAB FILM COATED A 28 GBR PALEXIA 50MG IR TABLETS A 56 GBR PALEXIA 50MG PR TABLETS A 28 GBR PALEXIA 50MG PR TABLETS A 56 GBR PALEXIA 75MG IR TABLETS A 28 GBR PALEXIA 75MG IR TABLETS A 56 GBR PALEXIA IR ORAL SOL 20MG/ML 100ML GBR PALEXIA IR ORAL SOL 20MG/ML 200ML GBR TRAMACET EFFERVES. TABS A 60 GBR (GRT) TRAMACET TABLETS A 60 GBR VERSATIS PATCH A 30 GBR ZYDOL 100 AMP. A 5 GBR (GRT) ZYDOL CAPSULES 50MG A 100 GBR (GRT) ZYDOL CAPSULES 50MG A 30 GBR (GRT) ZYDOL SR 100MG TABLETS A 60 GBR (GRT) ZYDOL SR 150MG TABLETS A 60 GBR (GRT) ZYDOL SR 200MG TABLETS A 60 GBR (GRT) ZYDOL SR 50MG TABLETS A 60 GBR ZYDOL TABS 50MG A 100 GBR (GRT) ZYDOL TABS 50MG A 20 GBR (GRT) ZYDOL XL 150MG A 30 GBR ZYDOL XL 200MG A 30 GBR ZYDOL XL 300MG A 30 GBR ZYDOL XL 400MG A 30 GBR RALVO 700MG MEDICATED PLASTER A 30 GBR QUTENZA 179MG CUTAN. PATCH A 1 GBR/IRL

5 We are pleased to announce that BABY D ORAL SOLUTION VIT D3 Manufacturer Discount Scheme is back at 20%. See below table for details. Kora Healthcare BABY D ORAL SOLUTION VIT D3 20% We are pleased to announce that Roche has increased the discount for Accu-Chek products range. For your convenience please refer to the table attached for details of the products ACCU-CHEK AVIVA BLD T/STRIP 15% 20% ACCU-CHECK PERFORMA T/STRIPS 5% 10% ACCU-CHEK MOBILE TEST CASSETTE 5% 10% We are pleased to announce that Scope Opthalmics has added a new product to the current MDS scheme from 1st December. For your convenience please refer to the table attached for details of the product. Scope Ophthalmics Optase Moist Heat Mask 14% (New) Scope Opthalmics HYLO-TEAR 0.1% PRESERVE FREE 14% Scope Opthalmics HYLO-FORTE 0.2% PRESERVE FREE 14% Scope Opthalmics HYLO-CARE PRESERVATIVE FREE 14% Scope Opthalmics VITA-POS (PRESERV FREE OINT) 14% Scope Opthalmics TEAR-LAC PRESERVATIVE FREE 14% Scope Opthalmics HYLO-FRESH 0.03% 14% Scope Opthalmics HYLO-DUAL 0.1% FRESH 14% Manufacturer Discount Scheme has stopped from 1st of December. Manufacturer Discount Scheme has stopped from 1st of December. No other products on scheme has been affected. From 1st October, the discount on Tricare has been removed form the MDS scheme. 5

6 From the 1st February 2018, Agamatrix will discontinue the discount for U/Thin Lancets 33G and has decided to increase the discount for Wavesense Jazz Test Strips range, starting from 11+ packs. See below table for details WAVESENSE JAZZ TEST STRIPS 10% from pack 1 13% 11+ packs X25 WAVESENSE JAZZ DUO T/STRIPS 10% from pack 1 13% 11+ packs AGAMATRIX U/THIN LANCETS 33G 10% from pack 1 Removed Generating Audit (PA) Prescription Do you know if your GP s and nurses are remembering to produce a prescription each time they administer a drug? It s a good idea to set up a monthly audit to check a prescription has been issued, as you may be losing hundreds of pounds! Tetanus Depo Provera Zoladex/Prostap Hydroxocobalamin B12 Cholera Depo Medrone Depo-Medrone & Lidocaine Off patent Crestor has come of patent as from last month, reduce your Crestor stocks in preparation for the generic. See below a list of drugs which I would recommend doing a search on: By Lucy Jacques Dispensary Manager Hastings House Surgery We will continue to offer E-Consultancy Service to all our 8501 Forte Group Members. Whatever your commercial or dispensary query, all you need to do is Sally (sally.linch@nhs.net) with Forte followed by your Alliance account number in the subject header and she will reply with an answer within 3 working days. 6

7 Happy New Year! Words like extraordinary, shocking and even bizarre have been bandied around to describe the last 12 months, one things for sure, 2017 certainly has been an interesting one. We ve seen a snap General Election, unsuccessful independence elections in Spain, La La Land win the best picture Oscar, and Trump s inauguration well, the less said about that, the better. Moving swiftly on; Teresa May triggered article 50 meaning the Brexit discussions are moving full steam ahead, for good or for ill. I m sure at the moment there are more headaches for our politicians than directly affecting us currently, but these will come. The immediate effect on our industry was the increase in PI line prices, which meant that every practice wasn t able to enjoy the luxury of the previous year s import prices and having to look at more financially stable and profitable ways of purchasing. Despite FMD (Falsified Medicines Directive) being a European venture, this has been confirmed that it will still be applicable to Britain post Brexit and so processes need to be in place to ensure both your practices and the industry are ready. We saw a record number of PSNC price concessions running half way through the year and into A couple of generic manufacturers failed their MHRA inspections meaning they had to cease production for some time, sadly lowering supply and increasing prices for many lines across the market. On to better news all round; The PSNC appointed their new CEO Simon Dukes at the end of the year after the previous CEO, Sue Sharpe resigned from the position she held since Julian Mount became the Managing Director of Alliance Healthcare at the end of March, following the announcement of Jeremy Main s retirement. Julian brings with him a wealth of knowledge and experiences a senior healthcare industry executive with 30 years experience in building and leading teams in business transformation, sales, marketing and business excellence across international markets. Julian s appointment saw a renewed vigour and drive towards the key fundamentals of the business to ensure your practices and patients receive the very best standard of service from Alliance Healthcare. In August, Forte was acquired by Alliance Healthcare UK and we are now part of the wider WBA family. With this acquisition, we continue to be able to offer our members the same dedicated service and commitment we always have, with the added benefit of a global power behind us to further enhance your membership benefits and package. Watch this space for exciting developments throughout It was a pleasure to work with you all in 2017, and we look forward to continuing you help you service your communities and care for your patients in 2018 and beyond. At Forte, we are incredibly excited with the announcement from Alliance Healthcare and its new customer-centric campaign - we re doing things differently, aimed at making business with Alliance Healthcare easier. Keep up to date with the exciting news at: differently From all of us here at Forte, we would like to wish you a very happy and prosperous new year. It is important that we hold the most up-to-date information regarding our customers. If you have recently changed any of your details, such as your name, address or telephone number, please let us know by ing info@fortegroup.uk.com or alternatively contact us on opt#3. 7