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Pharmaceutical Services Negotiating Committee

Generic Medicine Shortages (NCSO)

Quick Links:

What is NCSO Status?

NCSO Endorsing Guide

Historical Information on Concessions Granted

NCSO Frequently Asked Questions


APRIL CONCESSIONS  are listed further down this page- Contractors are reminded that NCSO/price concessions agreed with the Department of Health only lasts for the month in which it is granted.

May 2013

PSNC is in discussion with the Department of Health on a number of generic medicines in short supply.

Please note that PSNC cannot provide details of generic products that are suspected of being affected by generic supply problems unless and until the Department of Health grants a concession.

If you have problems obtaining a Part VIII product or problems obtaining the product at the set Drug Tariff price, please report the issue to PSNC using the online feedback form on the PSNC Website. PSNC will investigate the extent of the problem and if appropriate discuss the issue with the Department of Health. Contractors will be alerted to any updates through our website and via our e-news email.  If you wish to subscribe to our email list, you can receive an email as soon as any announcements are made

April 2013

The following product was granted NCSO status for the month of April:Contractors are reminded that NCSO/price concessions agreed with the Department of Health only lasts for the month in which it is granted

Indapamide 2.5mg tablets (28)

The required endorsement must include the letters ‘NCSO’, manufacturer or supplier or brand name and the pack size of the product, the price paid before discount and ex VAT, the pharmacist’s initials and the date.

The following products had the following price concessions for the month of April:Price concessions do not require any additional endorsements as the agreed price is applied automatically by the NHSBSA when they process the prescriptions submitted with the April bundle.

  • Hydralazine 50mg tablets (56) - £16.32
  • Isosorbide mononitrate 10mg tablets (56) - £13.10
  • Isosorbide mononitrate 20mg tablets (56)- £13.88  please also see our related news story on Isosorbide
  • Isosorbide mononitrate 40mg tablets (56)- £20.55
  • Nabumetone 500mg tablets (56) - £6.18
  • Naftidrofuryl 100mg capsules (84) - £8.10
  • Sertraline 50mg tablets (28): £14.00 - please also see our related news story on Sertraline
  • Sertraline 100mg tablets (28): £18.00
  • Temazepam 10mg tablets (28) - £24.00
  • Temazepam 20mg tablets (28) - £23.00
  • Trazodone 50mg capsules (84) - £23.92
  • Trazodone 100mg capsules (56) - £28.14
  • Trazodone 150mg tablets (28) - £16.08

 

The Department of Health set price concessions using information derived from manufacturers and wholesalers.  Where contractors are unable to purchase products at the set prices, they may wish to challenge suppliers for an explanation of why their prices are so high.  Where contractors are unable to secure products at or near the concessionary price, PSNC would like to receive copies of invoices for monitoring of prices.  Please email these to info@psnc.org.uk or fax to 0207 8338007 for the attention of the Information Team.

Please ensure you continue to report any problems with supply to PSNC using the online feedback form on the PSNC Website. If you have been able to source the product, please provide full details of the supplier and price paid. PSNC will investigate the extent of the problem and if appropriate discuss the issue with the Department of Health. 

Contractors are reminded that NCSO/price concessions agreed with the Department of Health only lasts for the month in which it is granted.

PSNC understands that where products being granted an NCSO/price concession late in the month can cause confusion as to which month it is intended to be applied to.  However as stock situations are dynamic and constantly changing PSNC cannot guarantee that the granting of a concession in one month will be agreed in subsequent months.  Contractors are advised to procure as economically as is possible for their individual businesses.


What should I endorse whilst I am awaiting for a decision on NCSO to be made?

Ensure you report any problems with supply to PSNC using the following form on our website:  http://www.psnc.org.uk/pages/feedback_form.html 

PSNC would like to receive copies of invoices for monitoring of prices.  Please email these to info@psnc.org.uk or fax to 0207 8338007 for the attention of the Information Team.

Contractors could undertake one of the following whilst awaiting confirmation of the NCSO lines:-

1)  Where no product is available to contractors at the Drug tariff listed price, the prescription could be endorsed in anticipation of an NCSO concession being granted. (The required endorsement must include the letters ‘NCSO’, manufacturer or supplier or brand name and the pack size of the product, the price paid before discount and ex VAT, the pharmacist’s initials and the date). For NCSO lines on EPSR2 prescriptions contractors should wait to make the 'reimbursement claim' until the NCSO is announced. Please be aware that NHS Prescription Services will only reimburse based on the standard Part VIII  price if the product was not granted the NCSO concession in the month the prescription is submitted or if the NCSO endorsement is incomplete.

2)   Advise the prescriber to consider either:

  • Amending the prescription to include the brand, name of the manufacturer or supplier of the product which you are able to purchase, this will ensure the prescription is priced according to the appropriate list price. Remember that if the prescriber makes a hand written amendment or includes additional product information that does not appear in the product description (e.g. preservative-free or sugar-free within the dosage instructions), the prescription must be included in the red separator.
  • Consider issuing a new prescription for an alternative medicine for the patient.

Contractors may want to consider the following points in discussions with the prescriber:

  • Pharmacies always seek to procure cost effectively for the NHS but occasionally due to a shortage in the market the purchase price is not reflected in the Drug Tariff. The difference can be a significant amount of money. In order to ensure that reimbursement is accurately reflected by including the manufacturer, supplier or a brand on the prescription we can ensure the prescription is reimbursed appropriately.
  • Margin on dispensed medicines for pharmacy is set nationally and delivery of this funding is carefully monitored to ensure it remains within the agreed level. 

 Background information

The NCSO and price concessions only last for the month granted. If at the beginning of the following month the situation is not resolved, a new application is made.

Please note, PSNC cannot provide details of generic products that are suspected of being affected by generic supply problems unless and until the Department of Health grants a concession. Updates will be posted on the PSNC Website. Updates will also be sent out via our e-news email list so by subscribing to this email list, you can receive an email as soon as any announcements are made

NCSO Concessions: Archive

More information on the NCSO Concession including endorsing guidance and FAQs can be found below.

Other Products

If you have problems obtaining a Part VIII product or problems obtaining the product at the set Drug Tariff price, please report the issue to PSNC using the online feedback form on the PSNC Website. If you have been able to source the product, please provide full details of the supplier and price paid. PSNC will investigate the extent of the problem and where appropriate discuss the issue with the Department of Health.

Please note, PSNC cannot provide details of generic products that are suspected of being affected by generic supply problems unless and until the Department of Health grants a concession. Updates will be posted on the PSNC Website. Updates will also be sent out via our e-news email list so by subscribing to this email list, you can receive an email as soon as any announcements are made.


Historical information on NCSO/Price Concessions that have been granted.

Click on the link below to view the NCSO/Price Concessions granted since January 2003:

NCSO Concessions: Archive


What is NCSO Status?

There is a set reimbursement price for the supply of drugs listed in Part VIII of the Drug Tariff. Occasionally there are shortages of these products, for example, if there are manufacturing problems or a change in demand, leaving pharmacy contractors faced with dispensing an equivalent product that is only available at above the set Drug Tariff price.

When this happens, PSNC is able to apply to the Department of Health for the ‘No Cheaper Stock Obtainable' (NCSO) Concession to be granted for a particular month. If this status is granted, pharmacy contractors will be reimbursed based on their endorsement rather than the fixed Drug Tariff Price but it is essential that contractors endorse the prescription fully with the letters ‘NCSO' and full details of the product dispensed (e.g. manufacturer or supplier or brand name and pack size. If a particular supplier's product is not listed with a price on the NHS RxS pricing system, pharmacies must also endorse the price paid (before discount and ex VAT)). The endorsement must also be signed or initialed and dated. If any of this information is missing, payment will be based on the Drug Tariff price rather than the endorsed product.

If an item is in Category A or M of Part VIII of the Drug Tariff, out of pocket expenses cannot normally be claimed. However if the NCSO Concession has been granted and the prescription is properly endorsed, out of pocket expenses can also be claimed.

The concession is only granted where there is a licensed equivalent available. The concession is not granted where the product is still available in the market at or below the Drug Tariff price, for example where one key wholesaler still has stock.

Once the NCSO Concession has been granted, it only applies for that particular month. If at the beginning of the following month the situation is not resolved, a new application is made.


NCSO Endorsing Guide

 

PSNC has published a quick reference guide to endorsing NCSO prescriptions. Click on the link below to download a copy: 

NCSO Endorsing Guide

 Given the number of products in short supply at present, contractors may want to consider undertaking an additional check during the end of month prescription submission process, to ensure that all prescriptions have been endorsed correctly, where necessary. Key things to consider:

  • The NCSO Concession is granted at different times during the month, have staff been giving consideration to whether the Concession needs to be claimed for all products on the NCSO list?  
  • Where staff have endorsed to claim the concession, does the endorsement include all of the necessary information? In checks PSNC has undertaken on endorsing practice, the most common omission is not initialing the endorsement (any authorised staff member can add the initial, it doesn't need to be the pharmacist. The initials can be computer generated). 
  • If NHS Presciption Services do not have a price on their system for the endorsed brand or supplier, the endorsement must also include the price paid (before discount and ex VAT). An indication of which suppliers are listed on the NHS RxS system for a particular product is available through the Dictionary of Medicines and Devices.
  • NHS Prescription Services will only reimburse based on an NCSO endorsement, where a prescription has been submitted in the month that the concession has been granted. Care should be taken to ensure that prescriptions dispensed in a particular month are submitted with that month’s prescription bundle.

NCSO Frequently Asked Questions

What is the difference between NCSO and a price concession?

When there are shortages of drugs listed in Part VIII of the Drug Tariff (for example if there are manufacturing problems or a change in demand), pharmacy contractors are often faced with dispensing an equivalent product that is only available at above the set Drug Tariff price. In this situation the PSNC is able to apply to the Department of Health for the ‘No Cheaper Stock Obtainable' (NCSO) concession to be granted for a particular month.

If NCSO status is granted, pharmacy contractors will be reimbursed based on their endorsement rather than the fixed Drug Tariff Price, but it is essential that contractors endorse the prescription fully.

The Department of Health may decide to grant a price concession as an alternative to granting the NCSO concession. A price concession is a new fixed (higher than Drug Tariff) price for the month. Any prescriptions dispensed by the contractor would then be reimbursed at the agreed price, without the need for an endorsement to be made by the contractor.

How do I report a problem obtaining a Part VIII product in short supply that is not available at the Drug Tariff price?

If you have problems obtaining a Part VIII product or problems obtaining the product at the set Drug Tariff price, you can report the issue to PSNC using the online feedback form on the PSNC Website (click ‘feedback to PSNC’ on the front page of the website or access the feedback form via www.psnc.org.uk/NCSO). If you have been able to source the product, please provide full details of the supplier and price paid. PSNC will investigate the extent of the problem and if appropriate discuss the issue with the Department of Health.

Please note that PSNC cannot provide details of generic products that are suspected of being affected by generic supply problems unless and until the Department of Health grants a concession.

Background information on generic supply problems and details of products for which the Department of Health have granted either the NCSO Concession or a price concession, can be found in the supply shortages section of the PSNC website (www.psnc.org.uk/NCSO).

In-month Drug Tariff updates including details of products granted the NCSO concession or a price concession are posted on the PSNC Website. Updates are also sent out via the PSNC e-news email list (subscribe by clicking on the ‘sign up for email list’ link on the front of the PSNC website).  

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 received a prescription for a Part VIIIB unlicensed medicine but cannot obtain it at the Part VIIIB price, what should I do?

Unless there are exceptional circumstances pharmacy contractors should be able to purchase the products in Part VIIIB below the Tariff price. Pharmacy contractors will need to ensure they have considered a range of suppliers and where they are still having difficulties, pharmacy contractors should contact PSNC. PSNC will then be able to apply to the DH for an NCSO concession if appropriate.

Where an NCSO concession is granted, pharmacy contractors will be able to source the product from wherever it is available and be paid the cost of product they have procured. To ensure they are paid this cost, they must endorse in line with Part II Clause 9C of the Drug Tariff. 

I have been told by my wholesaler that a Part VIII licensed generic 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).

If a medicine has been granted the NCSO concession for March prescriptions, how long will the concession last?

PSNC needs to apply/re-apply for concessions on a monthly basis. Therefore the concession only lasts until the end of the month in which it was granted. If there is an ongoing supply problem, it is possible that a new concession will be granted by the Department of Health the following month, however this is not guaranteed.

Why aren’t NCSO concessions granted on the first day of each month?

If there is an ongoing supply problem, PSNC needs to make a fresh NCSO application at the start of every month. The Department of Health then take time to undertake checks and make a decision. In some cases, there is a need for negotiation between PSNC and the Department of Health on an individual product’s reimbursement circumstances. This can take time. PSNC would like to see changes to the arrangements that would allow contractors to have certainty over what they will be reimbursed, much earlier in the month.

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 letters ‘NCSO' and full details of the product dispensed (e.g. manufacturer or supplier or brand name and pack size). If a particular supplier's product is not listed with a price on the NHS RxS pricing system, pharmacies must also endorse the price paid (before discount and ex VAT). The endorsement must also be signed or initialled and dated.

Please be aware that 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.

Do I need to endorse a price when claiming the NCSO concession?

If a particular supplier's product is not listed with a price on the NHS RxS pricing system, pharmacies must also endorse the price paid (before discount and ex VAT).

Do I need to include the name of the supplier or is just the price acceptable for NCSO endorsements?

It is essential to endorse the brand name, manufacturer name or wholesaler name. If this information is missing, even if a price has been endorsed, the NCSO claim will not be accepted by NHS RxS.  

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. 

Does it need to be the pharmacist that initials the NCSO endorsement?

No, it can be any staff member who has been appropriately authorised by the pharmacy owner. It doesn’t need to be the pharmacist.

My pharmacy system has functionality to support making a computer-generated NCSO endorsement. Is it acceptable to provide computer-generated initials and the date or does this element of the NCSO endorsement need to be handwritten?

It is acceptable for the NCSO endorsement (including the date and initials of the staff member making the endorsement) to be computer generated.

If a medicine is granted the NCSO concession, are all strengths of the product covered by the concession?

No, the NCSO concession is granted specific to a particular strength of a product.


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