We should all put patients first - it's our number one priority and is top of the list in our code of ethics...but what if putting a patient first results in a loss?
 
Nobody in business should work for nothing...even worse if it costs money!
 
For the last month we've been putting patients first by ordering gabapentin for them assuming that due to the shortages of the product and the fact that the price was rising - a concessionary price would eventually be agreed.
 
How disappointing it was last Friday to see a price concession far below market price brought in for the month of October...The DOH said  "...indicate that stock is available at a wide range of prices for gabapentin, and we acknowledge that some is quite high when compared to the proposed concession prices, it also shows that the majority of stock on the market is available at or below the proposed price from multiple suppliers." I'm not sure which suppliers the DOH have been looking at, because the price I was quoted today from all our suppliers is well above concession - even from the large suppliers!
 
I recognise that this is a complex area; but we really need an answer that is fair to all.
 
Another non regular patient presented with a prescription for 420 loperamide capsules today...this product is unavailable at the 30 size and is cat M. The only way of dispensing this prescription is to use "over the counter product" at a significant loss...He had visited a lot of pharmacies before he got to us... 
 
I recognise that It's very frustrating for contractors to dispense at a loss, but the alternative is that patients suffer; and sadly many pharmacists are really struggling with this ethical dilemma?

These days there are always products going in short supply - due to a variety of reasons: quota, manufacturing problems, distribution issues etc - and pharmacy staff are spending considerable time and effort attempting to obtain supplies of these drugs for patients or liaising with prescribers to get an alternative product.
 
On rare occasions, however, a perfect storm occurs...a product goes short that is really difficult to replace and this time it's isosorbide mononitrate...
 
We have been told that the 20mg tablets will be unavailable until May, so pharmacies are struggling to meet demand with 10mg and 40mg tablets. The problem is that these products are obviously getting very expensive (if you can get them)...at the time of writing I've just bought some 10mg tablets for £19-97 for 56 - and the Drug Tariff reimbursement price is £1-74 (cat M)...I was glad to here that it has now gone NCSO so that pharmacies will be not be considerably out of pocket!
 
Adding to the problem is that modified release products and the dinitrate are in short supply, so It's likely that patients will be referred back to prescribers in droves soon for alternatives - adding more complexity to the situation.
 
Make sure you keep an eye on our home page for information and local guidance.