1. DISPENSING Back to Basics
A whistle-stop tour of how to ensure maximum efficiency within your dispensary and make your practice more resilient Dr Philip Koopowitz

2. DISPENSING Back to Basics
Dr Philip Koopowitz

3. DISPENSING Back to Basics
PROFIT PAs and VAT Inhalers D/NOACs Gliflozins Gliptins

4. DISPENSING PROFIT

5. DISPENSING PROFIT
The vast majority of Dispensing GPs plough their profits back into their practices to provide care and ensure practice resilience. Without Dispensing Profit, Rural General Practice is in danger!

6. DISPENSING PROFIT =

7. Profit/Loss = Reimbursement – Cost
DISPENSING PROFIT
Profit/Loss = Reimbursement – Cost

8. DISPENSING PROFIT Reimbursement
= Basic Price -Discount Abatement(11.18% Basic Price)
+ Dispensing Fee (Independent of product prescribed)
+ VAT (if Personally Administered Item)
+ £20 – if Special and endorsed correctly

9. (Not always the same as Basic Price)
DISPENSING PROFIT
Cost
= Cost price of product
(Not always the same as Basic Price)
Minus Discount
(- Wholesalers Discount (0-12%)
- Additional Discount (endangered species))
Ignore VAT as it is reclaimed from HMRC (unless it is a PA)

10. DISPENSING PROFIT
Assumptions Ignore VAT Discount Abatement = 11.18% Exclude Dispensing Fee (~£2.00)

11. Non-PA(Personally Administered)
DISPENSING PROFIT
Non-PA(Personally Administered)

12. DISPENSING PROFIT
Reimbursement Non-PA Reimbursement = Basic Price (BP) Minus Discount Abatement(DA)

13. DISPENSING PROFIT Non-PA Cost = Cost price (CP) Minus Discount(D)
Costs
Non-PA
Cost = Cost price (CP) Minus Discount(D)
Cost price is not always the same as BP

14. Reimbursement- Non PA - £10
DISPENSING PROFIT
Reimbursement- Non PA - £10
Reimbursement = BP-DA
= £10 - £1.12
=£8.88
= BP x 88,82%

15. Cost = Cost price (CP)– Discount
DISPENSING PROFIT
Costs - Non-PA - £10
Cost = Cost price (CP)– Discount
= £10 - £0
= £10

16. DISPENSING PROFIT Profit =Reimbursement –Cost = £8.88 - £10
Profit - Non-PA - £10 (no discount)
Profit =Reimbursement –Cost
= £ £10
= Loss of £1.12

17. DISPENSING PROFIT Profit =BP –DA –CP -D = £20-£2.24 - £20
Profit Non-PA - £20 (no discount)
Profit =BP –DA –CP -D
= £20-£ £20
= Loss of £2.24
Not offset by the Dispensing Fee !!

18. Controllable factors which affect profit
DISPENSING PROFIT
Controllable factors which affect profit
Cost Price
Discount

19. DISPENSING PROFIT Controllable factors Wholesalers Discount
In danger of extinction!
Full Wholesalers discount – now applies to very few products
Average RWM discount ~ 5%

20. No Additional Discount On:
DISPENSING PROFIT
No Additional Discount On:
Generics (but not all!)
Parallel Imports
Fridge Items
CDs
ZD products
Food supplements

21. DISPENSING PROFIT Additional Discount
MDS – Manufacturers Discount Scheme
Check to see whether MDS includes basic
Wholesalers Discount
Is the headline discount hiding something ???

22. PAs and VAT Unravelling the complexities
DISPENSING PROFIT
PAs and VAT Unravelling the complexities

23. DISPENSING PROFIT
VAT and PAs NHSBSA List Injectables, but not Implants Local anaesthetics, Sutures Vaccinations, Ring pessaries NHSBSA dm+d Browser

24. DISPENSING PROFIT NHSBSA dm+d Browser Attribute Name Attribute Value
  Product Information
Clexane 100mg/1ml solution for injection pre-filled syringes (DE Pharmaceuticals) 10 pre-filled disposable injection
Attributes
Prescribing Information
Attribute Name
Attribute Value
Description
PADM Ind
0001
Attracts an administration fee

25. DISPENSING PROFIT
NHSBSA List
PA - YES
Will receive VAT back

26. DISPENSING PROFIT
VAT and PAs HMRC If it is applied or injected at the surgery Not a PA if able to take it away in a bag

27. DISPENSING PROFIT PA –YES Will not be able to claim VAT back
HMRC
PA –YES
Will not be able to claim VAT back
ie. Pay Full VAT on cost price

28. NHSBSA –PA : HMRC –Non-PA NHSBSA –Non-PA : HMRC -PA
DISPENSING PROFIT
VAT and PAs
NHSBSA –PA : HMRC –PA
NHSBSA –PA : HMRC –Non-PA
NHSBSA –Non-PA : HMRC -PA

29. Most fall into this category eg. Flu jabs, Steroid injections
DISPENSING PROFIT
VAT and PAs
NHSBSA –PA : HMRC –PA
Most fall into this category eg. Flu jabs, Steroid injections

30. DISPENSING PROFIT
Reimbursement PA (Personally Administered) Reimbursement =BP-DA+VAT(on 88,82% of BP)

31. Reimbursement = BP-DA+(VAT on 88,82% of BP)
DISPENSING PROFIT
Reimbursement : PA : £10
Reimbursement = BP-DA+(VAT on 88,82% of BP)
= £10 - £ (20% x £8.88)
=£ £1.78
= £10.66
= BP x 106.6%

32. DISPENSING PROFIT PA Cost = CP – D + VAT(on CP-D)
Costs PA
Cost = CP – D + VAT(on CP-D)
Cost price is not always the same as BP

33. Cost = CP– D+ VAT (on CP-D)
DISPENSING PROFIT
Costs – PA- £10
Cost = CP– D+ VAT (on CP-D)
= £10 - £0 + £2
= £12

34. Profit – PA- £10 (no discount)
DISPENSING PROFIT
Profit – PA- £10 (no discount)
Profit =BP x106.6% minus
CP –D – VAT(on CP-D)
= £ £12
= Loss of £1.34

35. DISPENSING PROFIT = £20 x 106.6% =£21.32 Reimbursement : PA : £20
Reimbursement = BP x 106.6%
= £20 x 106.6%
=£21.32

36. Cost = CP– D+ VAT (on CP-D)
DISPENSING PROFIT
Costs – PA- £20
Cost = CP– D+ VAT (on CP-D)
= £20 - £0 + £4
= £24

37. DISPENSING PROFIT Profit = £21.32 - £24 = Loss of £2.68
Profit – PA- £20 (no discount)
Profit = £ £24
= Loss of £2.68
Not offset by the Dispensing Fee !!

38. Lack of Discount is a Killer
DISPENSING PROFIT
Lack of Discount is a Killer

39. Decent Discounts can lead to HAPPINESS
DISPENSING PROFIT
Decent Discounts can lead to HAPPINESS

40. DISPENSING PROFIT GnRH Analogues Basic Price Profit Lutrate £191.86
Basic Price
Profit
Lutrate
£191.86
£24.14
Prostap
£225.72
£28.40
Zoladex
£235.00
£21.35
Decapeptyl
£207.00
£3.28*

41. 2. NHSBSA –PA :HMRC –Non-PA
DISPENSING PROFIT
VAT and PAs
2. NHSBSA –PA :HMRC –Non-PA
This includes Insulins, Clexane, Metoject, etc.
Can claim full VAT back from HMRC

42. = £30.27 x 106.6% =£32.27 DISPENSING PROFIT Reimbursement : PA
Clexane 40mg x10 =£30.27
Reimbursement = BP x 106.6%
= £30.27 x 106.6%
=£32.27

43. (Can claim full VAT back on CP)
DISPENSING PROFIT
Costs – -Non PA
Clexane 40mg x10 =£30.27
Cost = CP–D
(Can claim full VAT back on CP)
= £ £0
= £30.27

44. = £2.00 PROFIT DISPENSING PROFIT Profit = £32,27 - £30.27
Profit – Clexane 40mg x10 =£30.27
Profit = £32,27 - £30.27
= £2.00 PROFIT

45. DISPENSING PROFIT
VAT and PAs 3. NHSBSA –Non-PA:HMRC –PA Nexplanon – No VAT paid by NHSBSA, but unable to claim VAT back from HMRC

46. Reimbursement : Non-PA
DISPENSING PROFIT
Reimbursement : Non-PA
Nexplanon - £83.42
Reimbursement = BP -DA
= £ £9.33
=£74.09

47. DISPENSING PROFIT Nexplanon - £83.42 -7% Discount
Costs –PA
Nexplanon - £ % Discount
Cost = CP– D+ VAT (on CP-D)
(Cannot claim VAT back from HMRC)
= £ £ (£77.58x20%)
= £93.10

48. = £19.01 LOSS DISPENSING PROFIT Nexplanon - £83.42
Profit/Loss = £ £93.10
= £ LOSS

49. DISPENSING Back to Basics
????Questions????

50. Patient First NHS Second Practice Third
Dispensing Inhalers
Patient First
NHS Second
Practice Third

51. Selecting the right inhaler
Dispensing Inhalers
Selecting the right inhaler
MDI (+Spacer)vsBreathe Actuated
Counter
Number of doses per inhaler
Frequency of usage

52. Selecting the right inhaler
Dispensing Inhalers
Selecting the right inhaler

53. Dispensing Inhalers Other Factors to Consider: Combinations
Step up/down according to NICE
Check dosage instructions when changing
Licensed Indication
Cost
Profit

54. LABA LABA + ICS LAMA LABA + LAMA
Dispensing Inhalers
LABA
LABA + ICS
LAMA
LABA + LAMA

55. LABA + ICS – MDI +/- Spacer
Dispensing Inhalers
LABA + ICS – MDI +/- Spacer
Fostair
Flutiform
Salmeterol + Fluticasone (Seretide, Sirdupla)

56. Dispensing Inhalers
MDI Low dose LABA + ICS  

57. MDI Medium dose LABA + ICS
Dispensing Inhalers
MDI Medium dose LABA + ICS  

58. Dispensing Inhalers
MDI High dose LABA + ICS  

59. Dispensing Inhalers Fostair NEXThaler DuoResp Spiromax or Symbicort
 LABA + ICS - BA
Fostair NEXThaler
DuoResp Spiromax or Symbicort
Relvar Ellipta
Seretide Accuhaler or AirFluSal

60. Dispensing Inhalers
Low Dose LABA + ICS - BA

61. BA/DPI Medium dose LABA + ICS
Dispensing Inhalers
BA/DPI Medium dose LABA + ICS

62. BA/DPI High dose LABA + ICS
Dispensing Inhalers
BA/DPI High dose LABA + ICS

63. LAMA Eklira Spiriva – Handihaler or Respimat Seebri Incruse
Dispensing Inhalers
LAMA
Eklira
Spiriva – Handihaler or Respimat
Seebri
Incruse

64. Dispensing Inhalers
LAMA

65. LABA + LAMA Duaklir Spiolto Anoro Ultibro
Dispensing Inhalers
LABA + LAMA
Duaklir
Spiolto
Anoro
Ultibro

66. Dispensing Inhalers
LABA + LAMA

67. Dispensing Inhalers ICS+LABA - MDI Fostair £££ Flutiform £ Seretide £
Sirdupla ££
Sirdupla generically ££££

68. Dispensing Inhalers ICS+LABA - BA Fostair Nexthaler £££ Seretide £
Airflusal ‡‡
Airflusal generically ££
Symbicort ££
DuoResp £
DuoResp generically £££
Relvar ££

69. Dispensing Inhalers LAMA Eklira Genuair ££ Encruse Ellipta £
Seebri Breezhaler ‡‡‡
Spiriva Respimat ££
Spiriva Handihaler ‡‡‡

70. LAMA+LABA Duaklir ££ Spiolto ££ Anoro £ Ultibro ‡‡
Dispensing Inhalers
LAMA+LABA
Duaklir ££
Spiolto ££
Anoro £
Ultibro ‡‡

71. N/DOACs for AF Stroke Prevention
Dispensing NOACs
N/DOACs for AF Stroke Prevention

72. Dispensing Gliflozins
Basic Price
Profit
Forxiga 5 and 10 28
£36.59
£7.62
Jardiance 10 and 25
£4.51
Invokana 100 and 300 30
£39.20
£5.81

73. Dispensing Gliptins Basic Price Profit Vipidia 25mg 28 £26.60 £7.67
Basic Price
Profit
Vipidia 25mg 28
£26.60
£7.67
Trajenta 5mg
£33.26
£4.10
Onglyza 5mg
£31.60
£6.58
Januvia 100mg
-£1.39
Galvus 50mg 56
£33.35

74. DISPENSING Back to Basics
There are still some good deals out there Drug companies still want your business Discounts come and go – keep an eye on the DDA website

75. DISPENSING Back to Basics
Minimise losses by focusing on High Cost Drugs
Invest time in checking what goes out the dispensary at a loss
Profit can still be made!!!!

76. DISPENSING Back to Basics
With a little bit of extra work you can go from
to to

77. DISPENSING Back to Basics
Thank You