MEASURES TO CONTROL THE PRICE OF GENERIC MEDICINES SOLD TO COMMUNITY PHARMACIES AND DISPENSING DOCTORS

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18 July 2000

To interested parties

Dear Sir/Madam

MEASURES TO CONTROL THE PRICE OF GENERIC MEDICINES SOLD
TO COMMUNITY PHARMACIES AND DISPENSING DOCTORS

SUMMARY

On 6 July Lord Hunt, the Parliamentary Under Secretary of State for Health, announced the Government's decision, in the light of consultation, to proceed with a statutory maximum price scheme for generic medicines sold to community pharmacies and dispensing doctors across the UK. Regulations to give legal force to the scheme were also put before Parliament on 6 July. Information about key elements of the scheme, including the maximum prices and the timetable for its introduction, was given to representative bodies with an interest in generics on that day and a press notice issued. The maximum prices and press notice were also posted on the internet. This letter confirms the information already made available and covers various points of detail about the scheme. In particular, it -

explains the decision to proceed with a statutory maximum price scheme
gives details of the scheme, including the maximum prices which will apply
responds to questions about the scheme raised in the course of the consultation exercise and since the announcement of the Government's decision
lists a number of preparations whose list prices are particularly out of line with prices in the market (given to us during consultation), and spells out the Government's expectation that suppliers will redress this inconsistency
sets out revised information requirements which will apply under the scheme
explains the position on reimbursement arrangements for community pharmacists and dispensing doctors
sets out the territorial scope of the maximum price scheme, information requirements and changes to reimbursement arrangements
explains the relationship between the maximum price scheme and the fundamental review of the generics supply chain

2.	A list of recipients of this letter is at Appendix A .

THE DECISION TO PROCEED WITH A STATUTORY MAXIMUM PRICE SCHEME

My letter to you of 20 April set out the Government's proposals for a statutory maximum price scheme and invited views. We subsequently carried out further, more limited consultations on revisions to certain proposed maximum prices and to the proposed information requirements. The Government has looked carefully at comments put forward in response to the consultations. It has concluded that a maximum price scheme, backed by statutory powers, is the only sure way to protect the position of the NHS in the short-term from the continuing effect of last year's price increases.

In our view, no viable alternative way of achieving this was put forward during the consultation. Although some responses proposed that maximum prices should be set on a voluntary basis (rather than through a statutory scheme), the course of consultation did not alter the Government's initial view – that it was difficult to see how a satisfactory voluntary scheme could be negotiated which would be effective. Nor have price movements since the launch of the consultation exercise reduced the need for a statutory scheme. While Drug Tariff prices for some generic medicines have fallen a little since April, there can be no certainty that the market would correct the effect of last year's increases if we did not take action.

THE DETAILS OF THE MAXIMUM PRICE SCHEME

5.	The main features of the maximum price scheme will be as follows.

Who the statutory scheme will apply to

The scheme will prohibit the sale of certain unbranded generic medicines to community pharmacies and dispensing doctors at more than the maximum price. It will apply to anyone who sells the generics concerned in these circumstances. (The consultation exercise suggested that some may have understood our proposals to mean that only companies with a turnover over a certain threshold would be subject to these provisions. This is not the case.)

7.	The scheme will apply to companies whether or not they are members of the voluntary PPRS. It will not affect current arrangements for determining the prices of branded medicines under the PPRS.

The products covered by the scheme

The scheme will apply only to certain unbranded generic medicines sold to community pharmacies and dispensing doctors for NHS use – in other words, for dispensing against an NHS prescription. An unbranded generic medicine is one which is not identifiable by and traded under a specific name given to it by any person who is the manufacturer, supplier or holder of a marketing authorisation relating to it (the addition of a manufacturer's or supplier's name or trademark does not count as a specific name for this purpose). The scheme will not apply to generics supplied to pharmacies for sale over the counter. Nor will it apply to the sale of generic medicines to hospitals.

The generic medicines covered by the scheme are listed at Appendix B . In broad terms, those covered are unbranded generics with an annual net ingredient cost (NIC) of over £750,000 a year plus related preparations of the same molecule. The scheme also covers other unbranded generics where the annual NIC is more than £100,000 and there has been a material increase in price since January 1999. The list at Appendix B sets out the different pack sizes of each preparation which are covered by the scheme.

10.	If there is a need to bring within the scope of the scheme any additional pack sizes (of preparations which are already within the scheme) or any new preparations, the Government will consult on the proposed addition and the proposed maximum price.

The level of maximum prices

11.

The maximum prices are set out in the list at Appendix B . In the majority of cases they are based on average prices in the Drug Tariff for November 1998 to January 1999 or, where a given pack was not in the Drug Tariff in January 1999, by pro-rata to the largest pack size of the same preparation which was already on the market. In a small number of cases the March 2000 Drug Tariff price was lower than the price based on historic Drug Tariff data, and this lower price was used. We have also adjusted certain prices, on an objective basis, where appropriate, in the light of comments put to us during the consultation period and in response to the further, more limited consultation (from 19-26 June) on revised prices. These adjustments include a number which address anomalies between the unit prices of different pack sizes of the same preparation to ensure that patient packs are not placed at a disadvantage to bulk supply.

12.

It is worth underlining that the prices in Appendix B are maxima. They do not preclude competition below the maximum price, and they do not necessarily equate to the reimbursement price. Indeed, some reimbursement prices are already below the new maximum price and we would expect this position to be maintained.

Timetable for introduction of the scheme

13.

Subject to Parliament's agreement, the Regulations giving effect to the statutory scheme (the Health Service Medicines (Control of Prices of Specified Generic Medicines) Regulations 2000) will come into force on 3 August and the maximum prices will apply from that date. Price changes effective between 1st and 8th August will not be implemented for reimbursement of August prescriptions as would normally be the case - these lower prices will be used to derive reimbursement prices for prescriptions dispensed from 1 September. This gives wholesalers and community pharmacists four weeks each (from the date of the announcement of the Government's decision) to clear stocks.

Duration of the scheme

14.

A review of the scheme will begin within twelve months of its effective date – 3 August – and will be completed within fifteen months of that date (in other words, by 3 November 2001). It remains the Government's aim to put in place longer-term arrangements to secure the needs of the NHS and ensure a fully competitive generics market. The fifteen-month time-scale for completion of a review of the statutory scheme will not prevent the introduction of longer-term arrangements before that date if we are ready to proceed with these.

Representations about maximum prices and appeals

15.

The Regulations make provision for companies to make representations for increases in the maximum price of products. Any such representations will need to be fully substantiated and accompanied by a full supporting analysis. We expect this route to be used only in exceptional circumstances. An appeals process for use in the case of unsuccessful representations is also available under the Health Service Medicines (Price Control Appeals) Regulations 2000 (SI 2000/124): available on the Internet at http://www.doh.gov.uk/pprs/pprsstat04.htm

Contravention of the scheme

16.

The Regulations provide for the supply of a generic medicine to a community pharmacy or dispensing doctor at more than the maximum price and the failure to supply information required by the scheme to be treated as contraventions of the scheme. Penalties under section 37 of the Health Act 1999 for contravention of the scheme are set out in Appendix C .

FURTHER REDUCTIONS IN LIST PRICES OF CERTAIN PREPARATIONS

17.

In the course of the consultation exercise a number of those in the generics market drew our attention to preparations for which some list prices remain excessively high compared to the real prices at which they are traded, and proposed lower list prices which would reduce this divergence. A list of such preparations which were put to us by more than one company is attached at Appendix D and includes a few preparations which are outside the price scheme as well as a number covered by it. The Government sees no reason for such anomalies between list price and market price. We are looking to the supply chain to reduce list prices for these preparations to bring them more closely into line with real prices. (In some cases this could mean list prices falling to well below the maximum price under the statutory scheme.) If such reductions do not take place rapidly, the Government will consult on proposals to bring about the reductions by statutory means.

18.	The indicative price listed against each of the preparations in Appendix D is the median of the proposed prices put to us by companies. It is included for information.

INFORMATION REQUIREMENTS

19.	We have revised the information requirements under the scheme in the light of comments received during the consultation exercise. The revised requirements are as follows.

20.

1.The Regulations provide for all product licence (PL) and wholesale dealer's licence (WDL) holders to have to supply the following information for each generic medicine falling within the scope of the scheme for the year ended 31 December 1999 -

the number of packs of each presentation sold
the receipts from the sales of each presentation

21.	All PL and WDL holders whose total receipts from this exercise exceed £1 million will be required to supply the same information for the year ending 31 December 2000.

22.	We will write again to all PL and WDL holders once the Regulations are in force to provide more information about these requirements, including deadlines for submission of the data.

CHANGES TO THE REIMBURSEMENT ARRANGEMENTS IN ENGLAND AND
WALES FOR COMMUNITY PHARMACISTS AND DISPENSING DOCTORS

23.

The relationship between the maximum price scheme and reimbursement prices for community pharmacists and dispensing doctors is as follows. Existing arrangements, under which the Drug Tariff (reimbursement) price is calculated by reference to a basket of manufacturers' and wholesalers' list prices or the list price of a single supplier, will remain in place. Any revisions to price lists after the coming into effect of maximum prices, on 3 August, will only be used to set reimbursement prices for community pharmacists and dispensing doctors with effect from the beginning of September, giving pharmacists from 3 August to 1 September to adjust stocks. From September onwards, those Drug Tariff prices derived from list prices of generic products will never be higher than the statutory maximum price. They could, however, be lower, for example if competition leads to the list prices of the basket manufacturers or wholesalers falling below the maximum prices. In some cases the current Tariff price is already below the maximum price and we would expect this to be maintained.

24.

The Government intends to end Category D with effect from September. We acknowledge that, occasionally, for a particular preparation there will be no generic version available due for example to production failures. When this happens pharmacists may have no choice but to dispense a more expensive branded version. We have discussed this issue with the PSNC and have now offered a facility such that where our inquiries show that there is no product available to contractors at or below the statutory ceiling price then we will allow PPA to accept endorsements for branded versions. However, this facility and the circumstances in which it may be used will be subject to firm controls, and we will be keeping the arrangement under review.

TERRITORIAL SCOPE OF THE GOVERNMENT'S MEASURES

25.

The maximum price scheme will apply throughout the UK, as will the accompanying information requirements. The changes to reimbursement arrangements for community pharmacists and dispensing doctors set out above will apply to England and Wales. Separate arrangements are being put in place for Scotland and Northern Ireland.

PROPOSALS FOR THE LONGER TERM

26.

The purpose of the maximum price scheme is to correct the effect of last year's turbulence in the generics market and, in so doing, to protect the position of the NHS. At the same time, the Government remains committed to encouraging generic prescribing and recognises that this, in turn, calls for a well-developed generics market. Last year's events have highlighted the need for the Government to consider carefully whether the existing arrangements for the supply of generics to NHS primary care are the best for the Health Service in the longer term and to consider possible alternatives. That is the purpose of the Fundamental Review of the market being undertaken by Oxford Economic Research Associates (OXERA). We expect OXERA's programme of work to be concluded over the summer. We will then wish to discuss the conclusions of the review with interested parties before moving forward. The Review, along with these discussions, will give us a sound basis on which to develop a soundly managed and fully competitive generics market which ensures a good supply of old and new generics to the NHS for the longer term.

FURTHER INFORMATION

27.	The list of maximum prices under the scheme is available on the Internet at www.doh.gov.uk/generics .

28.	The Regulations giving legal force to the scheme have been published on the HMSO website at www.hmso.gov.uk/si/si2000/20001763.htm . They will also be available from HMSO in printed form.

29.	Any questions about the operation of the maximum price scheme should be addressed to Richard Mattison, in Room 170, Department of Health, Richmond House, 79 Whitehall, London SW1A 2NS, or e-mail richard.mattison@doh.gsi.gov.uk .

Yours faithfully,

A J McKeon
Head, Medicines, Pharmacy and Industry Division

APPENDIX A

RECIPIENTS OF THIS LETTER

Holders of Product Licences issued by the UK Licensing Authority (excluding companies that only hold Product Licences for General Sales List products)

Holders of Wholesale Dealer Licences issued by the UK Licensing Authority

Association of the British Pharmaceutical Industry

British Association of European Pharmaceutical Distributors

British Association of Pharmaceutical Wholesalers

British Generic Manufacturers Association

British Association of Generic Distributors

General Practitioners Committee - British Medical Association

Pharmaceutical Services Negotiating Committee

Dispensing Doctors' Association

A full list of the individual companies who were asked to comment under the consultation is available on the Internet at www.doh.gov.uk/gendcon

APPENDIX B

LIST OF PREPARATIONS COVERED BY THE SCHEME AND MAXIMUM PRICES UNDER IT

Column 1	Column 2	Column 3
Medicine	Presentation	Price (pence)
Aciclovir Cream 5%	2g	307
Aciclovir Cream 5%	10g	998
Aciclovir Tablets 200mg	25	579
Aciclovir Tablets 400mg	56	1,565
Aciclovir Tablets 800mg	35	4,840
Aciclovir Tablets Dispersible 200mg	25	1,976
Aciclovir Tablets Dispersible 400mg	56	7,071
Aciclovir Tablets Dispersible 800mg	35	7,342
Allopurinol Tablets 100mg	28	91
Allopurinol Tablets 300mg	28	218

Amiodarone HCl Tablets 100mg	28	435
Amiodarone HCl Tablets 200mg	28	649
Amitriptyline HCl Oral Solution 25mg/5ml Sugar Free	500ml	4,130
Amitriptyline HCl Oral Solution 50mg/5ml Sugar Free	500ml	4,500
Amitriptyline HCl Tablets 10mg	28	78
Amitriptyline HCl Tablets 25mg	28	81
Amitriptyline HCl Tablets 50mg	28	120
Amoxycillin Capsules 250mg	21	125
Amoxycillin Capsules 500mg	21	185
Amoxycillin Capsules 500mg	100	535
Amoxycillin Oral Powder Sachets 3g Sugar Free	2	469
Amoxycillin Oral Powder Sachets 3g Sugar Free	14	3,194

Amoxycillin Oral Suspension 125mg/5ml	100ml	115
Amoxycillin Oral Suspension 125mg/5ml Sugar Free	100ml	130
Amoxycillin Oral Suspension 250mg/5ml	100ml	180
Amoxycillin Oral Suspension 250mg/5ml Sugar Free	100ml	225
Ampicillin Capsules 250mg	28	183
Ampicillin Capsules 250mg	500	1,559
Ampicillin Capsules 500mg	28	360
Ampicillin Capsules 500mg	250	1,494
Ampicillin Oral Suspension 125mg/5ml	100ml	175
Ampicillin Oral Suspension 250mg/5ml	100ml	325
Aqueous Cream	500g	107
Ascorbic Acid Tablets 100mg	100	90

Ascorbic Acid Tablets 200mg	100	112
Ascorbic Acid Tablets 500mg	28	126
Ascorbic Acid Tablets 500mg	100	201
Ascorbic Acid Tablets 50mg	500	151
Aspirin Dispersible Tablets 300mg	32	37
Aspirin Dispersible Tablets 300mg	100	113
Aspirin Dispersible Tablets 75mg	28	37
Aspirin Dispersible Tablets 75mg	100	67
Aspirin Effervescent Soluble Tablets 75mg	100	35
Aspirin Tablets 300mg	32	34
Aspirin Tablets E/C 300mg	100	661
Aspirin Tablets E/C 75mg	28	155

Aspirin Tablets E/C 75mg	56	309
Atenolol Tablets 100mg	28	174
Atenolol Tablets 25mg	28	139
Atenolol Tablets 50mg	28	144
Azathioprine Tablets 25mg	100	3,326
Azathioprine Tablets 50mg	56	1,000
Azathioprine Tablets 50mg	100	1,655
Baclofen Tablets 10mg	28	102
Baclofen Tablets 10mg	84	306
Baclofen Tablets 10mg	100	289
Beclomethasone Diproprionate Aqueous Nasal Spray 50mcg(200 Doses)	1	349
Beclomethasone Diproprionate Inhaler 100mcg (200 Doses)	1	824

Beclomethasone Diproprionate Inhaler 250mcg (200 Doses)	1	1,802
Beclomethasone Diproprionate Inhaler 50mcg (200 Doses)	1	434
Bendrofluazide Tablets 2.5mg	28	74
Bendrofluazide Tablets 5mg	28	73
Betahistine HCl Tablets 16mg	84	1,499
Betahistine HCl Tablets 8mg	84	574
Betahistine HCl Tablets 8mg	120	820
Bisacodyl Suppositories 10mg	12	77
Bisacodyl Tablets E/C 5mg	1000	2,950
Bumetanide Tablets 1mg	28	177
Bumetanide Tablets 5mg	28	1,121
Buspirone HCl Tablets 10mg	100	4,680

Buspirone HCl Tablets 5mg	100	3,120
Calcium and Ergocalciferol Tablets 400u	28	70
Calciferol Tablets 250mcg	100	2,199
Calciferol Tablets 1.25mg	100	3,035
Calciferol Injection 300,000u/1ml Ampoule	10	5,924
Captopril Tablets 12.5mg	56	280
Captopril Tablets 25mg	56	452
Captopril Tablets 50mg	56	583
Carbamazepine Tablets 100mg	28	147
Carbamazepine Tablets 100mg	84	243
Carbamazepine Tablets 200mg	28	171
Carbamazepine Tablets 200mg	84	513

Carbamazepine Tablets 200mg	100	611
Carbamazepine Tablets 400mg	28	503
Carbamazepine Tablets 400mg	56	590
Cephalexin Capsules 250mg	28	262
Cephalexin Capsules 250mg	100	935
Cephalexin Capsules 500mg	21	406
Cephalexin Capsules 500mg	100	1,934
Cephalexin Oral Suspension 125mg/5ml	100ml	140
Cephalexin Oral Suspension 250mg/5ml	100ml	232
Cephalexin Tablets 250mg	100	958
Cephalexin Tablets 500mg	100	1,919
Cephradine Capsules 250mg	20	355

Cephradine Capsules 250mg	100	1,708
Cephradine Capsules 500mg	20	700
Cephradine Capsules 500mg	100	3,372
Chloramphenicol Capsules 250mg	60	2,094
Chloramphenicol Eye Drops 0.5%	10ml	141
Chloramphenicol Eye Ointment 1%	4g	106
Chlordiazepoxide HCl Capsules 10mg	500	2,875
Chlordiazepoxide HCl Capsules 5mg	500	2,070
Chlordiazepoxide HCl Tablets 10mg	100	546
Chlordiazepoxide HCl Tablets 5mg	100	393
Chlorpromazine HCl Oral Solution 25mg/5ml	150ml	135
Chlorpromazine HCl Tablets 100mg	28	116

Chlorpromazine HCl Tablets 100mg	500	1,101
Chlorpromazine HCl Tablets 25mg	28	96
Chlorpromazine HCl Tablets 25mg	1000	764
Chlorpromazine HCl Tablets 50mg	28	95
Chlorpromazine HCl Tablets 50mg	500	1,517
Cholestyramine/Aspartame Powder Sachets 4g	180	6,634
Cimetidine Tablets 200mg	60	280
Cimetidine Tablets 200mg	120	560
Cimetidine Tablets 400mg	60	569
Cimetidine Tablets 800mg	30	582
Cinnarizine Tablets 15mg	84	459
Clomipramine HCl Capsules 10mg	28	126

Clomipramine HCl Capsules 25mg	28	194
Clomipramine HCl Capsules 25mg	100	460
Clomipramine HCl Capsules 50mg	28	243
Clotrimazole Cream 1%	20g	178
Clotrimazole Cream 1%	50g	444
Clotrimazole Pessaries 500mg	1	348
Co-Amilofruse Tablets 10mg/80mg	28	755
Co-Amilofruse Tablets 2.5mg/20mg	28	475
Co-Amilofruse Tablets 2.5mg/20mg	56	949
Co-Amilofruse Tablets 5mg/40mg	28	260
Co-Amilofruse Tablets 5mg/40mg	56	471
Co-Amilozide Tablets 2.5mg/25mg	28	185

Co-Amilozide Tablets 2.5mg/25mg	100	492
Co-Amilozide Tablets 5mg/50mg	28	203
Co-Amoxiclav Suspension 125mg/31mg/5ml Sugar Free	100ml	457
Co-Amoxiclav Suspension 250mg/62mg/5ml Sugar Free	100ml	642
Co-Amoxiclav Tablets 250mg/125mg	21	991
Co-Amoxiclav Tablets 250mg/125mg	100	4,720
Co-Amoxiclav Tablets 500mg/125mg	21	1,573
Co-Codamol EffervescentTablets 8mg/500mg	100	524
Co-Codamol Tablets 30mg/500mg	100	753
Co-Codamol Tablets 8mg/500mg	30	80
Co-Codamol Tablets 8mg/500mg	32	85
Co-Codamol Tablets 8mg/500mg	100	169

Co-Codamol Tablets 8mg/500mg	500	570
Co-Danthramer Capsules 25mg/200mg	60	1,286
Co-Danthramer Capsules Strong 37.5mg/500mg	60	1,555
Co-Danthramer Suspension 25mg/200mg/5ml Sugar Free	300ml	1,127
Co-Danthramer Suspension 75mg/1g/5ml Sugar Free	300ml	3,013
Co-Danthrusate Capsules 50mg/60mg	63	1,346
Codeine Phosphate Linctus 15mg/5ml	2000ml	807
Codeine Phosphate Linctus 15mg/5ml Sugar Free	2000ml	610
Codeine Phosphate Linctus Diabetic 15mg/5ml	500ml	363
Codeine Phosphate Oral Solution 25mg/5ml	500ml	451
Codeine Phosphate Tablets 15mg	28	105
Codeine Phosphate Tablets 15mg	30	113

Codeine Phosphate Tablets 30mg	28	145
Codeine Phosphate Tablets 30mg	30	155
Codeine Phosphate Tablets 30mg	100	459
Codeine Phosphate Tablets 60mg	28	261
Codeine Phosphate Tablets 60mg	30	280
Co-Dydramol Tablets 10mg/500mg	30	86
Co-Dydramol Tablets 10mg/500mg	100	212
Co-Dydramol Tablets 10mg/500mg	500	687
Co-Fluampicil Capsules 250mg/250mg	28	899
Co-Fluampicil Capsules 250mg/250mg	100	2,362
Colchicine Tablets 500mcg	100	1,668
Co-Proxamol Tablets 32.5mg/325mg	100	120

Co-Tenidone Tablets 100mg/25mg	28	388
Co-Tenidone Tablets 50mg/12.5mg	28	278
Danazol Capsules 100mg	60	1,497
Danazol Capsules 100mg	100	2,495
Danazol Capsules 200mg	100	4,771
Diamorphine HCl Injection 100mg Ampoule	5	2,249
Diamorphine HCl Injection 10mg Ampoule	5	679
Diamorphine HCl Injection 30mg Ampoule	5	811
Diamorphine HCl Injection 500mg Ampoule	5	10,342
Diamorphine HCl Injection 5mg Ampoule	5	591
Diamorphine HCl Tablets 10mg	100	1,230
Diazepam Oral Solution 2mg/5ml	100ml	145

Diazepam Oral Solution 2mg/5ml Sugar Free	500ml	1,115
Diazepam Solution 2mg/ml 2.5ml Rectal Tube	5	705
Diazepam Solution 4mg/ml 2.5ml Rectal Tube	5	918
Diazepam Syrup 2mg/5ml	100ml	175
Diazepam Tablets 10mg	28	84
Diazepam Tablets 2mg	28	54
Diazepam Tablets 5mg	28	58
Diclofenac Sodium Tablets E/C 25mg	84	294
Diclofenac Sodium Tablets E/C 25mg	100	350
Diclofenac Sodium Tablets E/C 50mg	84	454
Diclofenac Sodium Tablets E/C 50mg	100	541
Digoxin Tablets 125mcg	28	61

Digoxin Tablets 250mcg	28	61
Digoxin Tablets 62.5mcg	28	84
Dihydrocodeine Tartrate Oral Solution 10mg/5ml	150ml	320
Dihydrocodeine Tartrate Tablets 30mg	28	165
Dihydrocodeine Tartrate Tablets 30mg	30	177
Dihydrocodeine Tartrate Tablets 30mg	100	405
Dihydrocodeine Tartrate Tablets 30mg	500	1,904
Diltiazem HCl Tablets 60mg M/R	100	527
Dipyridamole Tablets 100mg	84	473
Dipyridamole Tablets 25mg	84	281
Dipyridamole Tablets 25mg	100	203
Disopyramide Capsules 100mg	84	1,582

Disopyramide Capsules 150mg	84	2,099
Disopyramide Capsules 150mg	100	1,277
Domperidone Tablets 10mg	30	253
Domperidone Tablets 10mg	100	840
Dothiepin HCl Capsules 25mg	28	161
Dothiepin HCl Capsules 25mg	100	365
Dothiepin HCl Tablets 75mg	28	284
Doxycycline Capsules 100mg	8	252
Doxycycline Capsules 100mg	50	1,083
Doxycycline Capsules 50mg	28	683
Emulsifying Ointment	500g	160
Erythromycin Tablets E/C 250mg	28	308

Erythromycin Tablets E/C 250mg	100	1,100
Erythromycin Tablets E/C 250mg	500	5,500
Ethinyloestradiol Tablets 10mcg	21	1,299
Ethinyloestradiol Tablets 1mg	28	2,885
Ethinyloestradiol Tablets 50mcg	21	1,549
Ferrous Sulphate Tablets 200mg	28	90
Flucloxacillin Sodium Capsules 250mg	28	295
Flucloxacillin Sodium Capsules 500mg	28	475
Flucloxacillin Sodium Oral Solution 125mg/5ml	100ml	325
Flutamide Tablets 250mg	84	6,953
Folic Acid Tablets 400mcg	90	213
Folic Acid Tablets 5mg	28	45

Frusemide Oral Solution 40mg/5ml Sugar Free	200ml	2,310
Frusemide Tablets 20mg	28	65
Frusemide Tablets 20mg	250	437
Frusemide Tablets 40mg	28	78
Frusemide Tablets 500mg	28	902
Frusemide Tablets 500mg	100	3,221
Glibenclamide Tablets 2.5mg	28	96
Glibenclamide Tablets 2.5mg	100	240
Glibenclamide Tablets 5mg	28	122
Gliclazide Tablets 80mg	28	325
Gliclazide Tablets 80mg	60	696
Glipizide Tablets 5mg	56	510

Glyceryl Trinitrate Spray 400mcg (200 Doses)	1	313
Glyceryl Trinitrate Tablets 500mcg	100	106
Glyceryl Trinitrate Tablets 600mcg	100	231
Hydrocortisone Cream 0.5%	15g	37
Hydrocortisone Cream 0.5%	30g	60
Hydrocortisone Cream 1%	15g	39
Hydrocortisone Cream 1%	30g	72
Hydrocortisone Cream 2.5%	15g	86
Hydrocortisone Cream 2.5%	30g	166
Hydrocortisone Ointment 0.5%	15g	37
Hydrocortisone Ointment 0.5%	30g	60
Hydrocortisone Ointment 1%	15g	38

Hydrocortisone Ointment 1%	30g	72
Hydrocortisone Ointment 2.5%	15g	102
Hydrocortisone Ointment 2.5%	30g	166
Hydroxocobalamin Injection 1mg/ml 1ml Ampoule	5	1,249
Hypromellose Eye Drops 0.3%	10ml	75
Ibuprofen Gel 5%	30g	242
Ibuprofen Gel 5%	50g	298
Ibuprofen Gel 5%	100g	595
Ibuprofen Oral Suspension 100mg/5ml Sugar Free	100ml	182
Ibuprofen Oral Suspension 100mg/5ml Sugar Free	150ml	273
Ibuprofen Tablets 200mg	84	170
Ibuprofen Tablets 400mg	84	247

Ibuprofen Tablets 600mg	84	388
Ibuprofen Tablets 600mg	100	462
Imipramine HCl Tablets 10mg	28	85
Imipramine HCl Tablets 10mg	250	318
Imipramine HCl Tablets 25mg	28	101
Imipramine HCl Tablets 25mg	1000	795
Indapamide Tablets 2.5mg	28	285
Indapamide Tablets 2.5mg	56	511
Isoniazid Tablets 100mg	28	760
Isoniazid Tablets 100mg	100	198
Isoniazid Tablets 50mg	56	724
Isoniazid Tablets 50mg	250	3,225

Isosorbide Mononitrate Tablets 10mg	56	113
Isosorbide Mononitrate Tablets 20mg	56	216
Isosorbide Mononitrate Tablets 40mg	56	395
Ketoprofen Capsules 100mg	100	1,378
Ketoprofen Capsules 50mg	100	1,615
Ketoprofen Gel 2.5%	30g	240
Ketoprofen Gel 2.5%	50g	339
Ketoprofen Gel 2.5%	100g	678
Labetalol HCl Tablets 100mg	56	483
Labetalol HCl Tablets 200mg	56	650
Labetalol HCl Tablets 400mg	56	1,112
Lactulose Solution 3.1g-3.7g/5ml	500ml	246

Lactulose Solution 3.1g-3.7g/5ml	1000ml	492
Lofepramine HCl Tablets 70mg	56	1,034
Loperamide HCl Capsules 2mg	30	228
Loprazolam Mesilate Tablets 1mg	28	446
Lorazepam Tablets 1mg	28	125
Lorazepam Tablets 1mg	100	236
Lorazepam Tablets 1mg	1000	1,254
Lorazepam Tablets 2.5mg	28	175
Lorazepam Tablets 2.5mg	100	256
Mebeverine HCl Tablets 135mg	100	782
Mefenamic Acid Capsules 250mg	100	250
Mefenamic Acid Capsules 250mg	500	1,251

Mefenamic Acid Tablets 500mg	28	254
Mefenamic Acid Tablets 500mg	100	726
Mesalazine Tablets E/C 400mg	90	3,269
Mesalazine Tablets E/C 400mg	120	4,358
Metformin HCl Tablets 500mg	28	85
Metformin HCl Tablets 850mg	56	248
Metformin HCl Tablets 850mg	300	1,012
Methadone HCl Injection 10mg/ml 1ml Ampoule	10	859
Methadone HCl Injection 10mg/ml 2ml Ampoule	10	1,450
Methadone HCl Injection 10mg/ml 3.5ml Ampoule	10	1,783
Methadone HCl Injection 10mg/ml 5ml Ampoule	10	1,923
Methadone HCl Mixture 1mg/1ml	30ml	44

Methadone HCl Mixture 1mg/1ml	50ml	73
Methadone HCl Mixture 1mg/1ml	100ml	152
Methadone HCl Mixture 1mg/1ml	500ml	759
Methadone HCl Mixture 1mg/1ml Sugar Free	30ml	44
Methadone HCl Mixture 1mg/1ml Sugar Free	50ml	73
Methadone HCl Mixture 1mg/1ml Sugar Free	100ml	145
Methadone HCl Mixture 1mg/1ml Sugar Free	500ml	725
Methotrexate Tablets 10mg	100	5,507
Methotrexate Tablets 2.5mg	100	1,141
Metoclopramide HCl Tablets 10mg	28	87
Metoprolol Tartrate Tablets 100mg	28	198
Metoprolol Tartrate Tablets 100mg	56	396

Metoprolol Tartrate Tablets 100mg	100	611
Metoprolol Tartrate Tablets 50mg	28	134
Metoprolol Tartrate Tablets 50mg	56	267
Metoprolol Tartrate Tablets 50mg	100	333
Metronidazole Oral Suspension 200mg/5ml	100ml	775
Metronidazole Tablets 200mg	21	134
Metronidazole Tablets 200mg	250	500
Metronidazole Tablets 400mg	21	154
Metronidazole Tablets 400mg	100	415
Mianserin HCl Tablets 10mg	28	271
Mianserin HCl Tablets 20mg	28	416
Mianserin HCl Tablets 20mg	56	760

Mianserin HCl Tablets 30mg	28	540
Mianserin HCl Tablets 30mg	100	1,928
Minocycline HCl Tablets 100mg	28	1,146
Minocycline HCl Tablets 50mg	28	765
Nabumetone Tablets 500mg	56	1,811
Naftidrofuryl Oxal Capsules 100mg	84	791
Naproxen Tablets 250mg	28	160
Naproxen Tablets 250mg	60	343
Naproxen Tablets 250mg	250	1,428
Naproxen Tablets 500mg	28	372
Naproxen Tablets 500mg	60	797
Naproxen Tablets 500mg	100	1,329

Naproxen Tablets E/C 250mg	56	452
Naproxen Tablets E/C 500mg	56	823
Nifedipine Capsules 10mg	84	448
Nifedipine Capsules 10mg	100	533
Nifedipine Capsules 5mg	84	372
Nifedipine Capsules 5mg	100	443
Nitrazepam Tablets 5mg	28	83
Norethisterone Tablets 5mg	30	216
Oxprenolol HCl Tablets 160mg	100	1,162
Oxprenolol HCl Tablets 20mg	56	129
Oxprenolol HCl Tablets 40mg	100	425
Oxprenolol HCl Tablets 80mg	100	731

Oxybutynin HCl Tablets 2.5mg	56	514
Oxybutynin HCl Tablets 3mg	56	871
Oxybutynin HCl Tablets 5mg	56	1,385
Oxybutynin HCl Tablets 5mg	84	2,077
Oxytetracycline Tablets 250mg	28	82
Paracetamol Capsules 500mg	32	85
Paracetamol Oral Solution Paediatric 120mg/5ml	2000ml	586
Paracetamol Oral Solution Paediatric 120mg/5ml Sugar Free	2000ml	648
Paracetamol Oral Suspension 250mg/5ml	500ml	372
Paracetamol Oral Suspension 250mg/5ml Sugar Free	200ml	124
Paracetamol Oral Suspension Paediatric 120mg/5ml	500ml	206
Paracetamol Oral Suspension Paediatric 120mg/5ml Sugar Free	150ml	65

Paracetamol Oral Suspension Paediatric 120mg/5ml Sugar Free	200ml	86
Paracetamol Oral Suspension Paediatric 120mg/5ml Sugar Free	500ml	216
Paracetamol Oral Suspension Paediatric 120mg/5ml Sugar Free	1000ml	345
Paracetamol Suppositories 120mg	10	925
Paracetamol Suppositories 240mg	10	950
Paracetamol Suppositories 500mg	10	990
Paracetamol Tablets 500mg	32	47
Paracetamol Tablets 500mg	100	76
Paracetamol Tablets Soluble 500mg	60	282
Penicillin V Oral Solution 125mg/5ml	100ml	167
Penicillin V Oral Solution 250mg/5ml	100ml	229
Penicillin VK Tablets 250mg	28	179

Pethidine HCl Tablets 50mg	50	492
Phenobarbitone Elixir 15mg/5ml	500ml	386
Phenobarbitone Tablets 15mg	28	63
Phenobarbitone Tablets 15mg	1000	292
Phenobarbitone Tablets 30mg	28	67
Phenobarbitone Tablets 60mg	28	73
Phenytoin Sodium Tab 100mg	28	170
Phenytoin Sodium Tab 50mg	28	125
Piroxicam Capsules 10mg	56	295
Piroxicam Capsules 10mg	60	316
Piroxicam Capsules 20mg	28	334
Piroxicam Capsules 20mg	30	358

Piroxicam Tablets Dispersible 20mg	28	957
Pizotifen Hydrogen Malate Tablets 1.5mg	28	428
Pizotifen Hydrogen Malate Tablets 500mcg	60	257
Prednisolone Tablets 1mg	28	53
Prednisolone Tablets 5mg	28	68
Prednisolone Tablets E/C 2.5mg	30	26
Prednisolone Tablets E/C 2.5mg	100	57
Prednisolone Tablets E/C 5mg	30	43
Prednisolone Tablets E/C 5mg	100	102
Prochlorperazine Maleate Tablets 5mg	28	168
Prochlorperazine Maleate Tablets 5mg	1000	6,000
Procyclidine HCl Tablets 5mg	28	152

Propranolol HCl Tablets 10mg	28	59
Propranolol HCl Tablets 160mg	56	239
Propranolol HCl Tablets 40mg	28	65
Propranolol HCl Tablets 80mg	56	97
Propylthiouracil Tablets 50mg	100	4,473
Quinine Bisulphate Tablets 300mg	28	145
Quinine Bisulphate Tablets 300mg	500	2,062
Quinine Sulphate Tablets 200mg	28	147
Quinine Sulphate Tablets 300mg	28	137
Quinine Sulphate Tablets 300mg	500	2,024
Ranitidine HCl Tablets 150mg	60	1,813
Ranitidine HCl Tablets 300mg	30	1,764

Salbutamol Nebuliser Solution 1mg/ml 2.5ml Unit Dose	5	80
Salbutamol Nebuliser Solution 2mg/ml 2.5ml Unit Dose	5	160
Salbutamol Nebuliser 100mcg (200 Doses)	1	178
Salbutamol Syrup 2mg/5ml Sugar Free	150ml	72
Salbutamol Tablets 2mg	28	83
Salbutamol Tablets 4mg	28	152
Selegiline HCl Tablets 10mg	28	1,082
Selegiline HCl Tablets 5mg	56	1,125
Senna Tablets 7.5mg	500	738
Sodium Bicarbonate Capsules 500mg	100	3,054
Sodium Bicarbonate Capsules 600mg	100	3,054
Sodium Bicarbonate Ear Drops 5%	10ml	118

Sodium Bicarbonate Tablets 600mg	500	1,240
Sodium Cromoglycate Eye Drops Aqueous 2%	13.5ml	197
Sodium Cromoglycate Inhaler 5mg (112 Doses)	1	1,530
Sodium Valproate Oral Solution 200mg/5ml Sugar Free	300ml	571
Sodium Valproate Tablets 100mg	100	435
Sodium Valproate Tablets E/C 200mg	100	561
Sodium Valproate Tablets E/C 500mg	100	1,480
Sotalol HCl Tablets 160mg	28	625
Sotalol HCl Tablets 40mg	100	396
Sotalol HCl Tablets 80mg	100	587
Spironolactone Tablets 100mg	28	468
Spironolactone Tablets 100mg	30	501

Spironolactone Tablets 25mg	28	211
Spironolactone Tablets 25mg	30	226
Spironolactone Tablets 50mg	28	450
Spironolactone Tablets 50mg	30	482
Stilboestrol Tablets 1mg	28	2,640
Stilboestrol Tablets 5mg	28	3,960
Sulphasalazine Tablets 500mg	112	774
Sulphasalazine Tablets 500mg	500	3,374
Sulphasalazine Tablets E/C 500mg	100	1,000
Sulphasalazine Tablets E/C 500mg	112	969
Sulpiride Tablets 200mg	30	523
Sulpiride Tablets 200mg	100	1,744

Sulpiride Tablets 400mg	100	3,629
Tamoxifen Citrate Tablets 10mg	30	202
Tamoxifen Citrate Tablets 20mg	30	230
Tamoxifen Citrate Tablets 40mg	30	844
Temazepam Oral Solution 10mg/5ml Sugar Free	300ml	995
Temazepam Tablets 10mg	28	98
Temazepam Tablets 10mg	500	1,709
Temazepam Tablets 20mg	28	171
Temazepam Tablets 20mg	250	1,433
Terfenadine Tablets 60mg	60	299
Tetrabenazine Tablets 25mg	112	10,000
Thioridazine Oral Solution 10mg/5ml	200ml	615

Thioridazine Oral Solution 25mg/5ml	500ml	267
Thioridazine Tablets 100mg	28	241
Thioridazine Tablets 25mg	100	174
Thioridazine Tablets 50mg	28	168
Thyroxine Sodium Tablets 100mcg	28	86
Thyroxine Sodium Tablets 100mcg	1000	3,068
Thyroxine Sodium Tablets 25mcg	28	85
Thyroxine Sodium Tablets 25mcg	500	1,006
Thyroxine Sodium Tablets 50mcg	28	57
Thyroxine Sodium Tablets 50mcg	1000	2,046
Tibolone Tablets 2.5mg	28	1,305
Timolol Maleate Eye Drops 0.25%	5ml	402

Timolol Maleate Eye Drops 0.5%	5ml	437
Tolbutamide Tablets 500mg	28	110
Tramadol HCl Capsules 50mg	30	432
Tramadol HCl Capsules 50mg	100	1,440
Triclofos Sodium Oral Solution 500mg/5ml	300ml	2,823
Trimethoprim Tablets 100mg	28	68
Trimethoprim Tablets 200mg	14	68
Trimethoprim Tablets 200mg	100	242
Ursodeoxycholic Acid Capsules 250mg	60	3,525
Ursodeoxycholic Acid Tablets 150mg	60	1,867
Verapamil HCl Tablets 120mg	28	134
Verapamil HCl Tablets 120mg	100	480

Verapamil HCl Tablets 160mg	56	565
Verapamil HCl Tablets 160mg	100	465
Verapamil HCl Tablets 40mg	84	163
Verapamil HCl Tablets 80mg	84	212
Warfarin Sodium Tablets 1mg	28	150
Warfarin Sodium Tablets 3mg	28	160
Warfarin Sodium Tablets 5mg	28	171
Zopiclone Tablets 3.75mg	28	308
Zopiclone Tablets 7.5mg	28	448

APPENDIX C

PENALTIES FOR CONTRAVENTION OF THE SCHEME

In broad terms, under the Health Act 1999 the Secretary of State may set a limit on prices charged for NHS medicines and seek payment of the excess over the limit charged by a supplier or manufacturer (section 34). He is also able to:

impose a daily penalty of up to £10,000 if a supplier or manufacturer exceeds the limit (section 37(2));
increase the amount to be paid by up to 50% (section 37(3)); and
charge interest (section 37(4)).

Where a supplier contravenes the scheme, they will be required to repay the excess sum they received above the maximum price plus that sum multiplied by the appropriate additional percentage specified in Table 1, dependent on the number of previous contraventions.

Table 1

Contravention Column (1)	Additional Percentage Column (2)
First contravention	5 %
Second contravention	15 %
Third contravention	25 %
Fourth contravention	35 %
Fifth or subsequent contravention	50%

The scheme will have a sliding scale of penalties and premia based on the level of health service sales of a manufacturer or supplier and the length of the contravention. Table 2 sets out the penalties under the scheme.

Table 2

Health service sales of manufacturer or supplier Column (1)	Daily penalty for first 14 days Column (2)	Daily penalty for subsequent 14 days Column (3)
Less than £5 million	£250	£500
Less than £10 million but not less than £5 million	£500	£1,000
Less than £100 million but not less than £10 million	£2,500	£5,000
Not less than £100 million	£5,000	£10,000

APPENDIX D

FURTHER REDUCTIONS IN LIST PRICES OF CERTAIN PREPARATIONS

		Price derived from proposals received during consultation
		(for information)

Preparation	Pack	Pence


Aciclovir_Tab Disper 200mg	25	500
Aciclovir_Tab Disper 400mg	56	2000
Aciclovir_Tab Disper 800mg	35	2064
Atenolol_Tab 100mg	28	91
Atenolol_Tab 25mg	28	61
Atenolol_Tab 50mg	28	72
Betahistine HCl_Tab 8mg	120	618
Captopril_Tab 12.5mg	56	225
Captopril_Tab 25mg	56	295
Captopril_Tab 50mg	56	375
Enalapril_Tab 10mg	28	564
Enalapril_Tab 2.5mg	28	284
Enalapril_Tab 20mg	28	663
Enalapril_Tab 5mg	28	413
Fluoxetine HCl_Tab Cap 20mg	30	846
Gliclazide_Tab 80mg	28	250
Gliclazide_Tab 80mg	60	600
Ranitidine HCl_Tab 150mg	60	735
Ranitidine HCl_Tab 300mg	30	735
Tramadol HCl_Cap 50mg	100	993

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Published by the Department of Health © Crown Copyright 2000 This page last updated 20 July 2000

Published by the Department of Health
© Crown Copyright 2000
This page last updated 20 July 2000