9th January 2023 - Source: Amanda Chell

Hi Amanda,

Hope you are well?

Our ICB are pushing us to prescribe Salamol by brand rather than Salbutamol – am I correct in thinking if we do this the dispensary will make a small loss on each? At the moment we prescribe generically and dispense Salamol. From what I can see on DM+D they’d reimburse us £1.46 for Salamol but reimburse us £1.50 for the generic? We get salamol sent via our wholesaler for £1.15 currently.

Hi there,

You are absolutely right; the best commercial option is to prescribe generically and dispense Salamol.

Hi Amanda,

We are having to administer at the surgery Nebido Injection, and I was wondering if this would be better for the prescription to be dispensed at the local pharmacy?

I don’t think there is any wholesale discount on the Nebido. Is there a standard P/A fee for every item and if so do you know how much this is, although I cannot imagine this will make up the short fall.

I am thinking about sending the prescription to the local Pharmacy but wanted to check your depths of knowledge first!

Look forward to hearing from you.

Hi there, lovely to hear from you – hope you are well?

So as with most areas of dispensing doctor- nothing is straight forward.

You have already said the Nebido is being administered at the surgery so only 1 VAT claim.

I’ve worked it out for you below.

· List price of Nebido is £87.11 (no wholesaler discount applies) + VAT at £17.42 = total payment is £104.53

Reimbursement as follows:

· List price £87.11 less clawback of 11.18% = £77.37 + VAT at 20%= reimbursement of £92.84 + average disp fee of £2.00 = £94.84.

So purchasing and administering on site = loss of approx. £10.00

It is complicated as the VAT reclaim is paid through your PCSE statement – worked out at list price less clawback + VAT at 20%

So my suggestion would be to outsource your Nebido patients who do not pay as we class Nebido as PA and no levy is due.

If a paying patient takes a Nebido to a local pharmacy – pharmacy cannot PA anything (not a facility in pharmacy world) so the patient would pay £9.35.

If however the patient administered the Nebido at home, then the VAT claim would be different.

So I would only outsource exempt patients and I would take the financial hit with patients who do pay.

Hi Amanda

Quick question

When one of our G.Ps uses medication from his or her doctors  bag, can I  raise a script for these items, or do the docs just have to absorb this cost?


Hope you are well?

Depends what the item is – if the item is classed as personally administered such as a Stemetil inj for example, then definitely raise a script as no levy is due.

If the patient is age exempt or has other exemption, then again yes raise a script.

However, if the doctor administers for example a Salbutamol inhaler and the patient is of paying status, then its up to you whether you charge the patient or absorb the cost.

Hope that makes sense?