How Specials Can Deliver Value to the NHS | Seite 4

SUPPLYING A SPECIAL
LOWEST RISK/PREFERRED CHOICE
UK-licensed medicine

Off-label use of UK-licensed
medicine
Imported product licensed in
(approved) country of origin

The relationship between cost and quality
There is concern that a continued drive to reduce cost could
force a trend toward higher risk supply of Specials as well as
a reluctance to prescribe an appropriate Special according to
patient need. This would compromise quality and introduce
an unacceptable level of patient risk into what is generally
recognised as a well-regulated and high quality Specials sector.
The purpose of this White Paper is to identify:

UK-manufactured Special
in MHRA-licensed facilities

1. What is the benefit of a Special to the patient –
and what is the value to the NHS?

An extemporaneously
dispensed medicine

2. To what extent could that value be compromised by
the lower cost source of supply and resulting risk to
patient safety?

An imported product not
licensed in the country of origin

3. Can high quality, ‘safe’ manufacture still provide the
high value required by the NHS?

Incorrect crushing or splitting
licensed tablets or capsules
A non-UK-made unlicensed
medicine or food supplement

HIGHEST RISK/LAST CHOICE
Adapted from RPS practical guidelines on
supplying Specials
Hierarchy may alter in patient groups; for
example, neonates

Average spend per person
on all prescriptions*

Average spend per person
on Specials*

£165.00

£1.74

*England and Wales

*England and Wales

A case study approach
The highly bespoke nature of unlicensed medicines makes it difficult to generalise their patient
benefit and almost impossible to quantify their overall value to the NHS. So for this White
Paper, individual case studies have been selected which typify the scenarios where a Special
might be indicated. They explore the patient benefit in the context of the potential outcome
of adopting a higher risk alternative to meet the patient’s need.
Although not all are actual case studies, they are each based on real events as told by clinicians,
patients and those involved in the supply chain.

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