How Specials Can Deliver Value to the NHS | Page 6

ASSESSING CLINICAL NEED
The role of the pharmacist – best practice
When considering the clinical need for a Special, it is good practice to assess the risk associated with this supply
and for pharmacists to use their professional judgement.
A pharmacist should, according to the Royal Pharmaceutical Society10:
• Make sure the prescriber is aware of the unlicensed status and, if requested to, make every reasonable effort
to identify a UK-licensed product equivalent, or near equivalent product, to the prescribed Special that meets
the patient’s clinical needs.
• Where no appropriate licensed medicine is available, and it is essential to supply a Special, consider options
that include, but are not necessarily limited to:
-- Importation of a product licensed in Europe, USA, Canada, Australia or in another MHRA-recognised
authority
-- Purchase of a Special from an external manufacturer with an MS
-- Prescription and supply of an alternative licensed presentation such as a soluble or dispersible formulation,
transdermal patch or suppository
-- Extemporaneously dispensing in the pharmacy – this would include crushing of tablets if appropriate
information is available

• Choose the option which minimises the risk to the patient, bearing in mind
the patient’s clinical need.
• Where a patient receives prescriptions on a continuing basis,
periodically reconfirm with the prescriber that the
ongoing use of an unlicensed product is appropriate,
having regard to any circumstances that might
suggest that a licensed product may become
more suitable.
• Document any discussions with the prescriber
in relation to the unlicensed nature of the
product and its suitability.
• Consider the urgency, or otherwise, of the
patient’s need for the medicine and take
reasonable steps to ensure timely supply.

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10. Royal Pharmaceutical Society http://www.rpharms.com/pharmacy-practiceresource/specials.asp, [date accessed Apr 2014]