Data collection focussed on non- Drug Tariff specials highlighted by the ePACT reports (Prescription Pricing Division), and information retrieved from each Surgery recorded on the Medical Information System. Only complete data sets i.e. appearing on both the surgery systems and the ePACT reports were included. Hand written prescriptions (for formulations that

defeated the surgery computers) were included when the details of the issue were recorded by the practice. ePACT pricings for individual item issues were compared to the data present on the GP computers and a common unit cost determined (e.g. £/Tab) Subsequently Dapagliflozin the initial findings were presented to the Prescribing Leads for each practice, and their understanding and knowledge of the ‘specials’ prescribed was qualitatively gathered. Ethics approval was not required. Examples of Variation in Specials Pricing Name Formulation and Strength Quantity per issue Cost per Tab/Cap Total Cost difference between most expensive Issue and least expensive issue Magnesium Glycerophosphate _Tablets 97.2 mg Acetylcysteine_ Capsules 600 mg 185 people received a special medicine across all surgeries. Of these 21% were 12 years and under and 29% were aged 65 years and older. Most specials (42%) were issued for conditions affecting the central nervous system (CNS) while 21% were issued for conditions MAPK inhibitor relating to Nutrition and Blood. Gastrointestinal

and Cardiovascular drugs were next most common at 7% each. Topical administration accounted for 10% of the items while the Mannose-binding protein-associated serine protease rest were for oral medicines apart from one item for rectal use., Melatonin was most frequently prescribed (188ocassions ), followed by , Levomepromazine 6 mg (70). The total spend on specials was £157,700. Individual

surgery expenditure ranged from £561 to £36,580 and was not dependent on list size. Considerable price variations were identified (table 1) Not all specials prescribed to patients were dispensed, and frequently handwritten prescriptions appearing on e-PACT reports were not found on the computer records. Specials prescribed by general practice were found to be predominantly oral tablets and capsules. Frequently GPs were unaware that the products they prescribed were specials. Some costs were not captured because of the inability of the computer systems to identify the products and handwritten prescriptions were produced. The large variations in cost indicate that value for money is often not achieved, and patient benefit is difficult to determine and further work is required. 1. MHRA Policy Unit, Inspection, Enforcement and Standards Division. Medicines that do not need a licence (Exemptions from licensing). http://www.mhra.gov.uk/Howweregulate/Medicines/Doesmyproductneedalicence/Medicinesthatdonotneedalicence/index.htm (accessed 19 December 2012).