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Six pharmacies have been hit with clawbacks amounting to a total of £36,286 after their appeals over ‘out of pocket’ expenses from before and during the pandemic era failed.

Appeals body NHS Resolution recently published the outcome of six attempts by pharmacies to have clawbacks of their OOP expenses from between 2019 and 2021 overturned.

All six appeals rejected when the cases were reconsidered in February and March this year - including an appeal from one pharmacy that will now have to pay back over £11,000 in expense claims for milkshakes and other nutritional products.

This follows an investigation by the NHS Business Service Authority’s pharmaceutical provider assurance team (NHSBSA PAT) into the “highest claimers” of OOP expenses: those with claims of £10,000 or more in 2019 and/or 2020.

OOP expenses are approved under the Drug Tariff in “exceptional circumstances” for products that are not frequently supplied, where a contractor can show they incurred addditional expenses in sourcing these medicines for patients, such as postage or the cost of phone calls to manufacturers.

Only certain products are eligible, including medicines in Part VIIA Category C, Part IXB and Part IXC.

The PAT's investigation targeted pharmacies for claims it said fell outside the rules, also focusing on those it said had claimed for drugs that a majority of contractors in England sourced without claiming OOP expenses.

The PAT was criticised by some pharmacies for the length of time it took to investigate them, with south London-based Mansons Chemist – which had £1,107 deducted from its total claim of £17,059 for the 2019 calendar year – protesting that it was “astounding how long it has taken a well-resourced NHSBSA pharmacy support team to review payment verification”.

The PAT objected to this account, claiming the pharmacy was first approached in 2021 to provide evidence backing up its OOP claims.

Mansons also complained that the Drug Tariff “does not provide either one of us with a definitive meaning nor examples of what is exceptional circumstances, frequently supplied or reasonable steps”.

"It would appear PAT does not understand or is ignoring the fact that when there are medicine supply issues, this can vary from one locality/region to another," said Mansons.

Meanwhile, after having its appeal rejected on March 6 this year, North Walsham Pharmacy in Norfolk had £9,013 clawed back from a total of £12,591 in OOP claims between February 2020 and January 2021.

The pharmacy pointed out that this was an exceptionally busy period for pharmacies as they dealt with the pandemic and significant supply chain disruption affected the availability of drugs.

North Walsham Pharmacy had made claims on more than 12 occasions relating to Metoject pens and Methotrexate devices, pointing out that because of difficulties sourcing these products from mainline wholesalers it had been forced to use other suppliers and incur the associated costs.

But the PAT found the pharmacy had provided only "limited" information to back up its claims. It pointed out that the pharmacy had submitted almost half of all OOP claims for these products within its ICB region - and said more OOP expenses submitted by the pharmacy in the year to January 2022 may be recovered when claims for that period are investigated.

Other affected pharmacies included:

• Duncans Chemist in Bromley, which will have £2,760 from its £10,557 in OOP claims for 2019 recovered
• Fakenham Pharmacy in Norfolk: £3,910 recovered from a total of £10,134 in OOP claims for 2019
• Daya Ltd in Hillingdon: £11,420 recovered from a total of £28,928 in OOP claims made in 2019 and 2020 - principally for nutritional products like Ensure milkshakes and liquids
• School Lane Pharmacy in Norfolk: £8,162 to be recovered out of a total of £11,471 after it was found to have claimed OOP expenses for products like Stexerol-D3 tablets at a higher rate than most pharmacies in England.

In March, P3pharmacy revealed that the NHSBSA had clawed back over £170,000 in hypertension case-finding fees from nine pharmacies - including a clawback of over £45,000 from just one pharmacy.