Unlicensed medicines, or ‘Specials’, account for approximately 1% of the NHS prescriptions budget.

The amount being spent on ‘Specials’ was estimated to have risen from £57 million to £160 million between 2007 and 201064.

Concerns regarding the cost of ‘Specials’ to the NHS was compounded by a wide variation in cost for the same medicines. Data supplied by NHS Business services Authority Prescription Services showed net ingredient cost for same strength, volume and quantity of unlicensed omeprazole liquid have ranged from £112.98 to £1113.13, and for hypromellose eye drops from £38.70 to £2882.1063.

To address this variability, the Department of Health allowed 'Specials' manufacturers to publish their price lists in August 2010 and introduced new arrangements for the reimbursement of ‘Specials’ in November 2011. This means that certain products formerly categorised as Special Order Products are now categorised as Drug Tariff Special Order Products with pharmacists now being reimbursed a fixed amount for the most commonly prescribed ‘Specials’. The ‘Specials’ Tariff has its prices updated quarterly and prescribing data examined every six months to allow products to enter and exit the list. Where a ‘Special’ becomes available as a licensed product outside of these reviews, the Drug Tariff will be updated to reflect the introduction of the licensed product.

In recent years, the costs associated with prescribing ‘Specials’ in England has decreased. In the three years since the ‘Specials’ Tariff was introduced, the Association of Pharmaceutical Specials Manufacturers state that the mean cost per (‘Special’) item has reduced by more than 32%98.

Dispensing ‘Special order’ prescriptions in the community (England)65

No. of ‘special’ items dispensed Net ingredient cost Avg cost per item No. of different chemical substances
2010 713,908 £138.7 million £194 416
2011 614,834 £115.5 million £188 399
2012 491,632 £75.2 million £153 410
2013 391,038 £59.0 million £151 396
2014 338,136 £44.8 million £133 415