GP practices face delays in receiving correct inclisiran reimbursements
GP practices are facing delays in receiving correct reimbursements for the cholesterol-lowering drug inclisiran, due to ‘incorrect calculations’.
In a message to GPs, the BMA’s GP committee said it was ‘aware of an issue regarding reimbursement for inclisiran, whereby payments have been delayed’.
Practices buy inclisiran for £45 and claim a £60 reimbursement from the NHS through the discounted drug tariff, which covers the initial price as well as an injection administration and handling fee.
Prior to October 2024, a standard discount was deducted from the reimbursement, but last year inclisiran was exempted from this discount, meaning GP practices were entitled to the full reimbursement.
But NHSBSA told Pulse that instead contractors were reimbursed at the drug tariff price minus the discount, and reimbursements were incorrectly calculated and money is owed.
NHSBSA calculates how much dispensing doctors and GP practices should be reimbursed, and Primary Care Support England (PCSE) processes the payments.
It told Pulse it was still in the process of calculating the number of contractors due for reimbursement and the total value of payments owed.
However, it stressed that ‘no payments to dispensing doctors or GP practices have been missed or delayed’ as a result of this.
NHS England and NHSBSA said they are calculating retrospective adjustments from October 2024, when the discount was disregarded for inclisiran, with a ‘long term solution’ coming in Spring 2026.
It will implement a system change to ensure inclisiran is ‘reimbursed correctly going forward’.
In a message to GPs, the BMA’s GP committee said: ‘We have been informed by NHS England of an issue regarding reimbursement for Inclisiran, whereby payments have been delayed.
‘NHSE is working with NHSBSA to implement a system change to ensure Inclisiran is reimbursed correctly going forward.
‘In the meantime, NHSBSA is in the process of calculating retrospective adjustments from October 2024 to ensure that any missed payments will be made to contractors via PCSE.
‘The long-term solution will be implemented in spring 2026. GPC England reminds practices that Inclisiran prescribing and delivery need to be part of a locally commissioned enhanced service agreed by your local medical committee.’
Inclisiran manufacturer Novartis told Pulse: ‘Novartis is committed to the management of CVD patient’s cholesterol, reduction of health inequalities and the easing of pressure on the healthcare system in the UK.
‘We are aware of the situation and understand that arrangements are being put in place by the NHSBSA to resolve the issue with no expected impact on GP reimbursement of inclisiran.’
In April, NHS England renegotiated a deal with Novartis to maintain GP access to Inclisiran at the same price until 2027.
Last year local leaders said that GP practices are ‘under no obligation’ to prescribe inclisiran without a local enhanced service (LES).
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