Objective This study evolved as part of the drug cost containment initiatives within University Hospital of North Staffordshire (UHNS) and the National Health Service (NHS) as a whole. The project was initiated when analysis of the child health ePACT data from 2009 to 2010 demonstrated significant costs associated with dispensing of unlicensed medicines. The objective was to evaluate the cost of supplying unlicensed medication on FP10HP within child health at UHNS and project the financial benefit of standardising supply of these unlicensed medications by dispensing at UHNS.

Methods The ePACT data for child health at UHNS April 2009 – March 2010 was reviewed to determine the quantities and cost of prescription on FP10HP. The top 50 spend from this hospital ePACT data was then evaluated to determine which drugs contributed significantly to this spend and the data further analysed to establish the detail of prescription, including quantities and net ingredient costs (NIC). These prescriptions were then costed using the current NHS price model to determine the relative price for dispensing the equivalent products at UHNS.

Results The initial ePACT searches demonstrated that child health had prescribed 5 606 items on FP10HP for the financial year 2009–2010. The top 50 NIC demonstrated that the unlicensed medication melatonin, then other hypnotics, (biomelatonin) were the two highest cost drugs accounting for 212 (3.8%) of the items prescribed. Unlicensed omeprazole suspension also featured in the top 50 NIC accounting for only 17 items dispensed. The table below demonstrates the relative cost of dispensing these items at UNHS compared with FP10HP and highlights drug formulations where significant cost savings were demonstrated.

Conclusion There are clear financial benefits from dispensing these unlicensed medications at UHNS pharmacy compared with supply on FP10HP, with potential annual savings of approximately £26 000.

In addition, hospital supply allows the pharmacy team to check unlicensed medications are only supplied when they are the only clinically acceptable option and ensure an unlicensed medication risk assessment has been completed, in concordance with the Healthcare Commission report ‘The best medicine’.1 It also allows the medicines management team to select the most suitable formulation, taking into account the manufacturer; availability, licensed status in other countries as well as cost efficiency.2 Standardisation of supply has the clinical benefit of reducing the risk of therapeutic failure or advert drug reactiondue to variance in formulation and the advantage of providing the patient with a familiar product, reducing the risk of administration errors and potential therapeutic duplication.3 In terms of pharmacy workload the item numbers are low, but to negate any impact on work flow and patient waiting times the medical team agreed to prescribe these medicines in advance of the clinic visits.