In need of special attention?

Market factors 

Despite a decline in the market and a continual process of licensing products previously available as specials, Sharon Clift says there is still a need for specials, although the market remains in flux.

“New formulations continue to be prescribed mostly in secondary care, with subsequent repeat prescriptions in primary care. Much of this has now been standardised within the Tariff, but there will continue to be the need for truly bespoke specials formulations,” she believes.

However, other factors have forced the market to change in recent years, with the ongoing effects of Covid and Brexit, together with the war in Ukraine, felt across the sector.

“Pressures on access to a skilled workforce, ongoing out-of-stocks, a significant increase in costs and subsequent product discontinuations are challenging our ability to provide such a varied and bespoke product portfolio,” says Clift. “At the same time, the reduced demand for specials and increasing cost and time of quality processes make specials an ever more complex sector. For example, the increased cost of APIs might make a manufacturer think twice about making an up-front investment when there is no guarantee of demand.”

Specials also face the dilemma that their bespoke, on-demand nature makes them very hard to commercialise, which can also make them a challenging proposition for community pharmacy. “The response of some manufacturers has been to specialise and focus on what they can offer, efficiently and quickly,” says Clift, “and as a result there have been some changes in the way community pharmacies acquire specials. 

“In the past they may have gone to one specials manufacturer for all their needs but now it is more likely they’ll need to shop around as not everyone makes everything – although the sector will always work to ensure that a formulation is available somewhere when it is needed.”

As well as a commitment to individual patients, Clift says the specials sector also has a key role to play in bolstering the market from the supply disruption that has affected the whole of the pharma industry. “When licensed products or APIs go out of stock, it is often down to us to provide a short-term alternative. In many ways we are becoming even more solutions-driven, working with all stakeholders to maintain a safe and timely supply of essential medicines.”

Future view

Specials remain an important part of the medicines supply chain, but APSM’s Clift predicts changes, and challenges, ahead. “Much of the cost is – and will increasingly be – regulated by the Tariff, and cost and market pressures may mean fewer ‘one-stop-shop’ specials suppliers and more specialist suppliers,” she says. 

“However, patient safety and quality will remain a priority, and that will ensure that only well-funded and expert providers, who can fully support community pharmacy, can continue to meet the needs of this market.”