Tariff Tip: Temgesic or Subutex?

Q: I have a generic prescription for buprenorphine 400mcg sublingual tablets. It is being used for breakthrough pain – should I dispense Temgesic or Subutex?

A: From a legal and ethical perspective the answer is clear - Temgesic is licensed as a strong analgesic for moderate to severe pain. Subutex on the other hand is only licensed for substitution treatment of opioid dependence. So supply of Subutex for the management of pain would be an unlicensed indication and should be avoided.

But the scenario is complicated by the existence of generic buprenorphine 400mcg sublingual tablets [1]. Surely these are cheaper and should be supplied on a generic prescription? Won’t I be out of pocket if I supply a branded product?

So the real question is – will I be fully reimbursed if I supply Temgesic on a generic prescription for buprenorphine?

Thankfully the answer is yes.

‘Buprenorphine 400mcg sublingual tablets’ has two listings in the Drug Tariff for two different pack sizes.

• A pack size of 7 tablets is reimbursed at £1.36 and is a category C drug [2].
• A pack size of 50 tablets is reimbursed at £10.07 with the price based on Temgesic.

So provided you endorse the pack size you have used (50) you can supply the licensed product Temgesic and be reimbursed correctly without fear of being out of pocket.

[1] Generic buprenorphine 400mcg sublingual tablets are also only licensed for substitution therapy.
[2] Prices as listed in the August 2022 England and Wales Drug Tariff.

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