I am writing to all practices to confirm the LMCs current advice to practices regarding the prescribing of Inclisiran, in the light of a number of queries the LMC Office has received.
Colleagues will be aware there have been recent changes in the national arrangements relevant to Inclisiran, in particular:
- An increase in the NHS reimbursement for purchasing Inclisiran giving an increased
payment from £5 to £15 (the negotiated reimbursement has risen to £60 with a £45 charge) - Enhanced QOF target level payments for a number of cardio-vascular disease related indicators.
- Inclusion of Inclisiran (and, currently, only this drug) within section Part VIIIC of the Drug Tariff. The dispensing discount deduction (clawback) does not apply to this
drug. - VAT reimbursement is available on purchase but not on Personally Administered item claims (for VAT registered practices)
Taken together, these changes affect the potential reward associated with prescribing Inclisiran, which practices may wish to take into account. However, the LMC’s position remains that, whilst the decision to prescribe Inclisiran is a clinical matter for individual colleagues, the workload associated with the management of patients prescribed Inclisiran should be funded locally, ideally via a Locally Commissioned Service (LCS) vehicle. The format of such an LCS can be for local negotiation, but should include:
- Costs associated with the administration of the drug.
- The call/recall required (noting that QOF no longer reimburses for the maintenance of disease registers).
- Training and other governance requirements.
In some ICB areas within SSLMCs there are payment arrangements in place for some of these practice workloads.
The LMC does not normally provide clinical advice since this is a matter for individual GP judgement; however, a number of current trials of Inclisiran use are underway, details of
which are available at:
Inclisiran Gains Indication as Stand-alone Therapy to Reduce LDL Cholesterol | tctmd.com
These should report during 2026/27. This should give further clarity to the concerns identified in the joint BMA/RCGP statement on Inclisiran prescribing in 2021. The RAG indicator for Inclisiran, currently green for ICBs, is not a comment on the contractual/commissioning arrangements associated with drug prescribing and commissioning colleagues should not conflate the two.
I hope this background is helpful.
Dr Julius Parker, Chief Executive