Pharmaceutical contractors

Fraud relating to inappropriate claims for dispensing and enhanced services offered by community pharmacies, inflated claims under the drug tariff or activities that contravene contractual terms.

This area has not been subject to a loss measurement exercise this financial year and relies on historic loss measurement reporting and comparative analysis to dental and optical contractor fraud.


from an expenditure of £11.7 billion

Recent loss measurement exercises for dental and optical have identified overall vulnerability percentages of between 1% and 3.5%. 1% has been used to express the possible financial vulnerability.

Financial fraud vulnerability: £ 117 million.

NHSBSA provider assurance work in this area continues with post payment verification (PPV) and it is highly likely that such activity is changing the behaviour of how some pharmaceutical contractors make NHS claims for services provided, and positively impacting on potential loss in this area.

Information reports received for Pharmaceutical contractors

Change in the number of fraud referrals (allegations) received in relation to Pharmaceutical contractors from 2016-17 to 2019-20.


decrease in referrals for this theme compared to last year

2016-17 2017-18 2018-19 2019-20
132 138 178 156