Hints & Tips

Issue 6

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Payment for Specials and Imported Unlicensed Medicines - Drug Tariff Part VIIIB
Part VIIIB was introduced to the Drug Tariff with effect from 1 November 2011, comprising a limited list of unlicensed medicines for which reimbursement is made based on the basic price listed. Specials and imported unlicensed medicines included in Part VIIIB are listed with a minimum quantity and corresponding price which is payable for any amount prescribed up to and including the minimum quantity. Quantities in excess of the minimum quantity are paid at the additional price per ml/g/tab/cap stated, unless in a special container in which case the relevant number of special containers will be reimbursed.

Unlicensed Medicines Invoice Price

Specials and imported unlicensed medicines not included in Part VIIIB will be reimbursed depending on how the item has been obtained. Where extemporaneously dispensed under the manufacturing part of the Section 10 exemption from the Medicines Act 1968, the cost of the

ingredients used will be reimbursed. Where obtained from a If an unlicensed medicine not listed manufacturer holding a MHRA specials licence, reimbursement in Drug Tariff Part VIIIB is manufactured will be made according to the price endorsed by the contractor. under a specials licence or sourced under The price endorsed should be the invoice price less any an importers licence issued by the MHRA, discount or rebate linked to the procurement of the item. the invoice price less any discount/rebates should be endorsed. That is the actual price See the Drug Tariff for full details. paid for the product.

Contents

Page 2 New Pharmacy Contractor Additional Fees Drug Tariff Part IIIA

Page 3 Broken Bulk and out of pocket expenses

Page 4 Pre-Payment Certificates All you need to know

Claiming Out of Pocket Expenses for Unlicensed Specials or Imported Products.

Under the new arrangements for unlicensed specials and imported products, out of pocket expenses cannot be accounted for in the same way they were traditionally claimed. You are reminded not to record these expenses on the submission form (FP34C) you send in to the NHSBSA along with your prescriptions, as this could be interpreted as a fraudulent claim.

New Pharmacy Contractor Additional Fees and Endorsements Drug Tariff Part IIIA
Where a preparation has been manufactured under an MHRA specials licence or sourced under an MHRA importers licence, contractors can claim an additional fee by endorsing SP. Please note that SP should not be endorsed under any other circumstances. Where a preparation has been prepared under the section 10 exemption from the Medicines Act 1968, contractors can claim an additional fee by endorsing ED. Please note that ED should not be endorsed under any other circumstances. DNG endorsements are no longer required - no discount will be deducted where specials/imports not included in Part VIIIB are dispensed. Out of Pocket Expenses cannot be claimed for specials/imports and should no longer be included in the declaration on the FP34C. Broken Bulk cannot be claimed for specials/imports, although Broken Bulk can be claimed on the ingredients where a preparation has been prepared under the section 10 exemption from the Medicines Act 1968. See the Drug Tariff for full details.

Midazolam
With effect from 1 November 2011 Midazolam 10mg/ml oral solution is included in Part VIIIB of the Drug Tariff, listed as a minimum volume pack of 5ml plus a price per extra ml above this minimum volume. Contractors will be reimbursed at the price for 1 x 5ml minimum volume pack plus the price of the 1ml pack for every extra ml dispensed above 5ml, unless it is clearly endorsed that the whole quantity has been dispensed in containers with an integral means of administration, e.g. 20ml prescribed and the contractor endorses 20ml/5ml or 4 x 5ml. The following are all covered by the Part VIIIB entry: Standard (STD), Sugar Free (SF), Lactose Free (LF), Colour Free (CF) and Oromucosal formulations Both Midazolam maleate 10mg/ml oral solution and Midazolam Hydrochloride 10mg/ml oral solution Midazolam 10mg/1ml oromucosal solution Pre-Filled Oral syringes (1 Pre-Filled Syringe = 1ml) Midazolam 10mg/ml buccal solution

Where Midazolam 10mg/ml Liquid is prescribed, contractors need to endorse the exact pharmaceutical form dispensed, e.g. solution or suspension. This will ensure prompt and correct reimbursement. Where this information is not endorsed, the item will be referred back.

Broken Bulk and Out of Pocket Expenses

Please note that Drug Tariff Part II Requirements Enabling Payments to be made for the supply of Drugs, Appliances and Chemical Reagents was amended in December 2011 to give clarification regarding Clauses 11 and 12. Clause 11, Broken Bulk, paragraph A was amended to clarify that broken bulk cannot be claimed on specials and imported products covered by Part VIIIB (previously read unlicensed medicines). Broken Bulk can still be claimed on unlicensed medicines other than specials and imported products covered by the arrangements set out in Part VIIIB. Clause 12, Out of Pocket Expenses was amended to clarify that out-of-pocket expenses cannot be claimed for specials and imported products (previously read unlicensed medicines). Out of Pocket Expenses can still be claimed for unlicensed medicines other than specials and imported products

Not Dispensed items

The following information has been taken from the PSNC website to provide guidance for dispensing contractors on how to endorse not Dispensed items. Where an item has not been dispensed, the ND endorsement should be made in the prescriptions endorsement column immediately adjacent to the prescribed product name and a score should be made through the product name in the prescribing area of the form. If the prescribed item is not scored out, there is a risk of incorrect reimbursement. Below are examples of an incorrectly endorsed and correctly endorsed non-dispensed item.

Incorrectly endorsed non-dispensed item

Correctly endorsed non-dispensed item

Advance Payments
To ensure an Advance Payment is received, it is essential to send your prescription batch to NHS Prescription Services in a timely manner. Drug Tariff Part I Clause 5 states that forms should be despatched no later than the fifth day of the month following that in which the supply was made. If batches are received too late in the month, there is a possibility that no Advance Payment can be made.

Drug Tariff Part VI

Please note the following amendments made to Drug Tariff Part VI with effect from 1 December 2011: Part VIA Payment for Essential Services (Pharmacy Contractors) changes made to Practice Payments in England. Part VIC Advanced Services (Pharmacy and Appliance Contractors) (England) now refers to England only (previously also referred to Wales), and now also includes Stoma Customisation and Appliance Use Reviews which were previously included in Part VIE. Part VID Advanced Services (Pharmacy and Appliance Contractors) (Wales) refers to Advanced Services (Pharmacy and Appliance Contractors) in Wales only, which was previously included in Parts VIC and VIE. Part VIE Enhanced Services (Pharmacy Contractors) this Part was formerly Part VID.

Pre-Payment Certificates All you need to know

Whether you already sell pre-payment certificates (PPCs) to your patients, or youre new to the PPC business, this article will provide some useful information to help you deliver this important service.
Prescription pre-payment certificates work on the same basis as a season ticket. They can save patients a lot of money on their prescription charges and there are two types of certificate available. A 3 month certificate covers the cost of all prescriptions over a 3 month period for 29.10. Any patientsnot exempt from charges needing more than four items over a 3 month period would save money with a 3 month certificate. An annual certificate is available if prescriptions are needed over a longer period of time, costing 104. Any patients needing more than 14 items in a year would save money with the annual certificate.

Register now to sell Pre-Payment Certificates

You may wish to consider selling PPCs; you can register with the How to sell the PPC NHSBSA on the PPC websales website. Pharmacies are reminded to fully complete PPC application forms (form FP95) and they should be sent with the completed sales advice slip (PE31) to the NHSBSA. When completing the PE31, please ensure you provide: Your pharmacy details (name, address, telephone number) OCS code - begins with the letter F The number of PPCs (3-month and 12-month) sold The name, signature and position of sender The date of sale

Incorrectly completed details can cause: delayed issue of the PPC to the customer financial implications for the customer delayed adjustments to your payments It is important that you send PE31 and application forms to us on a daily basis, so that we can issue the PPC to the customer without delay. Please dont send any payment with the application forms. You should retain the money paid for the certificates and this will be deducted from your monthly payment. These payments will show on your monthly schedule under details of other amounts authorised. The NHSBSA will supply additional PE31s and reply envelopes. You can obtain these by calling our Customer Contact Section on 0845 6018076. Additional FP95 application forms can be obtained from your Primary Care Trust (PCT) Form Supplies Department / Agency when you need some more. If you require assistance with the completion of these forms, please contact our Technical and Procedural Section on 0191 2034945.

PPC declaration on the reverse of the FP10

Many of your customers are already likely to be using PPCs. Whilst the NHSBSA sends out the PPC cards quickly, there can be a delay between receipt of the application and the despatch of the certificate. This can mean that a patient who has paid for a valid PPC is unable to show the PPC card to their Pharmacist when their prescription is dispensed. Whilst we appreciate the vigilance of all contractors to reduce fraud, its worth noting that patients are permitted to tick box F on the reverse of an FP10 to indicate that they are exempt, even when they are unable to show the PPC card as they are awaiting delivery.

Free posters and leaflets

Leaflets and posters are available for you to order free of charge. Please order the Quickguide (HC12) leaflet containing charge rates and exemption information and the PPC poster (HC20). Call 0845 610 1112 to order yours today.

Reasons for Referred Back items and how to reduce the volume you receive
Referred back items account for 0.22% of the overall total of dispensed items. Some of the common reasons for referring items back, and the information we require, are listed below: Reason Generic order for a drug not listed in Drug Tariff Part VIIIA. Pharmaceutical form not prescribed and more than one pharmaceutical form is available Ambiguous pharmaceutical form prescribed Action Required Endorsement of brand, manufacturer, or wholesaler required Endorse with pharmaceutical form dispensed Endorse with pharmaceutical form dispensed Examples of products where information is often missing Alimemazine 10mg tablets Tramadol modified release capsules Venlafaxine 75mg and 150mg modified release tablets Prednisolone 5mg Donepezil Tamsulosin M/R Epaderm Emollient Please indicate whether cream or ointment was dispensed Glyceryl Trinitrate spray Please indicate whether pump or aerosol was dispensed Amoxicillin 250mg tablets only capsules are available Sterile Dressing Pack x 1 box Please indicate how many dressings were dispensed for an order of one box. Dianette available from Bayer Plc and Generics UK Nifedpress MR 20 tablets available from Dexcel-Pharma Ltd, Actavis UK Ltd and Teva UK Ltd Lansinoh lanolin ointment

Pharmaceutical form prescribed is not available Number / quantity not prescribed

Endorse with pharmaceutical form dispensed Endorse with number / quantity dispensed

Branded items where more than one supplier supplies that brand

Endorse with name of supplier dispensed

For less common products (other than specials and imported products) where a price is not held on NHS Prescription Services internal systems.

Endorse the total net price for the prescribed quantity (before discount and ex VAT)

To avoid delays to payment, please provide NHS Prescription Services with enough information to allow prescriptions to be processed. For further information on endorsing guidelines please refer to our endorsing guide. Alternatively, call the Help Desk on 0845 6101171.

Reimbursement quantity guidance

NHS Prescription Services continue to receive prescription forms for some items e.g. medical devices or appliances where the prescriber had ordered one single unit or multiple units of a product but had been endorsed that one or more boxes had been dispensed, for example 1 bag or 4 device prescribed and endorsed that 1 x 30 bag, 4 x 20 device supplied. The products affected are not special container packs. NHS reimbursement policy (NHS England and Wales Drug Tariff Part II clause 10) specifies that payment will normally be calculated on the basis that the exact quantity ordered by the prescriber has been supplied, except only of those preparations referred to in B and C where B and C refer to special containers and calendar packs. Dispensing contractors are reminded that one single unit prescribed will be reimbursed as one single unit as set out in the Drug Tariff Part II clause 10. If you believe that the prescriber intended more than one unit to be supplied, then you will need to contact them to obtain a new prescription for the intended quantity. It is important also that the patients prescription record is updated by the prescriber to ensure future prescriptions contain the intended quantity.

Schedule of Payments
You may have noticed some changes to your schedule of payments over the last two months. This is to reflect changes to the Drug Tariff in relation to CIP compensation payments and New Medicine Services payments.

A sticky problem!

Its important that contractors dont put stickers on prescription forms to identify New Medicine Services activity or to identify Expensive items. Not only can residue from the stickers jam the scanning A further change will be shown from November 2011 machines used during the prescription Schedule of Payment (Payment date 1 February 2012) to processing activity, but they could affect reflect the changes made to the Professional Fee structure, as the accuracy of the information set out in Drug Tariff Part IIIA Additional Fees and will include captured from the prescription the Unlicensed Medicines fees. These fees will be displayed under form. the heading of Prescription Fees - Additional Fees found on the first page of the schedule.

Useful links on our website

NHS England and Wales Drug Tariff www.nhsbsa.nhs.uk/prescriptions/drugtariff NCSO products http://www.nhsbsa.nhs.uk/PrescriptionServices/935. aspx Information about sending in your reimbursement and remuneration claims http://www.nhsbsa.nhs.uk/2473.aspx NHS Prescription Services open days www.nhsbsa.nhs.uk/prescriptions/opendays

For further information please contact the Prescription Pricing Helpdesk on: 0845 610 1171 or email: prescriptionpricinghelpdesk@ppa.nhs.uk