Drug Tariff and Check34 Hayley Freeman Advice and Support - PowerPoint PPT Presentation

Drug Tariff and Check34 Hayley Freeman Advice and Support Technician

Objectives for today • Understand where dispensing income may be affected • How to improve dispensing processes and top tips on receiving, processing and sorting prescriptions • Understand the importance of maximising income through correct endorsement • Introduction to and how it can help contractors

Stages where errors often arise  Receiving a prescription  Dispensing/endorsing ! Errors can occur during these stages of the  Prescription sorting dispensing process  Prescription submission

Receiving a prescription • Complete the reverse of the Rx • Collect the correct number of Rx charges • Check patient exemption status is correct Checks when • Check for missing prescriber codes receiving a • Check prescribing rights of the prescriber prescription • Check the validity of the Rx • Check for out of date prescription forms FP10SS 0608 FP10SS 0406

Missing prescriber codes If a prescriber code is missing NHSBSA may return the script to pharmacy Ibandronic acid 50mg tabs This could lead to a delay in payment 1OD 28 tabs Baclofen 10mg Pharmacy could potentially lose money tabs 1OD 28 tabs Rx submitted in December January Ibandronic acid tablets £9.58 £8.63 Baclofen tablets £6.37 £2.99 GP code Total cost of drugs £15.95 £11.62 Difference ─ £4.33 Loss to the pharmacy = £4.33

Areas where errors commonly arise Unlicensed Specials/Imports Broken bulk claims (BB) Out of pocket expenses Expensive Items Doctor’s signature Supplementary information Not dispensed Flavours Red Separator Endorsing items Switching

Unlicensed specials and imports Imports ‘Special obtained’ Specials Unlicensed Unlicensed in UK Lines which wholesalers do medicinal products not routinely stock – a – licensed or ‘special obtained’ item is – no UK marketing available from not the same as a Special authorisation another country

Specials and ‘special obtained’ – endorsing Imports Special Obtain Special SP OOP or XP (EPS) SP (ED if manufactured Reason for claim under Section 10 Total amount (for exemption) claims over 50p)

Specials endorsing Item listed in Part VIIIB Endorse ‘ SP ’ or (‘ ED ’ if made by pharmacy) Bisoprolol SP Volume dispensed 1.25mg/5mL oral solution (where this is different 100mL from the quantity prescribed) No other endorsements required

Specials endorsing Item NOT listed in Part VIIIB Endorse ‘ SP ’ or (‘ ED ’ if made by pharmacy) SP Amount dispensed over 60/60 Acetylcysteine £89.15 pack size used for example capsules 600mg per pk 1OD Licence 60/60 60 capsules 165298 Price of pack size used Batch 121549 (minus discount and rebates) MHRA specials/ importers licence number Batch number

Co-proxamol tablets endorsement • Co-proxamol tablets were deleted from Part VIIIA of the England and Wales Drug Tariff in December 2015 • NHS Prescription Services has co-proxamol listed as an unlicensed special • Prescriptions would therefore need to be endorsed as a non part VIIIB special • In addition, the prescription will need to be placed in a red separator

Specials endorsing – extemporaneously dispensed Product manufactured under the Section 10 exemption ED Made by 3 rd party Made in pharmacy 1. Endorse ED 1. Endorse ED 2. Name, quantity and cost of each ingredient used 3. Endorse BB for any ingredients

For dispensing Specials  Endorse ‘ SP ’ or ‘ ED ’  DO NOT simply endorse £20 P+P  Use the Dictionary of Medicines and Medical Devices browser (dm+d)  Sort using red separator  Compare prices of specials from different suppliers

Broken Bulk Broken Bulk CANNOT be claimed on any the following: BB Bromocriptine All unlicensed medicines 50 /100 10mg capsules (unless claiming for ingredients used to prepare an 50 capsules unlicensed special extemporaneously dispensed) Category A and M products (reimbursement price of the smallest pack less than £50) Appliances (Part IXA) Chemical reagents (Part IXR) Special containers

Broken Bulk  Endorse ‘ BB ’ with amount dispensed over pack size used  Sort forms using red separator If red separator is not used, the form will not be seen by a claims handler and the item will be priced as ordered !  Mark container with date BB claimed  New BB claim can be made after 6 months

Out of pocket expenses OOP can be claimed on the following products: Part VIIIA Category C only OOP Details Appliances in Part IXB of the claim Appliances in Part IXC e.g. postage Readily available medicinal products Amount outside of Part VIIIA Products in ACBS list (gluten free items, fortified drinks etc)

Out of pocket expenses  Endorse ‘ OOP ’ (or ‘XP’ for EPS), details of claim and amount to claim. ‘ SP ’ endorsement is used for specials  Place in a red separator. If not placed, it will not be seen by a claims handler  OOP cannot be claimed for: • appliances in Part IXA and Part IXR e.g. dressings, catheters, reagents • Category A and category M drugs in Part VIIIA

Expensive items • An expensive item is any item (drug or appliance) that has a NIC of £100 or more • Fee of 2% payable per prescription item • Expensive items can significantly affect pharmacy cash flow as full payment is received THREE months after dispensing • Very expensive items can affect the AIV which in turn can affect the advance payment received

Expensive items  Place in a red separator  Highlight scripts for expensive items during the dispensing process  Sort red separator scripts daily to avoid them being misfiled  Keep records of all expensive items dispensed per month to allow for reconciliation checks with FP34C

Doctor’s signature • Prescription not placed in red separator • Doctor’s signature has Mefenamic acid 500mg tabs obscured the quantity ordered 1OD 28 tabs for Digoxin tabs • Item priced for 8 tablets Digoxin 125mcg tabs instead of 28 tablets 1OD 28 tabs • If placed in a red separator, script would be processed manually by a claims handler

Supplementary product information • Supplementary information Main product information field included as part of dosage can be missed by the pricing systems Carmellose 0.5% eye • Pricing authority will price for drops standard formulations instead of 2 drops in both eyes bd preservative free Preservative free 10mL • If placed in a red separator, script would be processed Supplementary information manually by a claims handler

Not dispensed items • Not dispensed items need to be endorsed as ‘ ND ’ and the Mefenamic product needs to be crossed ND acid 500mg through tabs 1OD 28 tabs • Mefenamic acid would be Digoxin reimbursed by NHS ND 125mcg tabs • If the patient is not exempt a 1OD 28 tabs patient charge is also deducted resulting in a loss of £8.20 to the contractor

Flavours Mocha 4 flavours endorsed but x10 only 1 flavour paid Vanilla Fortisip Compact x10 Liquid Feed Banana Prescriber has to specify Milkshake style x10 40 x 125ml ACBS ‘mixed flavours’ or Forest Fruits ‘assorted flavours’ or x10 write each flavour separately

Endorsement area Obscuring DOB DOB John chemist If back of Rx not 142 johns lane 14/8/31 N176RS completed then Atorvastatin 10mg Rx is switched Tabs 1ON 28 Only paid for Place in red 8 tablets Lisinopril 5mg tabs 1OD separator!!! Owing quantity 12/28 28 mistaken for Amlodipine 5mg quantity dispensed Tabs 28 Only paid for 8 tablets

Switching: Filling the reverse of a Rx Part 1 Paid (Part 2 Exempt and 3) (Part 1 and 3) Part 2 Part 3

Prescription Switching: Exempt to Paid Amlodipine 5mg tabs 1OD 28 tabs Ramipril 10mg capsules Part 1 completed but 1OD 56 tabs Part 2 incomplete: Simvastatin 40mg signature missing tabs 1OD 28 tabs 3 charges deducted £8.20 x 3 items = £24.60

To reduce prescription switching  Ensure that all prescriptions are filed correctly in the paid or exempt bundles at the end of the day  If possible, double check the exempt prescriptions bundle for misfiled paid prescriptions during end of the month submission

Sorting prescriptions Daily checks  Count prescriptions at the end of the day  Highlight/mark prescriptions for red separator  Double check all exemption declarations  Endorse in the left hand margin only  Check all endorsements are correct and legible  Keep a separate log of expensive items/OOP claims for reconciliation checks  Separate prescriptions into correct charge group  Ensure date stamps do not obscure the date of birth

Checks to make before submission of prescriptions  Follow up any outstanding queries on prescriptions  Set up owings reminder for uncollected items  Double check daily prescription counts  Check final prescription figures twice before entering details onto FP34c  Re-check exemption declarations  Check red separator items are placed in red separator  Remove any invoices, labels, paper clips, pins, post-it notes, tape or staples  Pack bundles neatly without using too many elastic bands  Send by courier before the 5 th of the month