Prescription charges & endorsing

Don Page, ID

Prescription Charges

• Abolished for Scottish prescriptions written and dispensed in Scotland

• Patient signature on reverse still needed• No charge for Welsh forms• No charge for Northern Ireland forms• England forms pay at English rate

England forms

• Current charge is £7.40p (1st April 2011)• Patient residence entitlement card• Exemption categories in Annex B• Patient must sign rear and tick correct

exemption category• Person signing the back is responsible

for the claim

Charges per item

• Normally one charge per product• Multiple charges if more than one product

in the container (e.g. HRT tablet & patch)• One charge for different strengths of

product (e.g. titration pack)• Contraceptive items are no charge• Hosiery is one charge per piece

Examples

• Warfarin 1mg tabletWarfarin 5mg tablet 1 charge

• Stockings (2 pairs) 4 charges

• Microgynon 30 No charge

• Prednisolone 5mg GR tabletPrednisolone 1mg tablet 2 charges

• Diclofenac Sodium 50mg GR tabletDiclofenac Sodium 100mg MR tablet 2 charges

• Canestan Duo-pack (cream & tablet) 2 charges

ENDORSING

• The purpose of endorsing is to communicate to PSD what actually happened

• The pharmacist can see the prescription and the item that was dispensed. PSD can only see the prescription

A SCHEMATIC APPROACH

• Item name• Brand or maker (if applicable)• Formulation type (if applicable)• Strength or dimensions (if applicable)• Pack (if applicable)• Quantity

Item Name

• This is usually not an issue• Ensure that if the prescription is hand

written that it is legible• Also check the spelling of the item• If you need to substitute the product

completely, it is good practice to get the prescriber to initial the change if possible

Brand or maker

• The pricing computer can link the brand name to the non-proprietary identifier

• Brand names are needed for some modified release products e.g. Nifedipine

• Maker’s names are needed for some homeopathic products

• Manufacturer codes are essential for most medical devices apart from dressings

Formulation Type

• The formulation type is commonly omitted from hand-written prescriptions

• The computer will default to tablet over capsule unless more cost-effective

• Likewise, cream will be given precedence over ointment

• You can indicate if you have to change the formulation type

Strength

• Again this is commonly omitted from hand-written forms

• The computer will default to the most cost-effective, which is not always the lowest strength

• For dressings, make sure the size is there (and check that it is in part 2)

Pack

• For part 7, this is needed if more than one pack. The default is to the pack nearest to 100 units

• The standard form has a location in the right-hand column of four small boxes. This is for pack size only in units.

• ALWAYS USE A BLACK PEN• Always fill in the boxes from the left

Quantity

• This is mandatory for correct payment

• Computer will default to 5 days’ supply or the smallest unbreakable pack

• If you have to fill this in, get the prescriber to initial the quantity, or else the default will be taken

What else?

• If you have to obtain the item as a `special’, state the invoice price

• Out of pocket expenses (including post & packing, and expensive phone calls) will be paid, but provide evidence

• Measure & fit for hosiery & trusses• Additional paperwork for Oxygen• Any other pertinent data

SUMMARY

• PSD needs to know:

• WHAT DID YOU GIVE?

• WHAT QUANTITY DID YOU GIVE?

• WHAT DID YOU PAY?

BROKEN BULK

• This is an allowance to claim for a full pack of an item that you may not use again

• For example, if a new product comes in a pack of 100, but the prescription is for 30, you can claim the full pack

• If a second form comes in within 6 months, it is assumed that you have used the same pack

HOW TO LOSE MONEY

• It is very difficult to make more money than you are entitled to from dispensing

• It is relatively simple to lose money through poor communication

• (It is also worth noting that about 70% of endorsements are either unnecessary or unhelpful. A large proportion of these come from endorsing programmes.)

Items not paid

• Non-tariff appliances• Blacklisted lines• Vaccines from the childhood

immunisation programme

• Also check that an item is legible

– “Can’t read”…

Pack size errors

• Dressings are in single wrapped units. A box of ten dressings is counted as ten packs. PSD will not pick up this error

• Enteral feeds are often shrink-wrapped into fours or sixes. State what you gave in terms on unbreakable containers e.g. 24 x 200ml (not 6 x 4)

Other defaults

• Urinary catheters• Formulation type default• Strength default• Pack size default• Quantity default

Prescription charges

• Only applies to FP10s now

• PSD assumes that the charge is collected and deducts from payment

• If prescription declaration is incomplete, it assumes that a charge is collected

Sources of information

• PSD web-site has some advice on endorsing and general prescription handling

• Community Pharmacy Scotland also publishes advice, including recent errors and trends

• National Pharmaceutical Association will also highlight any real issues

• Most queries can be answered from the Drug Tariff on the web.