By the dispensing and supply team at the Pharmaceutical Services Negotiating Committee (PSNC)
17 Aug 2018
The dispensing and supply team at the Pharmaceutical Services Negotiating Committee (PSNC) reveal the most common endorsing errors and why prescriptions are sent back to pharmacy teams for further endorsements
Top five referred back (RB) codes for March 2018 – electronic prescription service (EPS) vs paper
Combined total of RB prescriptions = 99,374 (ie 0.11% of all prescriptions submitted in March 2018)
PSNC TOP TIPS: General Endorsing
Endorse only as needed – don’t over endorse as this can cause confusion and lead to incorrect reimbursement.
Double check prescription endorsements, checking for:
Any item with a net ingredient cost of £100 or more is considered an expensive item. Expensive items automatically receive an expensive item fee of 2% of the prescription value. No endorsement is required for an expensive item, but PSNC recommends pharmacy teams do the following:
If you have a prescription for an unlicensed special or import, check whether it is listed in Part VIIIB of the drug tariff. This will help you to determine what you need to endorse – different rules apply for listed and unlisted specials.
Part VIIIB-listed unlicensed specials/Imports
Please note – Remuneration is based on the list price for the minimum listed quantity with price per unit for any additional quantity.
Non-Part VIIIB Unlicensed specials/Imports
Submit paper prescriptions in the red separator (EPS prescriptions are paid automatically, and tokens do not need to be separated)
Unlicensed Specials and Special Obtains: What is the difference?
Special obtains are items that the wholesaler does not stock as a standard line – meaning they have to order the product on an ad hoc basis. This can be any product: a medicine, appliance or a special. Therefore, do not assume that all special obtain items are unlicensed specials or imported lines.
Unlicensed specials made to order will come with a specials manufacturer number, which can be found on the Certificate of Conformity/Certificate of Analysis (COC/COA). Imports will have an importer’s licence number on the accompanying paperwork, while extemporaneously made items will usually have been made up in the pharmacy.
It is important to double check the classification of the product you are ordering, as an incorrect endorsement, could mean you will miss out on the relevant fees – OOP/XP for Special obtains and SP for Unlicensed specials/Imports.
PSNC TOP TIP: How can you check the classification of a product?
A good resource for checking whether a product is an unlicensed special is the Dictionary of Medicines and Medical Devices. Here you can find out whether a product is Drug Tariff listed Special, a non-Drug Tariff Special or an import.
Broken Bulk (BB)
Out of pocket Expenses (OOP or XP for EPS release 2)
If the prescriber has not stated ‘Assorted Flavours’, ‘Various Flavours’ or ‘Mixed Flavours’ or similar on the prescription, only one professional fee will be paid regardless of the number of flavours that have been dispensed and endorsed by the pharmacy. A pharmacy can claim one professional fee for each separate flavour dispensed and endorsed against a prescription stating, ‘mixed flavours’, or similar on the prescription.
One common misconception is that you can claim additional fees for supplying multiple flavours when a prescription states ‘flavour not specified’. In fact, you can only claim for single flavour – additional fees for supplying multiple flavours are only payable if this is specified on the prescription, e.g. ‘assorted flavours’ or ‘multiple flavours’.
Where a prescriber does not specify the flavour, to allow the patient or pharmacist to choose instead, they should prescribe the ‘Flavour Not Specified’ actual medicinal product (AMP). If the prescriber does not tick the ‘AF’ box you can only claim for a single flavour
Where the prescriber adds an AF endorsement in the prescriber endorsement field you will receive a dispensing fee for each flavour supplied. Where ‘AF’ is selected by the prescriber, the pharmacy should select the actual medicinal product pack (AMPP) for each specific flavour dispensed along with the quantity dispensed for that flavour.
If the prescriber does not endorse AF, you can still dispense different flavours but will only receive one fee.
Common errors leading to pricing issues
PSNC TOP TIPS: How to Prevent Prescriptions from Being Switched
Switching occurs for two main reasons:
Exemption and charge declarations must be completed in full to avoid prescriptions being switched between chargeable and non-chargeable. Signed and completed declarations are required on all prescription unless the patient is age exempt and their date of birth is computer generated on the prescription.
Prescriptions switched from exempt to paid can have serious financial consequences for pharmacy contractors as a prescription charge is deducted for each item (except for free-of-charge contraceptives) on the switched prescription.
For exempt paper prescriptions ensure that:
For paid paper prescriptions ensure that:
If evidence is not provided to the staff by the patient, ensure that you place an X in “Evidence not Seen” box.
Remember – Exemptions or charge declarations are recognized from the electronic message. Tokens are used for audit purposes only
PSNC TOP TIP: End of day endorsing checks
Separate any prescriptions to be filed in the red separator, such as;
Keep a separate log of expensive items and out of pocket expenses claimed for reconciliation checks
Make sure all prescriptions are filed in the correct patient charge group – i.e. exempt, paid, old rate paid. Incorrectly filed prescriptions are a major cause of over payments.
Do not use labels/sticky notes on prescriptions as residual glue can affect the scanning process. Pins, staples, paper clips, labels and invoices should be removed prior to submission.
Regularly monitor EPS owings and claim as soon as practical – especially those nearing the 180-day expiry.
Send claim messages for EPS prescription throughout the month – ensuring EPS claim messages are sent before the 180th day after the final dispense notification was sent.
Prescription switching: psnc.org.uk/switching
Endorsement guidance: psnc.org.uk/endorse
PSNC Endorsing Good Practice Guidance webinar: psnc.org.uk/endorsingwebinar