PSNC’s top tips for prescription endorsing

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

66% of all RBs were in paper
Twofold difference in errors between paper and EPS RBs

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:

Expensive items

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:

flag the item in some way during the dispensing process
file the prescription separately at the end of the day
submit paper prescriptions in the red separator (EPS prescriptions are paid automatically)
keep a log of all expensive items for reconciliation with the FP34 Schedule of Payment for that dispensing month.

Unlicensed specials/Imports

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

Endorse:

quantity dispensed (where different from quantity prescribed);
the letters ‘SP’ for the £20 sourcing fee.

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

Endorse:

Amount dispensed over pack size used;
Invoice price per pack size from which the order was supplied less any discount or rebate;
Manufacturers’/ importers’ MHRA license number;
Batch number of the product supplied;
‘SP’ for the £20 sourcing fee.

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)

Endorse the letters BB and the amount dispensed over the pack size used;
Place paper prescriptions in the red separator for submission.

Out of pocket Expenses (OOP or XP for EPS release 2)

Clearly endorse the letters OOP or XP (EPS R2) - no other variation is allowed;
Endorse the amount being claimed and a brief reason for the claim e.g. P&P;
Place paper prescriptions in the red separator for submission.

Out of pocket expenses cannot be claimed on Part IXA listed Appliances including catheters, dressings, elastic hosiery etc

Multiple flavours

Paper Prescriptions

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’.

EPS Prescriptions

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

Endorse clearly keeping all endorsements within the left-hand side margin of the prescription form
Make sure endorsements are complete and legible
Dispensing endorsements should line up correctly against each prescribed item
If your PMR system endorses, ensure the printer ink is clearly visible
Avoid any marks in the prescribing area of the such as ticks as this may affect how the prescription is priced.
Quantities owing should not be annotated on the prescription, this could be interpreted as the amount dispensed
Pharmacy stamp must not obscure any patient details such as date of birth, prescribed items, or endorsements.
Items not dispensed must be endorsed ‘ND’ and a horizontal line drawn through the item not dispensed.
Ensure that on EPS prescriptions any supplementary product information e.g. a particular brand or manufacturer is included as part of the prescribed product and NOT the dosage instructions, to ensure this is considered when calculating payment.
Endorsements on tokens will not be seen or used for reimbursement. Reimbursement is based solely on the electronically submitted claim message.

PSNC TOP TIPS: How to Prevent Prescriptions from Being Switched

Switching occurs for two main reasons:

A prescription is incorrectly filed in the wrong bundle before submission
The exemption declaration on the reverse of a prescription is incorrectly completed by the patient or their representative

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.

Paper prescriptions

For exempt paper prescriptions ensure that:

The correct exemption box in Part 1 is clearly marked with a cross or tick - a faint tick or cross may not be easily detected by the prescription scanners or operators;
No markings are present in the ‘amount paid’ box in Part 2
A signature is present in Part 3; a pharmacy stamp is NOT acceptable as a signature

For paid paper prescriptions ensure that:

The ‘amount paid’ box in Part 2 is completed correctly
A signature is present in Part 3. (ensure each prescription is signed when a patient has multiple prescriptions)

If evidence is not provided to the staff by the patient, ensure that you place an X in “Evidence not Seen” box.

EPS prescriptions

You must ensure that the paid/exempt field is completed prior to sending the claim message
Some PMR systems will prompt you to complete the paid/exempt field before sending claim messages however, others may default to ‘Paid’
Pharmacy teams should regularly check a patient’s exemption status and update the PMR system accordingly

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;

expensive items (individual items with a net ingredient cost of £100 or more);
hand written amendments/alterations by the prescriber;
unlicensed medicines/imports;
BB or OOP claims;
prescription forms containing items where the prescriber has provided additional information e.g. preservative-free or sugar-free within the dosage instructions;
where the prescribers signature touches or goes over the details of the last item on the prescription form.

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 180^th day after the final dispense notification was sent.

PSNC resources

Prescription switching: psnc.org.uk/switching

Endorsement guidance: psnc.org.uk/endorse

PSNC Endorsing Good Practice Guidance webinar: psnc.org.uk/endorsingwebinar