The Drug Tariff

Question 1

Outline what community pharmacy staff use the drug tariff to check (6)

Answer 1

1) the rules to follow when dispensing
2) the fees and allowances that will be paid
3) the drug and appliance prices
4) what is allowed and what is not allowed on NHS scripts
5) payment for essential services of NHS contract
6) payments and service details for advanced services (MUR/NMS/AUR/SCS)

Question 1

How many sections is the drug tariff made up of?

Answer 1

20 sections denoted by Roman numerals (not all sections used by community pharmacists)

Question 2

What is the drug tariff (4)

Answer 2

1) monthly publication by NHS business services authority (NHSBSA) sent free to every pharmacy/ GP who requests one
2) one addition for England and Wales, one for Scotland
3) it is a list of prices of drugs and fees for pharmacists and much more
4) contains details of the community pharmacy contract with the NHS

Question 4

List what is updated monthly in the drug tariff (3)

Answer 4

1) new and discontinued products or categories
2) new prices
3) rules relating to payment of fees may change

Changes are listed in the preface at the beginning - pharmaceutical negotiating committee (PSNC) negotiates these amendments

Question 5

Explain the prescription forms used in England and outline who can issue them. (5)

Answer 5

1) FP10 green- GP, Nurse, pharmacist, optometrist prescribers, independent, supplementary prescribers
2) FP10MDA blue bifold- GP, independent/ supplementary prescribers, hospitals for drug misuse patients ( mainly methadone/ Buprenorphine)
3) FP10D yellow - dentists
4) FP10P purple - nurse, pharmacist, optometrist prescribers
5) FP10PCD pink - private prescribers for CDs

• an NHS prescription is a prescribers order for medicine/ food/ appliances/ reagents. What is allowed on this order form requires knowledge of the drug tariff
• it is also an invoice for payment by the NHS . Processing this invoice correctly requires knowledge of the drug tariff

Question 6

Part XVII- formularies for certain prescribers on FP10 prescriptions is the section mainly used by community pharmacists. Outline what part XVIIA - dental prescribing formulary contains (4)

Answer 6

1) lists the substances permitted on the form FP10D
2) not all strengths and formulations allowed
3) generic list but equivalent brands can be ordered on FP10D and will be paid for
4) hospital dentists issuing FP10 prescriptions are not restricted to the dental prescribing formulary

Question 7

Explain what can be found in part XVIIBi - nurses prescribers formulary (4)

Answer 7

1) for community nurse practitioners FP10P lilac
2) medicines for minor ailments e.g treatment for constipation/ emollients for eczema
3) mostly P/GSL medicines , limited quantity of painkillers
4) all appliances in drug tariff stoma care, incontinence appliances and solutions, wound management etc

Question 7

What is the current prescription charge for patients in the UK?

Answer 7

1) £8.20

Approx - 90% of patients do not pay charges (exempt)

Question 8

Outline what can be found in part XVIIBii- nurse, pharmacist & optometrist independent prescribing (3)

Answer 8

1) pharmacists/ nurse independent/ prescribers can prescribe all medicines inc CDs if within their experience and competence
2) optometrist independent prescribers- only for treatments of eye/surrounding tissue : cannot prescribe unlicensed medicines or CDs
3) supplementary prescribers can only prescribe within their competence and as agreed by the Patient And the doctor or dentist as part of a patients clinical management plan

Question 9

How much does the NHS pay pharmacies for dispensing an item?

Answer 9

90p per item plus additional payments for certain other services that pharmacists provide

Question 11

Explain how you decide the prescription fee and charge for the following:

1) medicines and appliances
2) elastic hosiery
3) different strength and flavours of the same item
4) different formulations of the same item
5) combination packs
6) contraceptive tablets

Answer 11

1) for medicines and appliances ONE charge and ONE fee per item even if there are many of them. (E.g 100 tablets or 4 dressings)
2) EXCEPT for elastic hosiery , ONE charge per leg e.g 2 pairs of tight length stockings = 4 charges but 1 fee
3) if different strength/ flavours of the same item on the same FP10 form , one charge . E.g warfarin 1mg and 5mg tablets ( 1 charge, 2 fees , one no charge item (1NC))
4) if different formulations of the same item, a charge for each e.g prednisolone E.C 5mg tabs and prednisolone 5mg tabs (2 charges, 2 fees)
5) combination packs - if more than one item in a pack , more than one charge e.g can eaten oral and cream duo pack
6) contraceptive tablets - NO charge, but number of fees depends on tablets e.g logynon 3 tablet types (no charge, 3 fees)

Question 12

Describe what is allowed on an NHS prescription (6)

Answer 12

1) any medicine, food, drink or medicinal cosmetic item is allowed as long as it is not blacklisted
2) except for a small list of items allowed only in special circumstances (SLS- must be written by the prescriber or else the prescription is disallowed)
3) only appliances, dressings and reagents listed in the drug tariff part IX
4) items must be suitable quality for NHS use (GPhC define this -CE marked appliances)
5) certain prescribers can only prescribe certain items
6) if in doubt call prescription services

Question 13

Part VIIIA contains basic prices of licensed drugs. The drugs are divided into 3 categories ( A,C,M) outline which drugs can be found in each of these categories (3)

Answer 13

1) category A - popular generics which are widely available. Price is based on a weighted average of the list prices from 2 wholesalers and 2 generic manufacturers
2) category C- list of drugs not usually available as generic, and items are based on a particular brand or manufacturer
3) category M- drugs which are readily available where the reimbursement is calculated by the DoH based on information submitted by manufacturers- amended to give pharmacists a reasonable income. PSNC negotiates this deal.
- not all licensed medicines are listed in the DT

Question 14

what do the following symbols mean in the drug tariff:

1) ●
2) ▄
3) §
4) ▼

Answer 14

1 ● - items requiring reconstitution (will be paid for nearest whole pack necessary to cover the quantity required - endorse pack size supplied)
2 ▄ - special container (not practical to split an original pack e.g sterile drug, give nearest quantity possible and endorse the pack size)
3) § -Selected List Scheme (SLS)
4)▼ - newly licensed medicines that require additional monitoring by European Medicines Agency.

Question 15

Outline what special containers in the drug tariff are (6)

Answer 15

Where the quantity prescribed dose not coincide with that if an original pack and the drug or reagent is:

1) sterile
2) effervescent or hydroscopic
3) packed in an aerosol, tube, roll on bottle, spray, sachet, or other container where it it not practical to dispense the exact quantity
4) liquids for addition to bathwater
5) coal tar preparations
6) viscous external preparations

Question 16

Explain what borderline substances are (4)

Answer 16

1) a list of toiletry preparations which can be prescribed on NHS prescriptions e.g genius gluten free bread
2) advisory committee on borderline substances (ACBS) advises in what medical conditions these items may be regarded as drugs ordered on NHS prescriptions as “borderline substances”
3) list A is an alphabetical index of the products and list B is an alphabetical index of conditions and those products suitable for the conditions
4) ACBS must be written on the Rx by the prescriber - pharmacists can’t write it

Question 17

Outline what broken bulk is (4)

Answer 17

1) payment for complete pack if only part of it was dispensed
2) can be any drug except unlicensed specials/imports and category A or M only if the smallest pack is less than £50. Can claim for appliances part IXB and IXC but not IXA
3) can be claimed if it is unlikely the same product will be dispensed again within the next 6 months. If dispensed again within 6 months, payment for the drug cost will be adjusted to take off the first dispensing
4) must endorse the Rx with “BB” and pack size supplied.

Question 17

What do you write on the prescription if you decide not to dispense an item?

Answer 17

Cross the medicine out and write ND next to it in the endorsement column

Question 18

What are Out of pocket expenses “OOP” or “XP” (3)

Answer 18

1) Out of pocket expenses are charges included when obtaining a dispensed item ( mostly postage and packaging)
2) item cannot be any special or imported product and is not included in part VIIIA category A or M , part IXA or IXR of drug tariff
3) each Rx must be endorsed “OOP” or “XP” plus the cost of expenses claimed ( more than 50p)

Question 20

Outline how you endorse (5)

Answer 20

1) no need to endorse if in part VIIIA and only one pack size
2) endorse with quantity used if the Rx is written as number of treatment days
3) on a generically written Rx for items not listed in part VIIIA, endorse the brand name, pack size and price.
4) by endorsing, your are claiming relevant fees due e.g. BB, OOP and confirming exactly: what was supplied ( size, quantity , product type, brand) . Pack size If more than one available.
5) if in doubt endorse

Question 21

Describe the end of month procedure for prescriptions (6)

Answer 21

• for paper prescriptions, claims for payment are made monthly by sending the Rx (invoices) to the NHS BSA for pricing.
• red separators include any Rx with:
  1) items where prescribers have made a handwritten adjustment to the printed text
  2) prescriptions where the prescribers signature is near the text of the last item on the Rx
  3) broken bulk
  4) out of pocket expenses
  5) expensive items over £100
  6) specials