The drug tariff

Question 1

What is the purpose of the Drug Tariff?

Answer 1

1) Details the community pharmacy contract with the NHS.
Essential services-mandatory services provided as part of the NHS contract e.g. dispensing, receiving waste meds
2) Advanced services-nationally commissioned services e.g. MUR, NMS, SCS, AUR, FLU
3) Enhanced Services-now locally commissioned (Local Councils, NHS England, CCG)
4) A list of prices of drugs/ appliances and fees for pharmacies.
- Prices-Part VIII, IX,
- Fees- endorsements required for payments part II, III, XVI
5) Charges to the patient part XVI

Question 2

How community pharmacists are paid?

Answer 2

1) Establishment and Practice Payments- depends on number of items dispensed per month
2) IT and repeat dispensing payments
3) Fees-NHS payment to pharmacies for dispensing an item. 90p plus additional payments for other services provided
4) Advanced services payments MUR (£28/ up to 400 per year) NMS £20-28), AUR (£28-54) SCS (£4.32) flu (£9.14)
5) Enhanced Services payments reimbursement not in DT-locally commissioned and paid locally by councils, NHS England area team or CCG

Question 3

What is allowed on FP10 prescription?

Answer 3

1) ANY medicine, food, drink or medical cosmetic item as long as not in ‘The Black List’ part XVIIIA
2) EPS2 must be dm+d coded(NHS dictionary of medicines and devices)
3) Selected list scheme (SLS) items allowed only in certain circumstances part XVIIIB
4) only appliances, dressings and reagents in part IX-items must be of suitable quality for NHS use (DT/GPhC guidance, CE marked appliances)

Question 4

which items are black listed?

Answer 4

1) unnecessary
2) expensive
3) no medical use
4) duplication with other medical products

Question 5

outline who can prescribe what on FP10?

Answer 5

1) dentists : Can only prescribe products included in the Dental Prescribing Formulary
2) community nurse practitioner- Can only prescribe products included in the Nurse Prescribers’ Formular
independent and supplementary prescribers
3) new rules for physiotherapist and chiropodist/podiatrist
independent prescribers
4) Physiotherapist/podiatrist/optometrist independent prescribers cannot prescribe unlicensed medicines but can prescribe off label
5) Nurse/ pharmacist independent prescribers can prescribe any licensed or unlicensed medicines including all CDs.
6) Optometrist independent prescribers- prescribe for ocular conditions affecting the eye and surrounding tissue but no CDs schedule 2-5.

Question 6

what can Podiatrist independent prescribers prescribe?

Answer 6

any licensed medicine within their competence relevant to the treatment of disorders affecting the foot, ankle and associated structures, including the CDs: diazepam (oral), temazepam (oral), lorazepam (oral)), dihydrocodeine(oral).

Question 7

what can Physiotherapist independent prescribers prescribe?

Answer 7

prescribers- prescribe for any condition within their competence within the overarching framework of human movement, performance and function, including the CDs: temazepam (oral), lorazepam (oral), diazepam (oral), dihydrocodeine (oral), morphine (oral and injectable), fentanyl (transdermal) and oxycodone (oral).

Question 8

what % of patients are exempt from paying the prescription charge?

Answer 8

90% of patients are exempt

Question 9

how much does an item on prescription cost and what are the exceptions?

Answer 9

1) increased each April. England £8.40 in 2016
2) ONE charge per item
3) EXCEPT elastic hosiery, ONE charge per leg
different strengths/flavours of same item on same FP10 Rx, ONE charge
4) different formulations of the same item, one charge for each
4) combination packs- one charge per item in the same pack
5) contraceptive tablets or items-NO charge except for co-cyprindiol if not endorsed in body of Rx with OC or ♀

Question 10

how do you endorse a prescription?

Answer 10

1) State pack size if more than one type
2) State quantity supplied if defined by number of treatment days on Rx,
3) Brand name, pack size and price if not in part VIIIA
Careful with special containers
4) Additional fees also paid for:BB, OOP or XP
5) Not dispensed ND
6) Prescriber contacted PC
7) Prescriber not contacted PNC

Question 11

what do the following endorsement abbreviations stand for? what are the fees?

1) sp
2) ed
3) PD(n)
4) MF

Answer 11

1) Additional endorsements with fees;
2) Special SP(£20.00)
3) Extemporaneously dispensed ED (£20.00)
4) Supervised consumption PD(n) (£0.55 x n)
5) Measured and fitted MF (£2.60)

Question 12

if you get a prescription with a Missing drug strength, quantity or dosage and you are able to contact the prescriber how would you endorse it?

Answer 12

1) PC
2) Missing drug strength, quantity or dosage as specified by prescriber to be endorsed with pharmacist initials and date. Only to be used with schedule 2 or 3 CDs if the prescriber has specified the total quantity only in words or only in figures

Question 13

if you get a prescription for a drug with a Missing drug strength, quantity or dosage and you are unable to contact the prescriber how would you endorse it?

Answer 13

1) PNC
2) Missing drug strength, quantity or dosage where the prescriber cannot be contacted, the pharmacist may supply sufficient quantity to complete up to 5 days treatment (not for schedule 2 and 3 CDs)

Question 14

what is a special? ( Unlicensed Specials and Imported Medicines Part VIIIB)

Answer 14

An unlicensed medicine ordered on prescription for a named patient, produced by a specials manufacturer who is licensed and inspected by the MHRA (Certificate of Analysis (COA)or Certificate of Conformity (COC) must be supplied with the item)

Question 15

what is an unlicensed imported medicine? (Unlicensed Specials and Imported Medicines Part VIIIB)

Answer 15

a medicine unlicensed in the UK but licensed medicine elsewhere in the world, acquired by an MHRA licensed and inspected importer.

Question 16

how would you endorse a Unlicensed Specials and Imported Medicine?

Answer 16

1) DT states payment for commonly used specials and imported unlicensed medicines.
2) Describes how to endorse prescriptions for unlicensed medicines whether in part VIIIB or not.
3) On all unlicensed meds Rx, endorse:
- SP
- Quantity or volume supplied and pack size
4) If not in part VIIIB, add:
- Price per pack and number of packs
- manufacturer /importer license number (MS number),
- batch number (BN).
- Describes other requirements when supplying unlicensed medicines (legally required documentation)

Question 17

for all Unlicensed Specials and Imported Medicines Contractors keep records for 5 years and make records available for inspection by the Licensing Authority. what do these records contain?

Answer 17

1) The source of the special or imported unlicensed product
2) The person to whom and the date on which the special or imported unlicensed product was sold or supplied
3) The prescriber’s details
4) The quantity of each sale or supply
5) The batch number of the special

Question 18

how do you endorse Unlicensed Specials and Imported Medicines NOT in Part VIIIB

Answer 18

1) Endorse the Certificate of Analysis (COA)/ Certificate of Conformity (COC) or the invoice if COC/COA not available with: pharmacy stamp, date, initials of pharmacist or dispenser, invoice price less discount
prescriber’s details
3) At month end, the contractor must send a copy of the appropriately endorsed COA/COC/ invoice to the NHS England area team of the prescriber- remove patient details (name and address) for this purpose

Question 19

how would you endorse FP10MDA Supervised Consumption scripts?

Answer 19

1) FP10MDA only Endorse PD(n) (£0.55(n))
- (also paid methadone fee £2.50 and schedule 2 CD fee £1.28 per Rx-no endorsement needed)
2) packaged dose endorsement= total number of separately packaged doses - number of patient interactions

Question 20

how do you endorse Measured and Fitted MF items?

Answer 20

The following items receive a payment for measuring and fitting if claimed using MF in the endorsement margin

1) Elastic/ compression hosiery part IXA
2) Trusses part IXA
3) Para stomal garments (belts and girdles) part IXC where size is not* indicated in DT
4) BUT NOT LYMPHOEDEMA GARMENTS!

Question 21

what are Elastic / compression hosiery / stockings and what are they used for?

Answer 21

1) Compression stockings - elastic leg garments which compress the limb, reducing the diameter of distended veins and cause an increase in venous blood flow velocity /valve effectiveness.
2) Compression therapy helps decrease venous pressure, prevents venous stasis, relieves heavy and aching legs, prevents the formation of blood clots in the lower legs, and aids the treatment of lower leg ulcers.

Question 22

what time during the day should you measure the legs for stockings.

Answer 22

Measure early morning whilst sitting for BK, standing for TL

Question 23

how would you endorse items in Part IXA Appliances?

Answer 23

1) NO BB allowed
2) No OOP (Out-of-pocket costs) expenses allowed
3) Elastic (compression) hosiery (legs only)-
- FP10 details : quantity, compression class (I, II or III), type- ‘made to measure’ if appropriate
- Tights/ anti-embolism stockings (TEDS) disallowed.
- Endorse with quantity, type, fabric/knit
- MF if appropriate
- Charges to patient per leg (£8.20 x number of articles)
4) Lymphoedema Garments (different parts of the body)
- FP10 details : quantity, size, length, type.
- Codes needed for certain brands if made to measure
- MF endorsement disallowed.
- Charge to patient per TYPE of item (£8.20 x items)

Question 24

what are trusses used for?

Answer 24

1) a framework, typically consisting of rafters, posts, and struts, supporting a roof, bridge, or other structure
2) a surgical appliance worn to support a hernia, typically a padded belt.

Question 25

how would you endorse Part IXA Appliances?

Answer 25

1) NO BB allowed
2) No OOP expenses allowed
3) Urinary Catheters -Should be in part IXB!
- FP10 details needed: quantity, size (Ch) and balloon size, preferably brand. male/female.
- Wipes and bags.
- Black heart symbol? ♥
4) Dressings-
- FP10 details needed: name or specification, size, quantity.
- Careful with 1 op-1 dressing or one pack?

Question 26

what items are found in Part IXB and IXC of the drug tariff? what are the charges associated with these items

Answer 26

1) Part IXB-Devices to manage urinary incontinence (not catheters!)
2) Part IXC-Devices to manage colostomy, ileostomy and urostomy post-surgery.
3) All items get a £3.40 fee for home delivery (no endorsement needed).
4) Many items have to be supplied with bags and wipes.

Question 27

what types of items are found in Part IXR – Chemical Reagents and what are they used for?

Answer 27

1) Mostly strips for detection of glucose/ketones in blood for diabetics.
2) A few urine test strips
3) INR test strips for warfarin patients.
4) All ‘Special Containers’.
5) Not allowed: ovulation and pregnancy tests, multiple test strips e.g. Multistix (for UTI, diabetes, kidney function)

Question 28

what type of prescriptions are placed in red separators?

Answer 28

expensive items, specials and unlicensed imports, items with broken bulk or out of pocket expense claims, hand written amendments, where the prescribers’ signature encroaches over an item on the prescription

Question 29

what information does the drug tariff provide?

Answer 29

1) NHS community pharmacy contract and payments by the NHS to pharmacy
2) How to claim for payment
3) What payments patients must make
4) What is allowed on the NHS
5) Who can prescribe what