NHSBSA Prescription Services.

Transcription

1 NHSBSA Prescription Services

2 History of NHS Prescription Services There has been a prescription pricing function since at least 1911 We ve gone through a number of different identities over the years, but since 2008 we ve been called NHS Prescription Services We handle all the processing work for English dispensing contractors from three regional offices; Middlebrook (Bolton), Newcastle and Wakefield We are part of the NHS Business Services Authority (NHSBSA)

3 NHS Business Services Authority The NHSBSA s services include: helping patients pay for their health costs providing EHIC cards calculating reimbursement and remuneration to dispensing contractors and NHS dentists providing prescribing and dispensing information to the NHS assessing bursary claims from healthcare and social care students preventing and investigating fraud, and protecting NHS staff administering pensions for NHS staff

4 Our processing volumes The NHS spends 9.4 billion* a year on prescription drugs in primary care in England. We process over 1.1 billion* prescription items from over 11,500 contractors in England including pharmacy contractors, dispensing doctors and appliance contractors. The amount of prescriptions we process increases every year by around 5%. * based on the Prescription Cost Analysis report 2016

5 How we process your work The way we process your work has changed considerably over the years In 2007 we redesigned our systems to make better use of technology and make sure that our systems would be able to accept electronic prescriptions We now use scanners and intelligent character recognition software (ICR) to read a lot of the information we need to calculate payments. The ICR can t read handwritten prescriptions so we still need to use staff to key this information in Our NE office has approx. 450 staff

6 How we process your prescriptions Regardless of the systems we use to process this work, we follow the rules set out in the NHS England and Wales Drug Tariff As the rules can be very complex, we have staff to verify more complicated items and information that ICR is not confident about. This might include: charge status prescriber numbers confirming the manufacturer/supplier of an item

7 Endorsements in EPS Release 2 All endorsements must be made electronically All prescriber endorsements (SLS, ACBS, AF and CC) must be in the prescriber endorsement field of the prescription message All dispenser endorsements must be in the dispenser endorsement field of the electronic claim message must always be user initiated and never automatic it may be appropriate for a dispensing system to prompt the user if a price endorsement or supplier is required Some EPS endorsements are just a code selected from a drop down menu e.g. BB, SP, ED, MF Others are a code plus an associated additional field e.g. IP, XP, NCSO

8 EPS dispensing endorsement codes that require additional supporting information IP - Invoice Price Allows you to endorse the price, pack size, supplier/brand. In addition for Non Part VIIIB specials and imports also the specials/importers licence number and batch number [IP] [ , 100ml, Specials Ltd, ML12345, BN ] Remember It must be the price per pack size and not the price for the total quantity dispensed It must be the pack size used for dispensing the system must not default to the special order pack size of 1 e.g. 1ml, 1gram, 1 tablet For specials and imports it must be the invoice price per pack size from which the product was supplied less discount/rebates

9 EPS dispensing endorsements that require additional supporting information XP - Out of Pocket Expenses Allows you to endorse the amount you are claiming and give full particulars of the claim [XP] [postage and packing, 3.75] NCSO - No Cheaper Stock Obtainable Allows you to input your initials, date, supplier and pack size. [NCSO] [KF, , Teva, 28 tablets] Remember if there is no price in dm+d then we ll need an Invoice Price (IP) endorsement as well as a NCSO

10 EPS dispensing endorsements that only require a code BB - Broken Bulk When it is applicable and you need to claim broken bulk make sure you add the BB endorsement [BB] We also need the pack size so remember to return the actual pack you dispensed as that is where we get the pack size SP Unlicensed medicine When it is applicable and you need to claim an additional fee for an unlicensed medicine manufactured under a MHRA special license or sourced under a MHRA importers licence [SP]

11 EPS dispensing endorsements that only require a code ED Unlicensed medicine When it is applicable and you need to claim an additional fee for an unlicensed medicine prepared under the Section 10 exemption from the Medicines Act 1968 [ED] MF Measured and Fitted When it is applicable and you need to claim an additional fee for some appliances requiring measurement and specified in Drug Tariff Part IIIA/B [MF]

12 Common problems Referred Backs or RBs EPS Release 2 prescriptions are referred back to the contractor for missing information far less than paper FP10s The most common reason is no price find out from your system supplier how you can identify products in dm+d with no price so that you can endorse an IP with price, pack size and supplier Sometimes it is when a generic product is prescribed and insufficient information about the dispensed product is supplied to NHS Prescription Services Remember in this situation, in order to reimburse you, we need to know the brand, manufacturer or wholesaler. So please return information about the actual dispensed product supplied. This will allow us to identify the supplier. If the product you want to dispense is not in dm+d then use the invoice price (IP) endorsement to give us the details of price, pack size and supplier.

13 What happens if it isn t clear what the pharmacist has dispensed? The prescription should be endorsed with the quantity and the pack size dispensed, and if the prescription has been issued generically, also endorse the brand name or the name of the supplier. If the NHS-listed reimbursement price is not on CDR, the prescription must be endorsed with the pack size and the total net price for that pack before discount and ex VAT. If the price paid is not clear, the prescription details must be returned for clarification. When a prescription is returned, it is called a Referred back and is coded with a reason.

14 Out of Pocket Expenses (OOPE) A payment can be claimed in exceptional circumstances when out of pocket expenses have been incurred in obtaining a drug, appliance or chemical reagent other than those in Part VIIIA (categories A and M), Part VIIIB, Part IXA, Part IXR (chemical reagents) See Part II (clause 12 for full details) Eligible for OOPE Part VIIIA Category C Readily available medicinal products outside of Part VIIIA (including ACBS) Part IXB Part IXC Not eligible for OOPE Part VIIIA Category A and M All unlicensed specials and imports* Part IXA Part IXR

15 What is a Special Specials are unlicensed medicinal products manufactured in the UK for human use which have been specially prepared to meet a prescription ordered for individual patients without the need for the manufacturer to hold a marketing authorisation for the medicinal product concerned Part VIIIB of the Drug Tariff lists high volume and high cost unlicensed specials and imports, with set reimbursement prices. The prices are set by the DH and the list is updated every 3 months. There are special requirements that Pharmacies must adhere to when submitting prescriptions for specials that are not listed in Part VIIIB.

16 What happens when a non-part VIIIB special is claimed for? For unlicensed specials or imports not listed in Part VIIIB, the pharmacy must stamp, date, initial and endorse the Certificate of Analysis (CoA)/ Certificate of Conformity (CoC) with the invoice price and prescriber s details. At the end of the month, the pharmacy must then send a copy of the CoA/CoC to the NHS England Area Team of the prescriber along with the prescriber s details. The Drug Tariff states that for imported unlicensed products not listed in Part VIIIB, where a CoA/CoC is not available, the contractor must stamp, date, initial and endorse the invoice with the invoice price less discount (where not clearly detailed by the supplier) and the prescriber s details. At the end of each month, the contractor shall send a copy of the appropriately endorsed CoA/CoC/invoice to the NHS England Area Team of the prescriber, allowing the Area Team to match expenditure to the special supplied.

17 NHS Prescription Services Open Days Held monthly at processing sites on a rota basis. Each site hosts an open day every quarter Visit the web site for more information or to book a place Hints and Tips published quarterly again visit website to subscribe Contact centre number

18 NHSBSA Digitisation Programme

19 Manage Your Service Contact Us- Dashboard

20 Help With Health Costs Although most NHS treatment is free, there are some costs people might need to pay. The NHSBSA administer applications and certificates for the majority of prescription exemption reasons under the banner of Help with Health Costs. Maternity exemption certificates Medical exemption certificates Prescription Prepayment certificates HC2/HC3 certificates Tax Credit exemption certificates

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24 Eligibility Checker This is also available via GOV.UK by using as can sometimes be easier to find

25 Questions?