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Pharmaceutical Services Negotiating Committee

Reimbursement Arrangements for Appliances

bottle tabletsOnly appliances and reagents listed in Part IX of the Drug Tariff can be prescribed on NHS prescriptions. Pharmacy contractors are reimbursed for appliances pro-rata based on the Drug Tariff price for the listed pack size dispensed.

In this section of the site you'll be able to find out more information on:


Setting and Amending Reimbursement Prices for Appliances

Appliance manufacturers are required to apply to the NHSBSA to request that a particular appliance is added to Part IX of the Drug Tariff. In deciding whether to list a product, consideration is given to whether the product is safe and of good quality, whether it is appropriate for prescribing on the NHS and whether it is cost effective. The price of the product is set following negotiations between the manufacturer and the NHSBSA.

Once a product has been listed, there is an agreed mechanism for the Drug Tariff reimbursement price to change. For products listed by brand or manufacturer’s name, the supplier may seek an optional price rise once a year which is capped at the forecast of the gross domestic product (GDP) deflator minus 0.75 percent. Suppliers can also apply for decreases to the reimbursement price for their products at any time. Where a manufacturer asks to withdraw their appliance from Part IX, for example because it has been discontinued, three months notice of deletion is provided in the Drug Tariff.

The reimbursement price of appliances with a generic listing in the Drug Tariff automatically increases every June by the forecast of the GDP deflator minus 0.75 percent.


Reimbursement for Incomplete Prescriptions

No size specified?

If a prescriber has not specified the size of an appliance or dressing, payment will be based on the endorsed size. For example, if a prescription is received for ‘Melolin Dressings’ and the size isn’t specified, the contractor should clarify with the prescriber which of the Drug Tariff pack sizes should be dispensed. Reimbursement will be based on the contractor’s endorsement.

If there is no endorsement, the contractor will be reimbursed based on the smallest size of the product listed in the Drug Tariff, therefore in this example, if there was no endorsement, payment would be based on the 5cm x 5cm size of Melolin.

No Type Specified?

If the prescriber has not specified the type of the appliance required and there is more than one type listed in Part IX of the Drug Tariff, the contractor should again clarify with the prescriber which of the listed product should be dispensed. Reimbursement will be based on the contractor’s endorsement.

Sealed Packs

All Catheters listed in Part IXA of the Drug Tariff are considered to be 'Sealed Packets' (Drug Tariff Part IX Note 2). Products recognised as 'sealed packets' are treated in exactly the same way as special containers.

When less than a complete pack of catheters is requested, NHSBSA Prescription Services will base payment on the nearest complete pack or combination of packs. If the quantity ordered falls exactly halfway between two complete packs, the contractor should round down and will be reimbursed accordingly.

Related Expenses

Out of pocket expenses and broken bulk cannot be claimed for items in part IXA and IXR of the Drug Tariff but can be claimed for items listed in Part IXB and IXC.

Product Specific Issues

Click on the link below to view product related guidance on particular products:

Product Related Guidance: Appliances

For information on whether a particular appliance can be dispensed, please contact the PSNC Information Team.


Ongoing Review of Appliance Reimbursement

The Department of Health consulted on the reimbursement arrangements for appliances in 2005. A second consultation was published in May 2006 on the arrangements for dressings and reagents with price decreases made in October 2006. More information is available in the National Contract Funding Section of the site.


Appliances with Non Reimbursable Carriage Charges

A number of appliances in Part IXA of the Drug Tariff cannot be obtained without handling charges or charges linked to the carriage of products. Pharmacy contractors will not be reimbursed for Out of Pocket Expenses incurred when items in Part IXA and IXR of the Drug Tariff are dispensed.

 NHS pharmacy contractors are not contractually obliged to supply appliances that would not normally be supplied in the course of their business. Therefore if a contractor is faced with making a financial loss through dispensing an appliance, they may choose not to dispense it.

 PSNC strongly believes that changes should be made to the reimbursement arrangements to allow contractors to claim out of pocket expenses for items in Part IXA and IXR of the Drug Tariff. Or as an alternative solution, the Drug Tariff reimbursement prices for these products should be set in such a way that reflects the distribution costs.


FAQ: I Can't Obtain a Part IXA Appliance without a Carriage Charge?

Where a Part IXA appliance is not available from your normal wholesalers without additional charges, it is worth contacting the manufacturer and finding out who they supply to and whether it is possible to obtain the product directly without charge.

 In order to list a product in the Drug Tariff, manufacturers must declare that their product "will be readily available to dispensing contractors either through the normal wholesale network or on equivalent terms" so if a product is unavailable without additional charges from either the manufacturer or the wholesale network, the manufacturer may not be meeting the requirements for their product to remain listed in the Tariff. Please report any products in this scenario to the PSNC Information Team (0203 1220 810) who will escalate this to NHS Prescription Services. For convenience, you can now report these issues on our new appliance supply issues form.

 Whilst a problem is being looked into, as it can take some time, it may be worth talking to the PCT as we are aware that in some areas, to ensure patient access to affected appliances, PCTs have agreed to make discretionary payments to cover the difference between the costs incurred in obtaining a particular appliance and the reimbursement.

 Another alternative is to discuss the problem with the prescriber and consider requesting a new prescription for an equivalent product which is available without additional charges.

As a last resort, NHS pharmacy contractors are not contractually obliged to supply appliances that would not normally be supplied in the course of their business. Therefore if a contractor is faced with making a financial loss through dispensing an appliance, they may choose not to dispense it.

 

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