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Pharmaceutical Services Negotiating Committee

Returns

Approximately 0.25 - 0.3% of prescriptions are returned to contractors each month for clarification. Whilst the majority of these forms are returned because the endorsement was insufficient, forms can also be returned in error. 

PSNC closely monitors problems with copies of prescriptions being returned for clarification unnecessarily. Please report suspected unnecessary returns to the PSNC Information Team (0203 1220 810).

PSNC will ensure that this information is fed back to NHS Prescription Services so that solutions, for example further training of staff can be adopted where possible. Alternatively, contractors can also contact the NHS Prescription Services Help Desk directly to report and discuss returns (0300 330 1349).

Known Issues include:

Different Terminology on Prescription vs Pricing System

At present, GP systems use different drug databases in their systems. In practice, this means that different systems can use slightly different descriptions for the same product. The NHS Dictionary of Medicines and Devices (dm+d) has been developed as the future standard for medicines and device identification and in EPS Release 2, all GP system suppliers will issue electronic prescriptions using the same standard dm+d descriptions.

NHS Prescription Services' pricing system and staff use the product descriptions held in dm+d and the staff refer to the dictionary for product information.  One reason for returns is the use of non-standard or synonymous formulation descriptions on prescriptions.

Same Brand Marketed by Multiple Suppliers

There are a number of cases where products with the same marketing authorisation number and brand name are marketed by a number of different suppliers, for example Dianette Tablets are manufactured by Bayer Plc and is supplied to Mylan under third party livery. A prescriber may issue a branded prescription for Dianette Tablets and a pharmacist will have the flexibility to dispense either supplier's product. As the reimbursement price of a branded drug is based on the manufacturer's list price, reimbursement prices for these brands may differ depending on the manufacturer supplied.

Under the legacy processing procedures, if a prescription was not endorsed to indicate supplier, NHS Prescription Services would default to the reimbursement price for the originator supplier's product. The CIP system no longer defaults to a particular supplier's product so the name of the supplier must be endorsed to ensure that copies of prescriptions aren't returned for clarification. Please click here to download a list of products known to be affected.

The Department of Health have confirmed that if after being returned to the contractor, the script is re-submitted without the required endorsement, reimbursement will be made based on Part II clause 7C of the Drug Tariff, whereby the Secretary of State for Health will determine the price paid. This will be the lowest price that can be paid for that particular brand.

Generic prescriptions for Inhalers which include a Trademarked Name 

Particular problems are being experienced with generic prescriptions for inhalers where the prescriber has included a trademarked name to describe the type of inhaler required, for example:

  • Accuhaler is a registered trademark owned by GSK 
  • Easi-breathe is a registered trademark owned by TEVA
  • Turbohaler is a registered trademark owned by AstraZeneca 
  • Twisthaler is a registered trademark of Schering-Plough

If a generic prescription for an inhaler is received which includes one of these trade-marked terms to describe the style of inhaler then legally and ethically, the pharmacy should dispense the proprietary product which meets this description.   For example if a prescription is received for, 'Fluticasone Proprionate 50mcg Accuhaler', GSK's 'Flixotide 50mcg/dose Accuhaler' should be dispensed. The prescription should be endorsed with the product's brand name, for example 'Flixotide 50mcg/dose Accuhaler'.

No Pharmaceutical Form Listed on the Prescription

The pharmaceutical form must be stated on the prescription, either as part of the prescribing or endorsing information, otherwise a copy of the prescription will be returned for clarification on what has been dispensed.

Where only one pharmaceutical form exists and the pharmaceutical form is not stated on the prescription,  payment will be automatically based on this pharmaceutical form.

Non-Part VIII Generic Endorsed with Supplier versus Brand Name

Non-Part VIIIA generic products are frequently returned for clarification where the prescription has been endorsed with the supplier’s name rather than the supplier, for example, ‘Propranolol SR Caps 80mg’ endorsed with the supplier ‘Sandoz’ or "Almus" rather than the brand name ‘Bedranol SR 80mg Caps’.

Part II Clause 9 of the Drug Tariff allows contractors to endorse prescriptions for non-Part VIII generics using either the brand name or the supplier; there are no plans to change this therefore there is no requirement for contractors to change their endorsement practice.

PSNC is continuing to closely monitor problems with copies of prescriptions being returned for clarification unnecessarily. An online reporting form is available on the PSNC Website (www.psnc.org.uk/CIP)  to report suspected unnecessary returns to the PSNC Information Team. PSNC will ensure that this information is fed back to NHS Prescription Services so that solutions, for example further training of staff, can be adopted where possible.

Total Quantity Not Stated but clear from Dosage Instructions

Prescriptions have been returned where the quantity to be dispensed is clear from the dosage instructions, for example ‘Take 1 tablet TDS for one week’ but the prescription does not include a total quantity, either as part of the prescribing instructions or the dispensing endorsement information.

Although contractors are not required to endorse a total quantity where the prescriber's intentions are clear on the prescription, in this scenario, it is helpful to NHS Prescription Services processing staff for a total quantity to be included on the prescription.  

Endorsement of non Part-VIII Generic Products

Part II Clause 9 of the Drug Tariff sets out the endorsement requirements. Where a product is not listed in Part VIII of the Drug Tariff and has been prescribed generically, for example requests for 'special obtain items', the prescription should be endorsed with the pack size from which the order was supplied and either the brand name or the name of the manufacturer or wholesaler from whom the supply was purchased. If the product is less common, the purchase price before discount (ex VAT) should also be endorsed on the form.

Where a manufacturer supplies multiple brands that meet the same generic description, an endorsement of the supplier name is insufficient and it is necessary for the product brand name to be endorsed, for example:

A generic prescription for Insulin Detemir 3ml pre-filled pen needs to be endorsed with details of the brand product supplied, for example:

  • Levemir Flexpen 3ml pre-filled pen (NovoNordisk), or
  • Levemir Innolet 3ml pre-filled pen (NovoNordisk)

Similarly, where Adizem is dispensed against a generic prescription for Diltiazem Hydrochloride M/R Capsules 120mg and 180mg, the endorsement will need to specify which product was dispensed as both Adizem-SR capsules and Adizem-XL capsules are modified release preparation.

Products where the brand name is very similar to the generic name (Glucosamine vs GlucOsamine)

As glucosamine and glucosamine sulphate are recommended International Non-proprietary Names (rINNs) and are not blacklisted by generic name, any brand of glucosamine including blacklisted items in Part XVIIIA of the Drug Tariff may be dispensed against a generic prescription for this product (Health Perception GlucOsamine Tablets are blacklisted). Contractors will be reimbursed based on the endorsed product.  

Glucosamine is manufactured by various manufacturers, one of whom is Health Perception who market a product called GlucOsamine, it is recommended that where the 'GlucOsamine' brand is dispensed, the prescription is endorsed 'Health Perception GlucOsamine'.  


Resubmitting Returned Prescriptions

Photocopied prescriptions returned to contractors for further information contain a reference code. From this code, it is possible to determine the form type and whether the form was considered exempt from the prescription charge or charge paid. Where the patient is exempt there is also an indication of the reason why the patient was considered exempt. For example, from the reference code ‘FP10D E B’ on a returned photocopy, it is possible to tell:

  • the prescription form type, in this case an FP10D dental prescription
  • the exemption status, in this case, the ‘E’ indicates the prescription was considered exempt from the prescription charge. Prescriptions that are considered ‘Charge Paid’ will show the letter ‘C’
  • the patient’s exemption group, in this case, the ‘B’ indicates that the patient was exempt from the prescription charge because they were 16, 17 or 18 years of age and in full time education.

 Exemption Group Reference Codes:

 

A  is under 16 years of age
B  is 16, 17 or 18 and in full time education
C  is over 60 years of age
 has a valid maternity exemption certificate
 has a valid medical exemption certificate
F  has a valid prescription pre-payment certificate
G  has a valid War Pension exemption certificate
 is named on a current HC2 Charges Certificate
 was prescribed free-of-charge contraceptives
H  gets income support
K  gets income based Jobseeker's Allowance
 is entitled to, or named on, a valid NHS Tax Credit Exemption Certificate
S  has a partner who gets a Pension Credit Guarantee Credit
Z  exemption status not captured

 

 Resubmitted copies of forms should be sorted at the top of the 'exempt' or 'charge paid' group as appropriate and as directed on the FP34C Submission document. The number of returned forms and items being resubmitted should also be declared, in the relevant boxes on Part I of the FP34C Submission Document, for example the number of re-submitted copies that were exempt from the prescription charge should be added to the total number of forms in the 'Exempt from patient charge' field on the schedule. For ‘items’, only the number of items returned for clarification where payment has been delayed should be declared on the submission document as payment will already have been received for other items on the returned copies of the prescription forms.

This will ensure correct advance payment, however if contractors do not enter these items in the relevant group, it is a self correcting process and the contractor will be paid correctly via the final payment.


Copies of Prescriptions Returned Marked Disallowed

Where a copy of a prescription has been returned incorrectly marked as ‘disallowed’, it should be returned to NHS Prescription Services with the normal monthly prescription submission. The resubmitted item should be placed on the top of the bundle and clearly marked ‘Prescription Services Error – resubmitted for reimbursement’ (or equivalent).

Guidance on whether a particular product can be dispensed on an NHS prescription is available from the NHS Prescription Services' helpdesk (0300 330 1349) or from the PSNC Information Team.

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