Endorsing

Pharmacists should use the right-hand side of the prescription to endorse with the volumes dispensed at each “pick-up” episode (i.e. each time the patient collects their drug from the pharmacy).  No other endorsement is required.

PSNC has produced guidance on how to endorse FP10MDA prescriptions (other than those prescribing oral liquid methadone): PSNC’s FP10MDA endorsing guidance

Worked example

Payment

Payment is based on each occasion the pharmacist provides an instalment to the patient; i.e. each time the patient collects their drug from the pharmacy.

Below is a summary of the fees which are payable against an FP10MDA prescription for Controlled Drugs other than oral liquid methadone:

For each interaction with the patient or “pick-up” for items prescribed on an FP10MDA form, contractors will receive a Single Activity Fee (SAF), Controlled drug fee, the consumables allowance and any relevant volume related fees.  Where applicable, a payment for containers (split pack fee) of 10p will also be paid where the total quantity prescribed on the form (i.e. the sum of all doses) is outside of a pack size (or a multiple of the pack sizes) listed in Part VIIIA of the Drug Tariff.

Sorting and submission

FP10MDA forms should be placed together in the prescription bundle so they are easily located and can be looked at separately by a Pricing Authority exception handler.

Further information can be found on the ‘Sorting your prescriptions prior to submission‘ page.

Endorsing

Pharmacists will endorse the prescription with the volumes dispensed at each “pick-up” episode (i.e. each time the patient collects their drug from the pharmacy).

No endorsement is required to be paid for each “pick-up” or “item level fee”, these are paid automatically for all prescriptions for oral liquid methadone (including FP10 forms).

An additional “Packaged Dose” fee of 55p can be claimed per additional bottle of oral liquid methadone supplied. The number of additional packaged doses claimed must be clearly endorsed on the prescription as payment of this fee will be based on the endorsement given only. The required endorsement is PD and the number of additional packaged doses supplied, e.g. PD 8 (see worked example that follows). The number of additional packaged doses supplied is equal to the total number of days’ supply given minus the number of patient interactions.

Worked example

PSNC has produced a full guide of worked examples for several differing scenarios showing how to endorse FP10 and FP10MDA prescriptions for oral liquid methadone:

PSNC’s methadone endorsing guidance

Payment

Payment is based on each occasion the pharmacist provides an instalment to the patient; i.e. each time the patient collects their drug from the pharmacy.

Below is a summary of the fees which are payable against an FP10 and FP10MDA prescription for oral liquid methadone:

All prescriptions for oral liquid methadone receive an item level fee of £2.50 per prescription (including FP10 forms). The item level fee for methadone is paid for each prescription. This fee is paid automatically; therefore no endorsement is required to claim it. Where applicable, a payment for containers (split pack fee) of 10p will also be paid where the total quantity prescribed on the form (i.e. the sum of all doses) is outside of a pack size (or a multiple of the pack sizes) listed in Part VIIIA of the Drug Tariff.

For each interaction with the patient or “pick-up” for items prescribed on an FP10MDA form, contractors will receive a Single Activity fee, Controlled Drug fee, the consumables allowance and any prescription volume related fees.

An additional “Packaged Dose” fee of 55p can be claimed per additional packaged dose supplied, where the individual doses have been packaged separately (by this, it is meant that each individual dose is packaged in a separate container). The number of additional packaged doses claimed must be clearly endorsed on the prescription as payment of this fee will be based on the endorsement given only.

Decisions related to frequency of collection continue to lie with the prescriber. However, contractors have the professional discretion to dispense individual doses in separate packages as appropriate.

Please note: Payment for Controlled Drugs (CDs) allowed on FP10MDA forms other than oral liquid methadone (e.g. diazepam or buprenorphine) works differently. For more information on the arrangements for other drugs prescribed on FP10MDA prescriptions, please see the ‘Instalment Dispensing‘ page.

Sorting and submission

FP10MDA forms should be placed together in the prescription bundle so they are easily located and can be looked at separately by a Pricing Authority exception handler.

FP10s containing the “PD” endorsement for oral liquid methadone can be placed in the main bundle as the CIP system is able to pick out the methadone prescriptions and send them to the Pricing Authority’s exception handlers to be checked for the endorsement.

Further information can be found on the Prescription submission requirements page.

Schedule of Payments

The FP34 Schedule of Payments contains a section headed “Prescription Fees” and it is within this section that fees relating to oral liquid methadone prescriptions for that dispensing month can be found.

FP10MDA forms can only be used for the purpose of ordering a supply by instalments for Schedule 2 Controlled Drugs plus buprenorphine, buprenorphine/naloxone (Suboxone) and diazepam. The period of treatment is not to exceed 14 days, and the prescriber must specify the number of instalments to be dispensed and the interval between each instalment (Reference: NHS (General Medical Service Contracts) Regulations 2004; Part 3 Regulation 39 (4)).

Not in England, only Schedule 2 Controlled Drugs plus buprenorphine, buprenorphine/naloxone (Suboxone) and diazepam can be supplied in instalments against an FP10MDA form.

In Wales, Schedule 2, 3, 4 and 5 Controlled Drugs can be supplied in instalments on a WP10MDA form.

Suboxone contains buprenorphine and naloxone. The Pricing Authority has confirmed that contractors will be reimbursed for dispensing Suboxone in instalments against Form FP10MDA.

Suboxone is available as both 2mg/500mcg and 8mg/2mg preparations. Therefore, a prescription stating a strength of “2mg” alone is not enough to indicate to processing staff which of these strengths has been dispensed, as “2mg” could relate to either of these products.

When a Schedule 2 or 3 Controlled Drug has more than one strength available and the prescribed strength cannot be easily identified from the prescription, it will be returned to you for confirmation of strength to enable correct reimbursement.

If a prescription such this is received, pharmacy contractors should send the prescription back to the prescriber for amendment to the full description of strength to avoid any delay in payment.

There remains no provision to dispense medicines in instalments on a standard FP10 prescription form. The prescriber may not be complying with the General Medical Services (GMS) contract requirements* by not using the form provided specifically for the purpose of supply in instalments. Ultimately, it is for NHS England to decide whether a general practitioner is compliant with their Terms of Service.

* The National Health Service (General Medical Services Contracts) Regulations 2015 specifies the prescribing requirements:

“Where prescriber orders the drug buprenorphine or diazepam or a drug specified in Part 1 of Schedule 2 to the Misuse of Drugs Regulations 2001 for supply by instalments for treating addiction to any drug specified in that Schedule, he shall—

(a) Use only the prescription form provided specially for the purposes of supply by instalments;

(b) Specify the number of instalments to be dispensed and the interval between each instalment; and

(c) Order only such quantity of the drug as will provide treatment for a period not exceeding 14 days.”

However, payments relating to dispensing additional packaged doses for liquid methadone prescribed on FP10 prescriptions have been introduced – please see the ‘Methadone dispensing (FP10 and FP10MDA)‘ page for further information.

Paragraph 8(15) of the Terms of Service of NHS pharmacists* require that any drug which the pharmacist is required to provide should be in a “suitable container”. Whilst there are no specific provisions that allow prescribers to specify how a drug is supplied, on instructing supply in daily dose containers, the prescriber is not specifying a particular type of container (i.e. glass, plastic, multi-compartment compliance aid, etc.) and so it may be considered that this is not cutting across this Terms of Service requirement where the pharmacist determines what is a suitable container in which to supply the daily doses.

More generally, pharmacists must exercise their professional judgement as to any instruction written on a prescription, having regard to the prescriber’s views. As in all cases, if the pharmacist thinks it appropriate to deviate from the prescription, they should discuss with the patient and/or the prescriber. If a pharmacist does decide to deviate from the prescription, they should make a record of their reasons and if necessary request a new prescription or suggest the prescriber amend their records. Ultimately, it is the pharmacist’s professional obligation to ensure that the patient will be able to take their medicine appropriately and safely; consideration needs to be given to supporting the patients to take the correct daily dose whether this is by packaging in daily dose containers or supplying a suitable measuring device.

*The Terms of Service of NHS pharmacists are set out in Schedule 4 to the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013

No, it is not mandatory to complete this box with the total items dispensed but it does serve as a useful check for prescription pricing staff so it is helpful if this box can be completed.

Please note: the number entered in this box should reflect the number of patient interactions/ “pick-ups” from the pharmacy only.

The arrangements brought in for oral liquid methadone recognise the difference in workload involved in the dispensing of methadone compared to other drugs on an FP10MDA form. For example, the measurement of the liquid and the entering and maintaining of the controlled drugs register, thus the £2.50 item level fee is only paid against prescriptions for oral liquid methadone.

The “PD” endorsement is only eligible against prescriptions for oral liquid methadone to recognised the workload involved in ensuring the patient is able to measure their medicine appropriately, including interaction with the patient or prescriber to understand whether dispensing in daily packaged doses is appropriate, preparing the daily packaged doses or providing an appropriate measuring device.

For more information on the arrangements for oral liquid methadone prescriptions, please see the ‘Methadone dispensing (FP10 and FP10MDA)‘ page.

No. Supervised consumption is an enhanced service agreed locally, the funding and subsequently the fees for supervision remain unaffected by these arrangements.

Below is a summary of the fees which are payable against an FP10 and FP10MDA prescription for oral liquid methadone

Item Level Fee – fee of £2.50 paid once per prescription (FP10MDA or FP10) for oral liquid methadone. This fee is paid automatically; therefore no endorsement is required to claim it.

Payment for Containers – When the total quantity prescribed on the form (i.e. the sum of all doses) does not meet a Drug Tariff listed pack size (or a multiple of), the 10p container fee will be paid.

Packaged Dose Fee – contractors are able to claim a fee of 55p per additional packaged dose supplied, where the individual doses have been packaged separately (by this, it is meant that each individual dose is packaged in a separate container).

Following contractor feedback, PSNC reviewed the new methadone payment arrangements introduced in July 2012 by: analysing contractor data taken from a time and motion study which looked at the dispensing costs of supplying methadone, undertaking a methadone prescription audit, and visiting contractors dispensing high volumes of methadone prescriptions for their expert opinions.

The review involved much time and resource in undertaking extensive modelling to fully consider all data received. The new automated audit system that PSNC has developed (PRISM) allowed a large prescription study to be carried out which helped to model the costs to contractors of dispensing different methadone prescriptions, i.e. of varying length of treatments and number of patient interactions or “pick-ups.”

The results of the review indicated that on top of the item level fee, paying a separate fee to contractors who package doses of oral liquid methadone into individual containers (either because they have been requested to do so by the prescriber or have chosen to do so for clinical reasons), would be more beneficial than just paying one item level fee.

A “Packaged Dose” Fee can be claimed when patients have been provided with separately packaged individual doses in addition to the dose they have come to collect from the pharmacy for that day i.e. either to take at home later on that day or to cover non-collection days.

For example, for a patient collecting three doses on a Friday to cover the weekend:

• If the contractor dispenses all three doses together with a suitable measuring device, the contractor is not eligible to claim for any additional 55p fees.
• If the contractor dispenses the Friday dose as a single dose (e.g. for supervised consumption) with the Saturday and Sunday doses packaged together in one container with a suitable measuring device, the contractor would be eligible for one 55p fee as one separate package was supplied for the Saturday and Sunday doses.
• If the contractor dispenses all three doses in separate containers, the contractor would be eligible for two 55p fees as two separate packages were supplied for the Saturday and the Sunday doses.

If because of the volume, and the size of available containers, one individual dose has to be dispensed between two or more containers, the contractor is only eligible for one (55p) packaged dose fee.

These fees will apply whether or not the prescriber has requested the additional containers on the prescription and will apply to both FP10 and FP10MDA prescriptions for oral liquid methadone.

The 10p payment for containers is paid to contractors on those occasions where the prescribed quantity requires a contractor to split a pack in order to supply the exact quantity as the quantity prescribed is not available in a manufacturer’s original pack/listed pack size in the Drug Tariff.

Where oral liquid methadone is prescribed, this 10p payment will only be made where the total quantity prescribed (sum of all the doses) is outside of a pack size listed in the Drug Tariff (or a multiple of a listed pack size) as the new payments include a contribution to the cost of the container supplied.

For all other drugs prescribed on an FP10MDA form, the 10p payment will be made at each patient interaction or ‘pick-up’ from the pharmacy, regardless of whether the quantity prescribed per interaction is available as listed pack size.

No, it is not mandatory to complete this box with the total number of instalments dispensed but it does serve as a useful check for prescription pricing staff so it is helpful if this box can be completed.

Please note:  the number entered in this box should reflect the number of instalments supplied or “pick-ups” from the pharmacy only and not any additional packaged doses (those are paid according to the separate endorsement).

The £2.50 item level fee and, where endorsed, additional packaged dose fees payable against prescriptions written for oral liquid methadone is to help support the contractor with the costs of the additional workload involved in ensuring the patient is able to measure their medicine appropriately, including interaction with the patient or prescriber to understand whether dispensing in daily packaged doses is appropriate, preparing the daily packaged doses or providing an appropriate measuring device.

The additional packaged doses for methadone must be endorsed clearly to ensure payment. Please see above for endorsement requirements.

Paragraph 8 (11) of schedule 4 of the 2013 regulations (The Terms of Service) requires the pharmacist to first decide whether it would be most appropriate to provide oral liquid methadone as:

(a) Each dose in a separate container;

(b) An original pack (or original packs); or

(c) The oral liquid methadone in some other way.

This may require that the pharmacist discuss with the prescriber and/or the patient, the most appropriate way of supplying oral liquid methadone to the patient concerned. For some patients, and with some dosages, a suitable measuring device will be sufficient, allowing the supply of a single container to last for several days. However, in other cases, the patient’s safety and accurate measurement of the oral liquid methadone will require the pharmacist to dispense individual doses in separate packages.

Where a prescriber has specified that each dose of the medicine should be packaged separately, the contractor must exercise their professional judgement having regard to the prescriber’s views.

The absence of any request on the prescription for daily dose containers should not be taken as an indication that the supply in a bulk container is appropriate – that assessment must be made by the pharmacist.

Once the pharmacist has decided upon how best to supply the medicine, they must package in accordance with their decision and endorse the prescription appropriately for any additional separately packaged doses as outlined in Part IIIA of the Drug Tariff.

They may also wish to keep a record e.g. on PMR of the assessment carried out and decisions made in case of future enquiries.

Payment for other controlled drugs which may be prescribed on an FP10MDA form (e.g. diazepam or buprenorphine) is based on the number of patient interactions or “pick-ups” from the pharmacy only. No item level fee is applied; nor can the fee for additional packaged doses be claimed.

The arrangements recognise the difference in workload involved in dispensing oral liquid methadone compared to other drugs on an FP10MDA form; thus the £2.50 item level fee and, where endorsed, 55p for each additional packaged dose, are only paid against prescriptions for oral liquid methadone.

No. Supervised consumption is an enhanced service agreed locally, the funding and subsequently the fees for supervision remain unaffected by these arrangements.

There remains no provision to dispense medicines in instalments on a standard FP10 prescription form. The prescriber is not complying with the GMS contract requirements* by not using the form provided specifically for the purpose of supply in instalments.

* The National Health Service (General Medical Services Contracts) Regulations 2015 Regulation 56, paragraph 10(a) – (c) specifies the prescribing requirements:

“Where a prescriber orders the drug buprenorphine or diazepam or a drug specified in Part 1 of Schedule 2 to the Misuse of Drugs Regulations 2001 for supply by instalments for treating addiction to any drug specified in that Schedule, he shall—

(a) Use only the prescription form provided specially for the purposes of supply by instalments;

(b) Specify the number of instalments to be dispensed and the interval between each instalment; and

(c) Order only such quantity of the drug as will provide treatment for a period not exceeding 14 days.”

However, please see the endorsement guidance above for payments relating to dispensing additional packaged doses for liquid methadone prescribed on FP10 prescriptions where only one patient interaction occurs (e.g. a weekly supply but the patient only comes into the pharmacy to pick-up on the Monday).