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Pharmaceutical Services Negotiating Committee

Drug Tariff News

Drug Tariff Simplification April update

As part of PSNC's ongoing negotiations with the Department of Health (DH), a number of measures have been agreed with the aim of simplifying Drug Tariff reimbursement arrangements in several areas. Although these changes will have no effect on the overall value of the national pharmacy funding package, some of the changes will affect how elements of the funding settlement are delivered to community pharmacy. Any such changes have been agreed with the principles of fairness and funding equitability as a primary concern.

A wide range of provisions laid out in the Drug Tariff as well as those provisions which are not detailed in the Drug Tariff but which have developed over time have been reviewed. These provisions range from small to larger more complex issues. The DH and PSNC have agreed to implement the changes in two phases – phase one in April and phase two in July

In April 2012, phase one will be implemented which includes:

  • Reimbursement for purified water
  • Payment for droppers and applicators
  • Reimbursement for diluents when not specifically prescribed
  • Payment for oral preparations which require reconstitution from granules or powder and the associated fee which recognises that due to the limited stability of the reconstituted product, contractors may need to dispense additional containers

In July 2012, phase two will be implemented, including changes to:

  • The payment system to reflect the increased cost of dispensing split packs
  • Payments for Methadone oral liquid
  • Out of pocket expenses
  • Broken Bulk
  • Common pack list

Phase one has been agreed as outlined below, we are currently working with the DH to finalise phase two.

Limited Stability list / products reconstituted from granules

For items currently recognised with limited stability status, contractors will receive the Limited Stability fee where the item has been reconstituted from granules resulting in a liquid with stability of 14 days or less, necessitating dispensing in more than one container.

Following Drug Tariff simplification the following will apply.

A. The limited stability fee will no longer be payable where an item has been reconstituted from granules resulting in a liquid with stability of 14 days or less, necessitating dispensing in more than one container.

B. Oral antibacterial, antiviral or antifungal products listed in BNF sections 5.1, 5.2 and 5.3 (except 5.3.1) will be considered under the rules for reconstitution.

When the quantity reconstituted from an original pack or packs is unavoidably greater than the quantity ordered and it has not been possible for the contractor to use the remainder for or towards supplying against another prescription, payment will be calculated from the Basic Price of the preparation and will be based on the nearest pack or number of packs necessary to cover the quantity ordered.

Additional Item endorsement for droppers and applicators

The payment for containers is at the average rate of 3.24p per prescription for every prescription (except for oxygen prescription) supplied by contractors whether or not a container is supplied. This provision now includes the supply of dropper bottles or separate droppers for prescriptions where the medicine is for administration to or via the ear, eye or nose, or a vaginal applicator for contraceptive gel or cream prescriptions, except where the manufacturer's pack includes one. There will no longer be a requirement to endorse prescriptions where a dropper bottle, separate dropper or vaginal applicator has been supplied.

Purified Water

Purified water will no longer be reimbursed unless it is specifically listed on a prescription. The only exception will be where it has been determined that the potable water ordinarily available in the area is unsuitable for dispensing purposes, and the contractor has been notified accordingly.

Additional Item endorsement for diluents

Products supplied as powder for injection require a diluent to reconstitute the powder to make it suitable for administration to the patient by injection. Under the Medicines Act 1968, all medicines for parenteral administration, including diluents such as Water for Injection, are currently classified as Prescription Only Medicines and should only be supplied in accordance with a valid prescription. Whilst there is an exception in the law that enables pharmacies to supply 2ml vials of sterile water for injection without a prescription when engaged in the lawful provision of water for injection for drug treatment, pharmacies will no longer be reimbursed for supplying diluents where they are not prescribed

Pharmacies will only be reimbursed by the NHS for supplying diluents where they are prescribed on an NHS prescription. Therefore, where a pharmacy receives a prescription for a dry powder for injection and a diluent is required to support administration, the pharmacist would need to use their professional judgement in contacting the prescriber so that a prescription can be issued for the diluent where the prescriber deems it appropriate.

If a diluent has not been prescribed and is required in an emergency, the pharmacy may contact the prescriber and ask them to request an emergency supply of the item using the usual emergency supply procedures. A range of prescribers, including doctors, dentists, supplementary prescribers and nurse independent prescribers, can now request emergency supplies of prescription only medicines.

Note, where a patient is not exempt from paying the prescription charge and both dry powder for injection and diluent has been prescribed on the same prescription form, only one prescription charge should be levied. However, where the diluent is prescribed on a separate prescription form to the dry powder for injection, two prescription charges should be levied. The following letter has been produced to help pharmacists with communicating this change to their GPs, please click here

NHS Prescription Services have produced some related FAQs which can be viewed here.

Posted 26 March 2012

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