Drug Tariff and Check34 Hayley Freeman Advice and Support - - PowerPoint PPT Presentation

Drug Tariff and Check34

Hayley Freeman Advice and Support Technician

• Understand where dispensing income may be

affected

• How to improve dispensing processes and top tips
• n receiving, processing and sorting prescriptions
• Understand the importance of maximising income

through correct endorsement

• Introduction to and how it can help

contractors

Objectives for today

! Errors can occur during

these stages of the dispensing process

Stages where errors often arise

• Receiving a prescription
• Dispensing/endorsing
• Prescription sorting
• Prescription submission

Receiving a prescription

• Complete the reverse of the Rx
• Collect the correct number of Rx charges
• Check patient exemption status is correct
• Check for missing prescriber codes
• Check prescribing rights of the prescriber
• Check the validity of the Rx
• Check for out of date prescription forms

FP10SS 0608 FP10SS 0406

Checks when receiving a prescription

Missing prescriber codes

NHSBSA may return the script to pharmacy This could lead to a delay in payment Pharmacy could potentially lose money Rx submitted in December January Ibandronic acid tablets £9.58 £8.63 Baclofen tablets £6.37 £2.99 Total cost of drugs £15.95 £11.62 Difference ─ £4.33 Loss to the pharmacy = £4.33 Ibandronic acid 50mg tabs 1OD 28 tabs Baclofen 10mg tabs 1OD 28 tabs

GP code

If a prescriber code is missing

Areas where errors commonly arise

Expensive Items Broken bulk claims (BB) Unlicensed Specials/Imports Out of pocket expenses Doctor’s signature Supplementary information Not dispensed Flavours Endorsing Switching

Red Separator items

Unlicensed specials and imports

Specials Imports ‘Special obtained’

Unlicensed medicinal products – no UK marketing authorisation Unlicensed in UK – licensed or available from another country

Lines which wholesalers do not routinely stock – a ‘special obtained’ item is not the same as a Special

Specials and ‘special obtained’ – endorsing

Special Imports Special Obtain

SP (ED if manufactured under Section 10 exemption) OOP or XP (EPS) Reason for claim Total amount (for claims over 50p) SP

Specials endorsing Item listed in Part VIIIB

Bisoprolol 1.25mg/5mL

• ral solution

100mL

Endorse ‘SP’ or (‘ED’ if made by pharmacy) Volume dispensed (where this is different from the quantity prescribed) No other endorsements required

SP

Specials endorsing Item NOT listed in Part VIIIB

Acetylcysteine capsules 600mg 1OD 60 capsules

Endorse ‘SP’ or (‘ED’ if made by pharmacy) Amount dispensed over pack size used for example 60/60 Price of pack size used (minus discount and rebates) MHRA specials/ importers licence number Batch number

SP 60/60 £89.15 per pk Licence 165298 Batch 121549

Co-proxamol tablets endorsement

• Co-proxamol tablets were deleted from Part VIIIA of

the England and Wales Drug Tariff in December 2015

• NHS Prescription Services has co-proxamol listed as an

unlicensed special

• Prescriptions would therefore need to be endorsed as a

non part VIIIB special

• In addition, the prescription will need to be placed in a

red separator

Product manufactured under the Section 10 exemption

Made in pharmacy Made by 3rdparty

• 1. Endorse ED
• 2. Name, quantity and

cost of each ingredient used

• 3. Endorse BB for any

ingredients

• 1. Endorse ED

ED

Specials endorsing – extemporaneously dispensed

For dispensing Specials

Endorse ‘SP’ or ‘ED’ DO NOT simply endorse £20 P+P  Use the Dictionary of Medicines and Medical Devices browser (dm+d)  Sort using red separator  Compare prices of specials from different suppliers

Broken Bulk CANNOT be claimed on any the following: All unlicensed medicines

(unless claiming for ingredients used to prepare an unlicensed special extemporaneously dispensed)

Category A and M products

(reimbursement price of the smallest pack less than £50)

Appliances (Part IXA) Chemical reagents (Part IXR) Special containers

BB 50 /100

Broken Bulk

Bromocriptine 10mg capsules 50 capsules

Broken Bulk

 Endorse ‘BB’ with amount dispensed over pack size used  Sort forms using red separator

If red separator is not used, the form will not be seen by a claims handler and the item will be priced as ordered !

 Mark container with date BB claimed  New BB claim can be made after 6 months

Out of pocket expenses

OOP can be claimed on the following products: Part VIIIA Category C only Appliances in Part IXB Appliances in Part IXC Readily available medicinal products

• utside of Part VIIIA

Products in ACBS list

(gluten free items, fortified drinks etc) OOP Details

• f the

claim e.g. postage Amount

Out of pocket expenses

 Endorse ‘OOP’ (or ‘XP’ for EPS), details of claim and amount to claim. ‘SP’ endorsement is used for specials  Place in a red separator. If not placed, it will not be seen by a claims handler  OOP cannot be claimed for:

• appliances in Part IXA and Part IXR e.g.

dressings, catheters, reagents

• Category A and category M drugs in Part

VIIIA

Expensive items

• An expensive item is any item (drug or appliance)

that has a NIC of £100 or more

• Fee of 2% payable per prescription item
• Expensive items can significantly affect pharmacy

cash flow as full payment is received THREE months after dispensing

• Very expensive items can affect the AIV which in

turn can affect the advance payment received

Expensive items

 Place in a red separator  Highlight scripts for expensive items during the dispensing process  Sort red separator scripts daily to avoid them being misfiled  Keep records of all expensive items dispensed per month to allow for reconciliation checks with FP34C

Doctor’s signature

Mefenamic acid 500mg tabs 1OD 28 tabs Digoxin 125mcg tabs 1OD 28 tabs

• Prescription not placed in red

separator

• Doctor’s signature has
• bscured the quantity ordered

for Digoxin tabs

• Item priced for 8 tablets

instead of 28 tablets

• If placed in a red separator,

script would be processed manually by a claims handler

Supplementary product information

Carmellose 0.5% eye drops 2 drops in both eyes bd Preservative free 10mL

• Supplementary information

included as part of dosage can be missed by the pricing systems

• Pricing authority will price for

standard formulations instead of preservative free

• If placed in a red separator,

script would be processed manually by a claims handler

Main product information field Supplementary information

Not dispensed items

Mefenamic acid 500mg tabs 1OD 28 tabs Digoxin 125mcg tabs 1OD 28 tabs

• Not dispensed items need to

be endorsed as ‘ND’ and the product needs to be crossed through

• Mefenamic acid would be

reimbursed by NHS

• If the patient is not exempt a

patient charge is also deducted resulting in a loss of £8.20 to the contractor

ND ND

Flavours

Fortisip Compact Liquid Feed Milkshake style 40 x 125ml ACBS

4 flavours endorsed but

• nly 1 flavour paid

Prescriber has to specify ‘mixed flavours’ or ‘assorted flavours’ or write each flavour separately

Mocha x10 Vanilla x10 Banana x10 Forest Fruits x10

John chemist 142 johns lane N176RS

Endorsement area

Atorvastatin 10mg Tabs 1ON 28 Lisinopril 5mg tabs 1OD 28 Amlodipine 5mg Tabs 28 Only paid for 8 tablets Only paid for 8 tablets

Place in red separator!!!

DOB 14/8/31

Obscuring DOB If back of Rx not completed then Rx is switched

12/28

Owing quantity mistaken for quantity dispensed

Switching: Filling the reverse of a Rx

Exempt (Part 1 and 3) Paid (Part 2 and 3) Part 1 Part 2 Part 3

Prescription Switching: Exempt to Paid

Part 1 completed but Part 2 incomplete: signature missing

Amlodipine 5mg tabs 1OD 28 tabs Ramipril 10mg capsules 1OD 56 tabs Simvastatin 40mg tabs 1OD 28 tabs

3 charges deducted £8.20 x 3 items = £24.60

To reduce prescription

switching

 Ensure that all prescriptions are filed correctly in the paid or exempt bundles at the end of the day  If possible, double check the exempt prescriptions bundle for misfiled paid prescriptions during end of the month submission

Sorting prescriptions

Daily checks

 Count prescriptions at the end of the day  Highlight/mark prescriptions for red separator  Double check all exemption declarations  Endorse in the left hand margin only  Check all endorsements are correct and legible  Keep a separate log of expensive items/OOP claims for reconciliation checks  Separate prescriptions into correct charge group  Ensure date stamps do not obscure the date of birth

 Follow up any outstanding queries on prescriptions  Set up owings reminder for uncollected items  Double check daily prescription counts  Check final prescription figures twice before entering details onto FP34c  Re-check exemption declarations  Check red separator items are placed in red separator



Remove any invoices, labels, paper clips, pins, post-it notes, tape or staples  Pack bundles neatly without using too many elastic bands  Send by courier before the 5th of the month

Checks to make before

submission of prescriptions

Part IXB Incontinence products Part IXC Stoma products Part IXA Appliances (catheters, dressings , hosiery) Part IXR Chemical reagents

Appliances

• Check if product is listed in the Appliances Section of the Drug

Tariff (Part IXA, IXB, IXC and IXR)

• If listed= ALLOWED
• Not listed= NOT ALLOWED
• Check the appliance is written as listed in the DT with correct

product codes to ensure correct payment

• Cannot claim OOP incurred when obtaining any appliances in

Section IXA and IXR

Appliances

Example 1: Otex Express ear drops (10mL)

• CE marked and classed as a medical device
• Not listed in DT
• Not allowed

Otex ear drops (8mL)

• Not CE marked
• Not in the Blacklist
• Allowed

Same ingredients in both products!!

Appliances

Example 2: Uro-Tainer sodium chloride 0.9% catheter maintenance solution AND

Uro-Tainer M sodium chloride 0.9% catheter

maintenance solution Uro-Tainer sodium chloride 0.9% ALLOWED Uro-Tainer M sodium chloride DISALLOWED as it has a CE marking and is not listed in the appliances section of the Drug Tariff

Appliances

Background

• Transparency – how do you know your prescription

bundle has been accurately priced?

• Schedule of Payment (FP34) data difficult to analyse

without adequate resources

• Contractors not always well informed about

prescription reimbursement

• Secure web-based service launched by NPA in 2015
• A powerful tool to help manage prescription

business

• Month by month performance data for 14 KPIs
• Turns raw data into useful information
• Graphical and tabular presentation of FP34 data
• Explanatory text to help interpret each KPI
• Troubleshooting algorithm to identify/resolve any

anomalies

What is Check34?

Benefits of Check34

• Enables you to benchmark your pharmacy
• Pharmacy performance for each KPI compared against:

National averages Other pharmacies in your area Other branches within your company

• Can be used at head office and branch level
• Provides up to 24 months history

1) Items dispensed per month 2) Average item value 3) Fees and drug costs 4) Working hours (for correct Practice Payment) 5) Script switches + fees lost 6) Expensive items (value, number, % of total account) 7) Zero discount (value, number, % of total account) 8) MURs completed per month and YTD 9) NMS completed per month and YTD 10) Advance vs Paid payment 11) Advance no. of items vs Actual no. of items paid 12) FP34 EPS Vs paper items 13) Script source analysis 14) Flu vaccinations

14 Key performance indicators (KPIs)

Home page

Explanatory text Trend line going up “Nearest 10” parameter chosen

Example KPI 1 – Number of items

Example KPI 7 – Switching

Example of KPI 8 – MURs

Mind map – Number of items (KPI 1)

• Sign up for Check 34 by logging on to

www.npa.co.uk

• For help and advice on Check34 or any other

questions relating to the Drug Tariff, NPA members can contact the Pharmacy Services team via telephone on 01727 891 800 or via email pharmacyservices@npa.co.uk

REMINDER