Endorsing and submission workshop: Part 1 The endorsing quiz

Endorsing and Submission Good Practice Workshop: How to Avoid Common Errors Harpreet Chana Head of Pricing

Komal George Head of Dispensing & Supply

After this workshop you will understand....

• • • •

Our roles How and why PSNC audits Areas where common errors occur Worked examples of endorsements (prewebinar quiz) • Prescription submission hints and tips

Our roles Head of Dispensing & Supply

Manage PSNC’s Dispensing and Supply Team who handle contractor enquiries on prescription related matters and routine Drug Tariff changes Lead for supply chain issues (medicines shortages and distribution arrangements)

Head of Pricing

Negotiating changes to the Drug Tariff with the Department of Health Lead for prescription pricing accuracy: • Oversee PSNC Audit Centre in Enfield • Liaison with NHS Prescription Services (part of NHSBSA), formerly known as PPD

Why does PSNC audit?

• Verify accuracy of pricing and switching by NHS Prescription Services (the BSA) • Identify errors and work with the BSA to make payment adjustments and drive improvements in pricing accuracy • Summarise endorsement errors made by the contractor and communicate these in a letter • PSNC’s automated auditing system (PRISM) has allowed better training of contractors on “How to Endorse”

PSNC’s Auditing

Independents

Multiples

At least 1 from every Local Pharmaceutical Committee in a 3 month period

Areas where main errors occur  Expensive items  Unlicensed specials/imports  Broken bulk  Sorting – prescriber’s signature  Out of pocket expenses  Endorsing area

Red separator items (not priced by ICR)

 Appliances  Flavours  Not dispensed  Switching – incorrect filing/declaration not completed on electronic prescriptions  FP10MDA forms

Endorsements/Pre-Webinar Quiz Overall aim is for you to review your own endorsement procedures to ensure that you are being correctly reimbursed for items you have dispensed

Part VIIIA of the Drug Tariff Part VIIIA has three categories:

• Category A (readily available generics) • Category M (readily available generics) • Category C (less readily available generics based on a proprietary product)

No endorsement is needed for Category A and M!! unless… you have part dispensed the item

Question 1 - Category M

There are two pack sizes listed in part VIIIA of the Drug Tariff, but NO endorsement is required

Question 2 – Category C lines in Part VIIIA Endorsement is only needed in the following situation:

• Where there is more than one pack size listed for a Category C item in the tariff; endorse the pack size used Remember: if you have part supplied any item on a prescription, whether it needs an endorsement or not, always endorse the actual quantity you dispensed on the prescription

Question 2 – Category C lines in Part VIIIA There are 3 pack sizes listed in pt VIIIA of the tariff: 15mls 22.5ml 30mls

4 x 15ml was dispensed = £16.24 but it also could have been 2 x 30mls = £22.08 therefore, the pack size used is required for payment

Question 3 - Expensive item Expensive item = any item with a net ingredient cost of ≥ £100 No endorsement required BUT • • • •

Highlight the item in some way during the dispensing process File the script separately at the end of the day Submit in the red separator at the end of the month Keep a log of all expensive items for reconciliation with the payment schedule for that month

Question 3 - Expensive item

No endorsement is needed for these Part VIIIA listed lines reimbursement is as per the Drug Tariff listed price

HOWEVER, Hydrocortisone is the expensive item on this prescription.

So this should be filed and submitted separately

Question 3 – Expensive item Rx example

This prescription had not been placed in the red separator even though it has been highlighted as an expensive item

Wrong appliance was paid with a difference in value = ÂŁ122.96 lost by the pharmacy

Unlicensed Specials and Imports Q - What is the difference between Specials, Imports and Special Obtain products?

What is a special? • Medicinal products that are not licensed medicines i.e. hold no marketing authorisation • They have been specially manufactured within the UK on a named patient basis, to fulfill an order on a prescription.

What is an import? • These are products that are unlicensed in the UK and have been sourced from another country • Can only be brought into the UK by an importer with MHRA approval on a named patient basis

• Any import whether it be licensed in the country of origin or not, is unlicensed in the UK, unless it is has entered as a parallel import

What Is A ‘Special Obtain’?

• This is the wholesalers’ term used to describe any product which is not a standard stock line

• This can be any product e.g. medicine, appliance, vitamin • Some wholesalers also distribute specials & unlicensed imports through this route • DO NOT assume that all Special Obtain items are unlicensed specials/imports

How to distinguish a special • Where has it been obtained from?

- Unlicensed special = Specials manufacturer’s number (COC/COA)

- Import = Importer’s licence number or - Extemporaneously dispensed

• Check Dictionary of Medicines and Medical Devices (DM+D) (http://dmd.medicines.org.uk) – will state whether the product is a special order or import or both e.g. melatonin 10mg capsules

PSNC Factsheet on Specials Endorsing

Question 4 – Part VIIIB listed unlicensed special • For any prescription calling for an unlicensed special check whether it is listed in Part VIIIB of the Tariff • This product is a Part VIIIB listed line • It doesn’t require endorsement of price but it does need to be endorsed with: volume dispensed the letters ‘SP’ for £20 sourcing fee

• Paid based on minimum listed volume then a price per unit on any additional volume

Question 4 – Part VIIIB listed unlicensed special However, the item has a net ingredient cost of >£100 so it is an expensive item

Price does not need to be endorsed, as reimbursement will be as per the listed price in pt VIIIB of the Drug Tariff

‘SP’ endorsement is needed to ensure pharmacy receives the £20 sourcing fee.

Question 5 - Unlicensed special not listed in Part VIIIB Endorsement requirements: • Amount dispensed over the pack size used e.g.

30/30 • Price of pack used (minus discounts and rebates) e.g. £30/pack • MHRA’s specials licence no. or importers no.

• Batch number of the product • Letters ‘SP’ or ‘ED’

Question 5 - Unlicensed special not listed in Part VIIIB Quantity dispensed has been endorsed.

This could also have been expressed as 200/100

Supplier name is not needed.

Endorsement is across the prescription – do not include endorsement in the body of the prescription

Batch number and Manufacturer’s Specials Licence No has been endorsed

Price per pack minus any discounts and rebates has been endorsed

SP endorsement has been included

This information is unnecessary as the price per pack has already been endorsed

Unlicensed specials/imports Rx example 1

Endorsed 2 x 3.5g = £190.53 each, total £381.06

Form was not sorted into red separators Endorsement should have stated total price per pack only

Only £190.53 priced = £190.53 lost by the pharmacy

Unlicensed specials/imports Rx example 2 sourcing fee (SP)

Endorsed Special with ÂŁ20.00 P + P

SP or ED not endorsed so sourcing fee has not been paid

Question 6 – Out Of Pocket expenses (OOP) Eligibility for OOP Claims

• Endorse the letters OOP or XP (EPS R2) - no other variation is allowed • Endorse the amount being claimed and a brief reason for the claim e.g. P&P

Question 6 – OOP expenses The required endorsement for claiming OOP has been included i.e. the letters ‘OOP’ with the amount being claimed

Aciferol D3 56 ex 90 OOP £14.99 For P&P/ Handling

Please Note: A brief reason for the claim has been given – full details are not required

Question 6 – OOP expenses Rx example

Prescription has been correctly endorsed with XP

Level of detail not required

Expenses endorsed = ÂŁ76.50 but not paid as it had not been placed in the red separator

Question 7 - Part IXA listed appliance • For appliances, contractors can only supply one of the Drug Tariff listed products • Where there are several appliances which meet the same generic description listed in the Drug Tariff, endorse the prescription with the one which has been supplied • Visit the FP10 database to check on disallowed appliances psnc.org.uk/fp10database

Question 7 - Part IXA listed appliance Item disallowed There are two appliances which meet this generic description in the Drug Tariff:

Hydromoor eye drops has been endorsed, which comes in 0.4ml BUT, this does not correspond to the item on the prescription

Lumecare or SoftDrops Only one of these items can be endorsed

Question 8 – Multiple flavours • If a prescription states (flavour not specified) you can only claim for a single flavour • Additional fees for supplying multiple flavours can only be claimed where this is specified on the prescription e.g. ‘Assorted Flavours’ or ‘Multiple Flavours’ • EPS prescriptions - prescribers need to tick the ‘AF’ box when issuing the prescription

Question 8 – Multiple flavours

Prescription only states one flavour The pharmacy will not be reimbursed for dispensing multiple flavours against this prescription

The prescriber must indicate multiple flavours to be supplied in order for the pharmacy to be paid for dispensing several flavours

Question 9 - Not Dispensed • Main reason for overpayments • Any item that has not been dispensed should be processed as following: – The letters “ND” in the left hand column – Item to be crossed through completely otherwise it could be paid by the BSA

Question 9 - Not Dispensed

This contractor correctly endorsed the letters ‘ND’ in the endorsement column

BUT they crucially missed out crossing through the item – this could still be paid

Question 9 - Not Dispensed Rx example

ND endorsed but item crossed out using a vertical line only

ICR was still able to read product and priced it

Question 10 - Methadone prescriptions All methadone prescriptions (both FP10 and FP10MDA) are eligible for the following: •

Automatic £2.50 methadone fee (no endorsement required)

•

Professional fees per instalment/patient pick-up-(right hand side)  dispensing fee  consumables allowance  CD fee  practice payment If applicable  container allowance

•

Packaged Dose (PD) fee of 55p per bottle for every “additional” bottle supplied in addition to the dose for that day (in left hand endorsement column)

Question 10 - Methadone Prescriptions

Endorse PD fees here for additional bottles supplied.

Calculated based on individual bottles given for 14 days bottles minus the 2 instalments/ pick ups

14 day Rx Total number of instalments/pic k ups = 2

Prescriber has requested individual containers

Total number of instalments/pic k ups should be endorsed here

Each instalment/pick up must be endorsed with the date on which it was made