Everything you wanted to know but were afraid to ask
In this article you will learn about: • how pharmacies are paid for dispensing prescriptions • the drug tariff and controlled drugs • the records a pharmacy must keep and legal requirements for prescriptions • what items doctors and pharmacists can prescribe
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How much does a pharmacy make per prescription?
Payment to pharmacies for services and medicines supplied is complicated, but is achieved through a mixture of fees and allowances, and an element of guaranteed purchase profit.
The pharmacy is paid 90p per item dispensed, whether it is a medicine or an appliance. Extra fees can be claimed for specials (non-standard formulations that have to be specially prepared) and for measuring and fitting hosiery and trusses. An expensive item fee is also paid if the item costs over £100 to purchase.
Practice payments are paid according to the number of items dispensed and staffing levels, and pharmacies can also claim top-up payments at the end of the year under certain conditions. The repeat-dispensing annual payment is paid to all pharmacies whether or not they dispense repeat prescriptions. Other fees are paid for advanced services, such as medicines use reviews (MURs), as well as various payments for the running of the pharmacy.
Overall, the pharmacy can expect to make around £2 per item dispensed, but there is more to it than that; patients will often purchase items when in the pharmacy and may return for your services, so the pharmacy can gain in other ways.
What is the drug tariff?
This is the document that outlines the drugs, reagents and appliances (dressings and devices) that can be supplied on an NHS prescription. It indicates the payment that can be expected for supplying the product – reimbursement – and the fees and allowances payable as part of the dispensing contract the pharmacy has with the local health trust – remuneration.It is divided into several sections; Part VIIIA deals with the prices paid for different drugs.
The drugs in this section are divided into three categories: ● Category A – readily available generics. A set price is paid irrespective of the brand used, which can change each month. ● Category C – drugs not readily available as generics. The price paid is based on a particular brand, manufacturer or supplier and can also change each month. ● Category M – readily available generics where a set price is paid, based on information provided by the manufacturers. These prices are updated quarterly and can cause problems, because if the cost of obtaining a drug changes within this time, there is no change to the price paid.
What is prescription endorsing and how does it work?
Endorsing is the annotation of prescription information to enable correct payment for medication supplied. Exactly which products require endorsement is determined by the drug tariff. Those with a pre-determined payment price do not require any endorsement; other drugs require further information. This could include the brand or quantity supplied, the cost or batch numbers. Various letters used to indicate what has been supplied are shown in box one (below).
However, the drug tariff is always changing; what may require endorsing one month may not need it the next and vice versa. Amendments for the month are listed at the front of the drug tariff and should be consulted regularly.
What is a controlled drug?
Controlled drugs (CDs) have further levels of restrictions about how prescriptions are written, who can prescribe and supply them, how they are stored and what records are kept. They are divided into five schedules; most of those in schedules 1, 2 and 3 must be stored in the CD cupboard. Schedule 5 drugs, such as codeine linctus, are typically available over the counter.
What records need to be kept in the pharmacy?
When a medicine is supplied on an NHS prescription the details that must be recorded are: ● supply date ● prescription date ● medicine details (name, quantity, form and strength) ● name and address of the prescriber ● patient details.
For a private prescription, a record must be made in the private prescription register. If the medicine is a CD, an additional record must be made in the controlled drugs register, which is either a book or computer-held document. Records must be kept for two years from the date of the last entry, and there are extra requirements for CD records.
Many other records are required to be kept by the pharmacy, which can be for services supplied to patients or about the general day-to-day running of the premises.
What are the details needed on a prescription to make it legal?
A prescription needs to be written legibly and in indelible ink. It must: ● be dated ● state the name and address of the patient (NFA – no fixed abode – is allowed) ● state the age of a child if under 12 (it is otherwise good practice to state the age and date of birth) ● be signed in ink by the prescriber; a computer-generated signature is not legal ● state the name and particulars of the prescriber ● state the address of the prescriber – the address for CDs must be within the UK, unless for schedule 4 or 5 drugs.
Extra details are required to make some CD prescriptions legal. These include: ● the form of medication ● the dose and directions ● the strength of medication ● the total quantity in words and figures.
A fax is not a legal prescription because it is not written in indelible ink and not signed by the prescriber, but can be used to confirm the presence of a prescription. Electronic prescriptions have been recognised in legislation as legal prescriptions.
A private or NHS prescription is valid for six months – 28 days for CDs in schedules 2, 3 or 4. The pharmacist, however, may not agree to dispense it if they feel that it is not clinically relevant on the date that the patient brings it into the pharmacy.
What is the responsible pharmacist (RP)?
This is very often the pharmacist on duty and their role is to ensure the safe day-to-day running of the pharmacy. This includes the safe and effective ordering, storage, preparation, sale, supply, delivery and disposal of medicines and that all the required records are kept.
The pharmacy is allowed to operate in the absence of an RP, but they cannot be away from the pharmacy for longer than two hours. They must remain contactable and must agree what activities can take place in their absence. A notice must be displayed to state the name of the RP and a log of who the RP was must also be kept.
What is a patient group direction (PGD)?
A patient group direction enables a prescription-only medicine to be supplied to a certain group of people for a defined clinical condition. It means that a prescription does not need to be written by a prescriber. The aim of a PGD is to enable patients greater ease of access to medical care.
The PGD must be a written instruction and define exactly who can and cannot be treated, the exact nature of the item to be supplied/administered, the information to be given to the patient and the records that must be kept. It requires the pharmacist to undergo extra training. Examples include flu vaccinations, emergency contraception to woman aged under 17 years of age, and travel vaccinations or medicines.
What can be prescribed?
A GP can prescribe anything that they deem to be required for medicinal effect for the patient. Items that the NHS will not pay for are listed in Part XVIIIA (the blacklist) of the drug tariff, which includes some drugs, foods and toiletries. Some items can only can be prescribed under certain conditions; these are listed in Part XVIIIB, the selected list scheme.
Supplementary pharmacist prescribers can prescribe any medicine, including CDs (but not cocaine, dipipanone or diamorphine for treatment of addiction), but should only prescribe within their clinical competence. Independent pharmacist prescribers can prescribe any medicine, including CDs, and again should only prescribe within their competence.
Key endorsement abbreviations
SP – specials item, requires further information for pricing
PC – prescriber contacted (to confirm unclear quantity or dose for example)
BB – broken bulk (only part of a pack was dispensed but the full quantity is claimed)
MF – measured and fitted (used for hosiery and trusses)
NCSO – no cheaper stock obtainable (applies for that month only)
XP or OOP – out of pocket expenses for acquiring the item prescribed
ED – extemporaneously dispensed
Further resources
The Prescription Services Negotiating Committee (PSNC) has lots of information all about the drug tariff NHS Prescription Services The front section of the British National Formulary (BNF) also contains prescribing information
Your next steps
● Look at the drug tariff and familiarise yourself with the different sections ● Find out about the records kept at your pharmacy ● Find out more about the differences between the CD schedules ● Ask your pharmacist how they decide whether a prescription is clinically relevant, whether they take part in a PGD and about the training involved for pharmacist prescribers