Concerns had been raised following new Medicines and Healthcare products Regulation Agency (MHRA) advice on levothyroxine that prescribers were not able to stipulate a specific manufacturer in the ‘drug line’ field on electronic prescriptions, which is read by the NHS Business Services Authority (NHS BSA) reimbursement system.

This could lead to pharmacists receiving prescriptions for medicines with the manufacturer in the ‘free text’ box instead, which cannot be read by the NHS BSA system and may cost more than the generic tariff contractors would subsequently be reimbursed for.

Dr Shaun O’Hanlon, chief medical officer at the EMIS Group – whose software is used by 57% of GP practices in the UK – confirmed to C+D that their clinical system EMIS Web “supports the prescribing of levothyroxine generically or via brand as per the dm+d”, (the NHS dictionary of medicines and devices).

A spokesperson for the EMIS Group added it would “welcome clarification from the relevant NHS authorities” on “how GP prescribing systems should manage this issue for EPS prescriptions”.

While EMIS Web has the functionality, some prescribers have told C+D that the manufacturer does not appear on the final EPS.

C+D has asked the EMIS Group to clarify.  

How the NHS BSA system works

As reported by C+D last week (May 26), an MHRA guidance update on levothyroxine said prescribers should “consider consistently prescribing a specific levothyroxine product known to be well tolerated by the patient…if a patient is persistently symptomatic after switching levothyroxine products”.

This includes “switching between different generic brands”, it told C+D. However, there was concern that this would lead to contractors losing out in cases where the prescriber only enters the generic – rather than the specific manufacturer – in the ‘drug line’ of the EPS.

According to the NHS BSA, prescribers can generate an electronic prescription service (EPS) prescription by selecting either a generically prescribed product (VMP) or for a specific brand or supplier (AMP).

C+D understands that the processing of electronic prescriptions is automated using concept IDs from dm+d, based on SNOMED, which is a clinical language that facilitates electronic communication between healthcare professionals.

An NHS BSA spokesperson told C+D: “If a prescriber issues an EPS prescription for a specific brand or supplier, we would receive the AMP SNOMED code as the prescribed product and would therefore reimburse the dispensing contractor based on that prescribed product.”

For the purposes of reimbursement, NHS BSA is only able to extract prescription data from the relevant fields, which do not include the ‘free text’ fields of the electronic prescription.

C+D understands that there are technical and information governance reasons for this and it is something that NHS BSA cannot change.