| Drug
Tariff Guidance
Drug
Tariff Guidance Notes
Drug
Tariff Part IX Guidance to Manufacturers and Suppliers
of Medical Devices
Drug
Tariff Guidance Notes
What
is the Drug Tariff?
The
title says it all! It's a tariff outlining what will
be paid to contractors for NHS services provided, be
they for reimbursement (the cost of the drugs, appliances
etc which you have supplied against an NHS prescription
form) or for remuneration (what you are paid as part
of your dispensing contract with your Health Authority
e.g. professional fees/allowances etc).
Tell me more!
It's
produced monthly by the Pharmaceutical Directorate of
the PPA for the Secretary of State and is supplied primarily
to pharmacists, doctors surgeries and (twice yearly)
to nurse prescribers. In a
nutshell, it tells you the rules you should follow when
dispensing, the value of the fees and allowance you
will be paid, the drug and appliance prices you will
be paid and what's allowed and what's not!
In short, it's a very important document if you know
how to use it!
But it's so big and difficult to find things
in!
Perhaps,
at first glance, the Tariff does appear that way. However,
if you break it up into smaller chunks it should be
more palatable! If you use no other part of the Drug
Tariff it would pay you to use the Preface that, as
you can tell by the name of it, appears right at the
front of the Tariff. It tells you all of the changes
to that month's Tariff excluding actual price changes
(of which more later) and it also tells you in advance
of important changes for the next month's publication.
Price changes themselves are highlighted throughout
the Drug Tariff by a triangle symbol - if it's pointing
up the price has increased, if down the price has decreased.
What about the rest of the Drug Tariff?
What
possibly makes the Drug Tariff slightly off-putting
is that it is primarily a legal document, split into
19 Parts (some of which are subdivided) which are identified
in roman numerals. All of those parts will give you
Dispensing rules Reimbursement rules Prices Allowed/not
allowed
Where
will I find the dispensing rules?
In Parts I and II you will find
-
Definitions
- The
endorsements needed to enable us to pay you correctly
- When
to send your prescriptions in to us
Tell me
again how "my payment" is calculated.
You
will be paid the total sum each month for the products
and services supplied as part of your NHS contract.
It can differ slightly, depending on the type of dispensing
contractor you are.
Drug Tariff (Pharmacists)
-
Net Ingredient Cost (NIC) (Drug Tariff Parts VIII
and IX)
-
Deduction Scale (6.51 - 13.10%) (Part V)
-
Container Allowance (Part IV)
-
Professional Fees (Part IIIA)
-
Additional Fees (Part III)
-
Out of pocket expenses (Part II, Clause 12)
-
Zero Discount (Part II)
Statement of Fees and Allowances (SFA) (Dispensing
Doctors)
-
Net Ingredient Cost (as per Drug Tariff)
-
Discount Scale (3.17 - 11.18%) (SFA, Paragraph 44,
Schedule 1)
-
On-Cost (10.5%) (Paragraph 44.2)
-
Container Allowance (Paragraph 44.2)
-
Dispensing Fees (Paragraph 44, Schedule 2)
-
Out of pocket expenses (as per Drug Tariff)
Drug Tariff (Appliance Contractors)
-
NIC (Drug Tariff Part IX)
-
On-Cost (Part VIB)
-
Professional Fees (Part IIIB)
-
Out of pocket expenses (Part II, Clause 12)
I'd like to
know more about Part VIII Part
VIII contains a range of generic items and pack sizes,
all of which have been agreed between the Department
of Health and PSNC, and which are there, basically,
to facilitate the generic prescribing of drugs and also
to control the NHS Drugs Bill. There are four categories
of drugs and each category has its own basis of payment.
Category
A - drugs which are commonly available from a number
of suppliers therefore the price is calculated using
Unichem, AAH, APS, Alpharma
and Ivax Pharm. Category B
- drugs that are "older" and less commonly-used.
The prices are calculated using (in the order shown)
Unichem, then (if not in Unichem)
AAH, then Celltech Pharma and finally Thornton
& Ross. Category C - drugs which are commonly available
but generally as branded items. Prices based on specific
brands or suppliers.
Category E - relatively little used extemporaneously
dispensed items.
Basically,
if an item is included in Part VIII then that is the
price you will be reimbursed, regardless of what you
have dispensed to meet the item. The only exception
to this is where it has been established that there
is a genuine shortage of a Part VIII generic and strict
criteria have been met in endorsing such an item, then
you will be paid for the item you have supplied. For
further information follow the link to NCSO
Endorsements.
Appliances
- So what about Part IX?
The
only appliances and chemical reagents which can be prescribed
and dispensed under the NHS are those listed in Part
IX of the Drug Tariff. Part IX is actually split into
4 separate sections
Part IXA - This is an alphabetical list of appliances
which are allowed to be prescribed (e.g. atomisers,
hypodermic equipment, pessaries
etc) and dressings (e.g. bandages, gauzes, wound management
dressings etc). All items included in Part IXA will
be listed in the Index at the back of the Drug Tariff.
Part IXB - This is a list of incontinence appliances
that are allowed to be prescribed. At the front of Part
IXB you will find an index of component headings and
each section thereafter is listed alphabetically by
manufacturer name. Part IXC - This is a list of stoma
appliances that are allowed to be prescribed. The format
of this section follows the same pattern as Part IXB.
Part IXR - This is a list of the only chemical reagents
that are allowed to be prescribed. A sentence at the
beginning of this section explains the order the products
are listed in. You will also find them listed by brand
name in the Index at the back of the Drug Tariff.
The
rule of thumb is - if it's not in Part IX you won't
be reimbursed if you dispense it!
Where else in the Tariff will I find what's allowed
and what's not?
Dental
Prescribing, Part XVIIA - This List tells you what a
dentist can prescribe on Form FP10 (D). Dentists can
order for their NHS patients only those items on this
list including, in England and Wales, their proprietary equivalents (providing
of course that the equivalent is not listed in Schedule
1, see Part XVIIIA). Pharmacists need to take care as
some of the entries on the dental list detail a specific
strength of a preparation and any other strength would
be disallowed for payment.
Nurse
Prescribing, Part XVIIB(i)
and (ii) - These Lists tell you what qualified nurse
prescribers can prescribe
on Form FP10 P so, in a similar fashion to dental prescriptions,
if it's there it's allowed and if it's not there contractors
will not be paid if they dispense it.
Since
1st April 2002 suitably qualified nurse prescribers have been able to prescribe from an extended formulary,
which includes a range of prescription only medicines
and all licensed GSL and P medicines.
Details for both formularies are listed
in the Nurse Practitioner's Formulary, Drug Tariff Part
XVIIB(i)
and (ii), and the BNF.
The Form FP10 P replaces Form FP10(CN)
and FP10(PN), contractors may still come across the
older forms as the new form is introduced.
Part XVIIIA reproduces Schedule 1 to
the NHS (General Medical Services Contracts) (Prescription
of Drugs etc.) Regulations 2004.
In 1985 the Government issued a list of preparations
which would no longer be prescribable on NHS prescriptions. To compile the list, the
Government looked at several therapeutic groups and
then assessed the products in these groups to see if
there seemed to be duplication or products that were
too expensive, not necessary, or which had no medicinal
use. The up to date version of the list can be found
towards the back of the Drug Tariff in Part XVIIIA.
It is vitally important to check items in the current
month's tariff. If a pharmacist dispenses an item in
Part XVIIIA they will not receive a payment and they
will be in breach of their 'Terms of Service', likewise
a doctor cannot prescribe an item that appears in Part
XVIIIA of the Drug Tariff and will also be in breach
of their 'Terms of Service'. Contractors may, however,
be able to dispense a Schedule 1item if the doctor has
ordered it by an "approved name" i.e. a generic
item with a monograph in a recognised formulary (BP,
BAN etc) so long as the "approved name" is
not included in Part XVIIIA. If the "approved name"
is also listed in Part VIII then, of course, the reimbursement
will be based on the Part VIII entry.
Selected List Scheme, Part XVIIIB reproduces Schedule 2 to
the NHS (General Medical Services Contracts) (Prescription
of Drugs etc.) Regulations 2004. This is a list of items that have been agreed
by the Department of Health as being part of the Selected
List Scheme (more usually described as "SLS").
These items must meet the criteria listed in Part XVIIIB
before they can be prescribed under the NHS. By marking
the prescription 'SLS' the doctor is indicating that
he is prescribing for a person listed in column 2 to
treat the condition listed in column 3.
These drugs are not allowed for any other patient or
purpose.
Are there any
other sections of the Drug Tariff that are important to
me? Yes!
Part XVI sets out how the prescription charge system
works and gives many examples of how many prescription
charges are applicable to different types of items and
even how many charges are applicable to different combinations
of items. Of course, it would be very difficult to make
this a fully comprehensive list therefore Part XVI has
been split into different sub-headings, each of which
should, hopefully, cover most eventualities. Remember
that you could lose out financially if you ask the patient
for the wrong amount of money relating to his/her prescription
charges. And then there's Part II, Clause 10 - this
is the Clause that tells you what quantities you should
supply, especially in relation to calendar packs (Clause
10C) and special containers (Clause 10B)
-
Calendar Packs - There are two reimbursement options
- either supply to the nearest calendar/sub-pack or
supply the exact quantity ordered. If the latter,
clearly endorse that this is what you've supplied.
-
Special Containers - These are packs that it would
not be practical to split therefore you need to supply
the nearest number of complete packs to the quantity
ordered.
By
using your Drug Tariff regularly you will begin to find
that it's not quite so unfriendly
as it might first appear. By not using the Drug Tariff
there is a possibility that you could lose out on some
payment you're entitled to. To coin a phrase "Use
it, don't lose it!"
NCSO
Drug Tariff Part II Clause 9 C refers to where there are
no Part VIII preparations available to contractors at
the appropriate price. Please follow the link to the PPA
website page on NCSO endorsements for further background
and up to date information regarding NCSO.
Useful Links
Department of Health www.dh.gov.uk
Pharmaceutical Services Negotiating Committee www.psnc.org.uk
Contacts
Any queries relating to these Drug Tariff
Guidance Notes, please contact the PPA Pharmaceutical
Helpdesk on
0191 203 5272
0191 203 5274
0191 203 5275
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