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Out of pocket expenses claims

NHS England and NHS Improvement is responsible for monitoring the provision of pharmaceutical services by contractors and they have a duty to check the quality and probity of activity provided under the Community Pharmacy Contractual Framework. Post payment verification (PPV) is one method by which they do this.  

NHS England and NHS Improvement has commissioned our Provider Assurance team to review out of pocket (OOP) expenses claims submitted between: 

  • February 2019 and January 2020 
  • February 2020 and January 2021 

Our PPV activity has identified a small number of pharmacies who have submitted high value claims during one, or both of the review periods, and our team will shortly be contacting them to ask them to review their claims.    

Contractors who have been contacted will be required to respond to us by a set date and may be asked to provide evidence. 

As a reminder, pharmacy contractors can claim OOP expenses as per Part II, Clause 12 of the Drug Tariff which states: 

‘Where, in exceptional circumstances, out-of-pocket expenses have been incurred in obtaining a drug, appliance or chemical reagent other than those priced in Part VIIIA Category A and M, Part VIIIB, Part IXA, Part IXR​ of the Tariff and all other specials and products not listed and not required to be frequently supplied by the contractor, or where out-of-pocket expenses hav​​​e been incurred in obtaining from a manufacturer, wholesaler or supplier specially for supply against a prescription, where such expenses on any occasion exceed 50p payment of the full amount may be made where the contractor sends a claim giving particulars to the Pricing Authority on the appropriate prescription form. The endorsement shall be ‘XP’ or ‘OOP’ to indicate that the contractor has taken all reasonable steps to avoid claiming.' 

We have engaged with the Pharmaceutical Services Negotiating Committee (PSNC) and NHS England and NHS Improvement to ensure that the PPV process is fair and balanced to all contractors asked to perform self-reviews or provide records.  

For more information on PPV processes, please visit our Pharmaceutical Services Provider Assurance webpage