Detailed information on Part XIV of the Drug Tariff.
Part XIVB: arrangements for contractors concerning prescription pricing errors
This information applies to pharmacy contractors in England only.
From 1 April 2012
From April 2012, a contractor who thinks there is an issue with their monthly payment can ask the NHS Business Services Authority (NHSBSA), in writing, to recheck a month or specific months' prescriptions.
All contractors who provide NHS pharmaceutical services can request a month or specific months' prescriptions to be rechecked. Contractors who have purchased a business since 1 April 2012 can only request a recheck for the months where they owned the business, unless they have purchased the business with liabilities and the account code has remained unchanged. Those contractors who ceased trading after 1 April 2012 and not sold the business with liabilities can request a recheck for any month where they owned the business, subject to the normal limitation periods.
To request a recheck from NHSBSA:
- a contractor must submit their request using the appropriate form available to download here in PDF format (to download in MS Word format click here). NHSBSA has redesigned the proforma pharmacy contractors must use to request a re-check of a specific month’s account(s) in order to allow contractors to indicate the nature of the enquiry which has affected payment. Any information that may assist the NHSBSA in checking the account(s) should be entered in the additional information box provided
- all requests must be submitted no later than 18 months from the end of the month of dispensing, for example: for prescriptions dispensed in April 2012 a contractor must submit their request for a check by 31 October 2013
- a separate form needs to be completed for each month they wish to have checked. Contractors with more than one pharmacy need to complete separate request forms for each pharmacy and month they wish to have checked
To ensure that adjustments fairly reflect both underpayments and overpayments, the NHSBSA will select an equivalent number of additional months to check where appropriate. Using the results:
- where a net underpayment is revealed, the contractor will be paid the value of the underpayment
- where a net overpayment is revealed, the NHSBSA will recover the value of the overpayment
Once the 18 month deadline for requesting a check has elapsed, for example: 31 October 2013 for prescriptions dispensed in April 2012, no further requests can be made for that particular month.
For the period 1 April 2011 to 31 March 2012
For the period 1 April 2009 to 31 March 2011
Part XIVC: temporary safeguarding payments
Drug Tariff Part XIVC sets out the temporary safeguarding arrangements put in place where a pharmacy contractor’s dispensing business is adversely affected if prescribers systematically increase prescription duration on all or a significant percentage of their prescription items. This could lead to dispensing contractors facing increased supplier bills in certain months (as more medicines are dispensed per prescription than usual) and then decreased prescription item volume in subsequent months.
Claim 1 – to provide support to pay an increase in supplier’s bill
For a month where the prescription item duration has increased compared to that seen previously, as the contractor will have dispensed significantly more medication per prescription item than usual, the 100% advance (which is based on a historic net ingredient cost) is likely to be insufficient to cover the contractor’s supplier bill for the month.
In these circumstances, the contractor is able to claim for that month, for an increase in their 100% advance (Claim 1) via the Pharmacy contractor additional advance/compensatory fee claim form. The amount that can be claimed should reflect the amount by which the contractor’s supplier bill has increased solely due to the increase in prescription item duration and no other reason.
Claim 2 - Remuneration
For the months following an increase in prescription duration, contractors may experience a drop in items dispensed and as a result earn fewer fees.
In these circumstances, the contractor is able to claim for an affected month, for any lost fees and allowances (Claim 2) via the Pharmacy contractor additional advance/compensatory fee claim form.
Please read Part XIVC of the Drug Tariff before submitting your claim.