The prescription your doctor writes does two things:
- Describes the medicine you need;
- Acts as token to show the prescription has been dispensed and supports a request for payment from the NHS.
This becomes a matter of assigning the right value to each prescription so that the pharmacy gets their proper payments.
(The same ideas apply whether it is a paper or electronic prescription.)
The basic rules
If prescribed as a brand, the pharmacist has to provide that brand at whatever the cost of the brand.
If prescribed as a generic, the pharmacist is reimbursed at NHS Drug Tariff Part VIIIA prices - if there is a NHS Drug Tariff price.
If there isn't a NHS Drug Tariff price then if there is a DM+D price that is used as the product would need to be fully endorsed.
If there is no DM+D price then the product requires full endorsing with price.
The mechanism is somewhat different for specials (see NHS Drug Tariff Part VIIIB).
The actual cost to the NHS is usually less than this because of the discount scale in the NHS Drug Tariff.
Appliances and dressings are paid as per NHS Drug Tariff price.
If they are not listed in the NHS Drug Tariff then you should not supply them on NHS.
Note: things are different in NI and Scotland but the payments are similar.
Problem Areas
Where the prescription isn't for a brand but the patient cannot tolerate all available products. Examples might include the need to be lactose-free, or must not include aspartame. Or they need a splittable tablet.
This is a fundamental flaw in generic prescribing. There is no position between brand and generic prescribing which allows for any special requirements. Adding the words "lactose free" does not change the price the NHS will pay the pharmacy. Nor does acknowledgement of the desirability of being dispensed the same product consistently (as for levothyroxine) have any place in the current prescribing/dispensing system.
Where the NHS Drug Tariff price is lower than the price the pharmacy has to pay. The pharmacy will probably lose out.
New formulations and brands becoming available and old formulations/brands disappearing.
Own supplier formulations which cannot substitute a product prescribed by brand even if they are identical.
Where the prescription identifies a manufacturer but does not qualify as a brand prescription.
Supply problems, including recalls, which can result in changes to sourcing, to products supplied, to prices (which often change quickly).
What is the NHS Drug Tariff?
In principal, this is a price list of medicines that the NHS has agreed with pharmacies. Inevitably the reality is considerably more complex than that.
https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff
What is the dm+d?
The NHS’ dm+d is a dictionary of descriptions and
codes which represent medicines and devices in use across the NHS. The
dm+d data is refreshed weekly and contains a huge variety of information. This provides data to other publications such as the British National Formulary hence is always the first to be updated.
https://helvella.blogspot.com/p/helvella-dictionary-of-medicines-and.html
Current NHS Drug Tariff Liothyronine Prices
Link to a blog post of Monthly NHS Drug Tariff prices for Liothyronine products from January 2023 onwards.
Also includes link to information for Scotland.
https://helvella.blogspot.com/p/current-nhs-drug-tariff-liothyronine.html
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[i][b]helvella - How Pharmacies Get Paid[/b]
A brief overview of how pharmacies get paid for dispensing medicines.[/i]
https://helvella.blogspot.com/p/helvella-how-pharmacies-get-paid.html
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