The Scottish Drug Tariff

Don Page, ISD

Plan of talk

• NHS Scotland: organisation• Prescribing, Dispensing &

Reimbursement• The Scottish Drug Tariff

• Prescription Charges (section 2)• Endorsing & other matters (section 2)

NHS Scotland

Providers (14)• Ayr & Arran HB• Borders HB• Fife HB• Grampian HB• Etc.

Special Boards (8)• Scottish Ambulance• NES• QIS• Health Protection• NSS• Etc.

National Services Scotland

• Central Legal office• SNBTS• Health Facilities Scotland• National Procurement• Information & Statistics Division• Practitioner Services Division• National Services Division

Practitioner Services Division

• Evaluates and pays for work done by contractors providing services to NHS Scotland

• Dental• General Medical Services• Ophthalmic• Pharmacy

PSD Pharmacy

• Bain Square, Livingston (scanning)• Bridge View, Aberdeen• Meridian Court, Glasgow• Gyle Square, Edinburgh

Prescriptions are sent to LivingstonEvaluation is done at the three bureaus

Information & Statistics Division

Collects, analyses and published all data regarding NHS Scotland

• Data Intelligence Group• Epidemiology & Statistics Group• Healthcare Information Group

– Evadis team– Prescribing Team

Prescribing, Dispensing & Reimbursement

• Prescribing Act of mandating treatment

• Dispensing Act of fulfilling prescription

• Reimbursement Payment for prescription

• Remuneration Overall payment for services

• Remuneration = Sum of reimbursement + fees

Who can prescribe?

• Medical practitioners• Dental practitioners

• Nurse prescribers• Pharmacists• Allied Health Professionals

All prescribers must be recognised by their home health board

Who can dispense?

• Community Pharmacy• Dispensing Doctor• Dispensing Appliance Contractor

The person or body must hold a contract to supply dispensing services with the Health Board where the premises are situated.

Reimbursement & remuneration

• All prescriptions are sent to PSD for evaluation

• Payment is based on calendar month of dispensing

• PSD will work out the sum of all work done, and calculate the sum to be paid

• Payment is made direct to contractor bank account by BACS

Reimbursement process

• Ingredient cost for each prescription• Prices are based on published NHS

prices, or on agreed Drug Tariff rate• Prices are updated from first working day

of the month• At end of processing, the sum of

ingredient costs are evaluated• Discounts are deducted

Remuneration

• Final net ingredient cost calculated• Additional payments based on overall

national pharmacy contract are added in• Additional claims and allowances will be

added in• Adjustments made for locally negotiated

services• Final sum is evaluated and paid

Pharmaceutical Care contract

Negotiated between Scottish Government and contractor negotiators

• Minor Ailment Scheme• Acute Medication Scheme• Chronic Medication Scheme• Public Health services

• Additional elements (Oxygen, Stoma etc.)

Prescription Types

• GP10 GP• GP14 Dentist• GP 10 N Nurse• GP10 A Stock Order• CP2, CP-US Pharmacy

forms• HBP, HBPA Hospital issues• FP10, WP10, HS21 Rest of UK

Commodities

• Medicinal Products• Medical Devices• Borderline Substances

• Pay & Report (Scotland only)

Medicinal products

Defined as when ingested, inhaled or applied produces a medicinal effect

• Defined here as holding a full marketing authorisation issued by MHRA or EMEA

• Will be paid on GP10 unless listed in the blacklist

Medical Devices

An inert product which when applied to the body will produce a medicinal effect

• Product must be listed in Drug Tariff

• Listing is usually specific regarding description, dimensions and specification

Borderline Substances

Lists as foods, cosmetics and other items that produce a medicinal effect

• Defined by the Advisory Council on Borderline Substances (ACBS)

• List can be found in BNF appendix 7• Will be paid on GP10 prescriptions

Pay & Report

• Only applies to Scotland• Occurs in the GMS regulations• Covers products outside the above• Includes food & vitamin supplements,

herbal products, unlicensed items

• PSD pays the contractor, and a report is sent to the Health Board

THE SCOTTISH DRUG TARIFF

• Founded in Regulation 9 of the Pharmaceutical Regulations in the NHS (Scotland) Act

• Compiled and published by ISD• www.isdscotland.org• Updated at start of month• Web-site has a mini-Google search

engine attached

Basic Structure

• Statutory Notices• Lists of allowed medical devices• List of drugs & preparations with tariff

prices• Formularies• Discount Scale• Restricted products

Part 1: General Information

• Statutory Notices & definitions• Ground rules for price determination• Ground rules for payment• Annex 1: Zero Discount List• Annex 2: Prescription charges• Annex 3: Remuneration letter

Part 2: DressingsNote the table of contents at front• Set out in commodity order• Dressings split into plain dressings and

wound management products• All products have a pack size of ONE• Note that not all dressing sizes available

are listed• Includes most sterile irrigations• The list does not include sticking plasters

Part 3: Appliances

• Note the table of contents• Urinary catheters: default prices• Hypodermic equipment• Sutures• Products for erectile dysfunction

Part 4: Elastic Hosiery

• Specifications: three grades of compression are listed

• Flight socks, anti-embolism stockings and support tights are not allowed

• Can be measured and fitted• Ensure patient has leaflet on care of

product: each garment can last up to 6 months

• Prescription charge is one piece per garment

Part 5: Incontinence

• Items sorted by– Commodity– Manufacturer– Brand Name (if applicable)

• Quote manufacturer code for correct payment

• Trade name index at end of part

Stoma products

• Formerly called part 6: accessible from tariff web page

• Similar structure to Part 5• Contractor MUST be registered as stoma

provider to be paid• Check with patient as to product needed• Use the manufacturer code

Part 7: Drugs & preparations with tariff prices

• List of medicines with agreed prices• Is on the web in Excel• Supplement A covers flu vaccines• Supplement B covers smaller packs used

in the Minor Ailment Scheme• In case of short supply, contact

Community Pharmacy Scotland

Part 8a: Dental Practitioner Formulary

• Medicines Act gives dentists same prescribing rights as doctors

• BDA instructs that dentists prescribe within their area of practice & training

• Part 8a covers items allowed on GP14• BNF also lists allowed items by

monograph• MUST USE FORMULARY TITLE

Part 8b: Nurse prescriber formulary

• For Practice Nurses & Health Visitors• Medicines must be prescribed by

formulary title• Allowed all medical devices unless

marked “Nx” in left hand column• Not allowed most POM lines, unlicensed

medicines and borderline substances

Independent Prescribers

• Will have taken 3 months training including one month supervised by a doctor

• Allowed most products in the BNF• Allowed most devices in tariff (not Nx)• Restrictions on Schedule 2 & 3 Controlled

Drugs• Not allowed unlicensed products and

borderline substances

Supplementary prescribers

• The prescriber enters an agreement with a primary prescriber (doctor or dentist) and the patient under a defined Clinical Management Plan (CMP)

• Allowed virtually any item, provided that it is in the CMP

Part 9: Reagents

• Restricted to lines in Part 9• Covers mainly blood glucose test strips• Meters and calibration products are not

allowed• Multiple test urine sticks not allowed• Urea breath test kits for Helicobacter are

medicinal products, and will be paid

Part 10: Oxygen

• Pharmacy contractor must be approved by Health Board to be paid

• Contains specifications for cylinders and associated equipment

• Requests for unusual requirements must be referred to the Board

• Oxygen concentrators: refer to Health Facilities Scotland

Part 12: Selected List Scheme

• List of specific items for specified patients for specific conditions

• Prescriber must indicate SLS on the prescription to denote correct prescribing

• Part 12B is the EC Transparency Notice• Part 12C is the current blacklist (web

only)

Part 13: Shortages List

• Published on web only• List of products for given month where

part 7 rules are suspended due to proven shortages

• Contractor can claim the invoice price if agreed that the product cannot be obtained at the Part 7 price

Part 14: Business rules

• This part is on the web only

• This is a summary of basic rules for prescription processing

• This part will be re-written at some stage to cover electronic prescription requirements

HELP!

• Contact local pricing office (group leader)• Community Pharmacy Scotland• PSD Help-desk• National Pharmaceutical Association• ISD Customer Help Desk

Web sites

• www.isdscotland.org• www.psd.scot.nhs.uk/pharmacists/index.html

• www.sehd.scot.nhs.uk• www.show.scot.nhs.uk• www.communitypharmacyscotland.org.uk • www.npa.co.uk