Medicinal products

Medicinal products

Endorsing workshop promoMedicinal products are items which are not considered to be appliances and include drugs, foods, toiletries and cosmetics. Please note that unlicensed specials and imports have separate arrangements which are covered on this page.

Click on a heading below to reveal more information.

How to determine if a medicinal product is allowed on prescription

Firstly, the item needs to be identified as either a medicinal product or a medical device and the easiest way to tell the difference is to look for a CE mark which signifies that the item is a medical device. The CE mark can normally be found on the packaging of a device, on the instruction leaflet and on the device itself (where practical).

If there is no CE mark, then you need to check the product is not listed in Part XVIIIA of the Drug Tariff (the ‘blacklist’).  If it is not in the blacklist, then it is allowed on an FP10.

If there is a CE mark, then please read our Appliances section.

Key points to consider

  1. If the product appears in Part XVIIIA of the Drug Tariff (the ‘Blacklist’).
  2. Whether the item requires the ‘SLS’ endorsement.
  3. The prescriber has given all the required details for the item they wish to be dispensed: i.e. form, strength, quantity.  If not, the prescription may need to be returned to be amended appropriately.
  4. If there is internet access in the pharmacy, the Drug Tariff can be viewed online. This can help to identify whether a product is in the ‘Blacklist’ or requires the ‘SLS’ endorsement more quickly.
  5. It is also important to note that whilst an item might be prescribable on the NHS, there may be local prescribing guidance in place about the appropriateness of prescribing that item, e.g. anti-malarial drugs.

For support on whether a particular product is allowed on an NHS prescription, the PSNC Dispensing and Supply Team will be happy to help (0203 1220 810 or www.askpsnc.org.uk).

The blacklist

The ‘blacklist’ can be found in Schedule 1 to the NHS (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004 which is reproduced in Part XVIIIA of the Drug Tariff. This is the list of medicinal products which cannot be prescribed on the NHS.

Any medicinal product not in the ‘Blacklist’ can be prescribed on the NHS. For example, whisky is not on the blacklist, so a prescription for this item would be passed for payment by NHS Prescription Services. The prescriber may however be questioned by their CCG about the appropriateness of prescribing this item at NHS expense.

As a general rule, if a proprietary (branded) product is listed in the ‘Blacklist’, it cannot be prescribed on the NHS. The only exception to this is:

If the prescription has been written generically and the generic product is not blacklisted AND if the generic name has an ‘Official Title’, that is, the drug appears as the head of a monograph in the European Pharmacopoeia (EP), the British Pharmacopoeia (BP), the British National Formulary (BNF), the International Pharmacopoeia, the Dental Practitioners’ Formulary or is included in the Cumulative List of Recommended International Non-proprietary Names.

In cases where a blacklisted proprietary product contains more than one ingredient, the combination product must have an official title.

For example:

Brand Name

Generic Name

‘Official Title’

Comments

Laxoberal Sodium picosulphate Recommended International Non-proprietary Name (RiNN) Because it has a monograph, Laxoberal could be dispensed if the prescription was written generically.
Regaine Minoxidil cream, lotion, ointment, solution Recommended International Non-proprietary Name (RiNN) Both the brand and its generic name appear in the blacklist so this product cannot be prescribed either way.

 

When a prescription for a blacklisted product is received, pharmacy staff have a number of options open to them:

a)    the prescription could be returned to the prescriber so that an alternative product can be prescribed; OR

b)    a private prescription could be issued (note, an NHS prescription cannot be used as a private prescription and a new prescription, which isn’t on an FP10, must be issued); OR

c)    if the item has GSL or P status, the product could be sold to the patient over the counter instead.

The Selected List Scheme

Please note that there are now separate lists in Part XVIIIB of the Drug Tariff for English and Welsh prescribers to follow.

The ‘Selected List’ can be found in Schedule 2 of the NHS (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004 which is reproduced in Part XVIIIB of the Drug Tariff. The items included on the list may only be prescribed for the patient groups and for the purpose listed in the Tariff. For example, Niferex Elixir 30ml Paediatric Dropper Bottle can only be prescribed to infants born prematurely for prophylaxis in the treatment of iron deficiency.

Prescribers must endorse prescriptions for these products ‘SLS’. If the ‘SLS’ endorsement is missing, the prescription should not be dispensed and will not be passed for payment by NHS Prescription Services. Pharmacy staff cannot make the SLS endorsement themselves.

The Borderline Substances List

Part XV of the Drug Tariff is known as the ‘Borderline Substances’ list. In certain conditions, some foods and toiletry preparations have the characteristics of drugs. A board known as the Advisory Committee on Borderline Substances (ACBS) advises on the circumstances in which these products may be regarded as drugs. Part XV of the Drug Tariff is split into two lists:

List A is an alphabetical index of the approved borderline products and the conditions they may be prescribed for.

List B is an alphabetical index of medical conditions and related approved products for managing those conditions.

Prescribers should endorse prescriptions with the endorsement ‘ACBS’ if they are issuing the prescription in accordance with the Committee’s advice.

If the ACBS endorsement is missing for a product on the borderline substances list, pharmacy contractors can still dispense the prescription and it will be passed for payment by NHS Prescription Services. However the prescriber may be asked by their CCG to justify why the product has been dispensed at NHS expense. Pharmacy staff should not add the ACBS endorsement.

Endorsements

For a product prescribed generically and listed in Part VIIIA or Part VIIIB of the Drug Tariff, the only endorsement required is the pack size where there are multiple pack sizes of the product listed in Category C of Part VIIIA of the Tariff.

For a product prescribed generically which is not listed in Part VIIIA of the Drug Tariff, endorse with the brand name or manufacturer/supplier as well as the pack size if multiple pack sizes of the product are available. If the product is less common, the net price before discount and ex VAT should also be endorsed.

For an unlicensed medicine, please visit this page of our website.

For a product prescribed by brand, the only endorsement required is the pack size. If the product is less common, the net price of that pack before discount and ex VAT should also be endorsed.

There are additional endorsement requirements for when a product has been granted an NCSO Concession by the Department of Health, please visit our NCSO section for more details.

Pricing

How reimbursement prices are set

Find more information by exploring the relevant pages below:

Price change mechanism

Split pack dispensing

 

Related expenses for procuring and dispensing medicinal products

Only some medicinal products are eligible for broken bulk and out of pocket expense claims; please visit the relevant sections to find out which are and which are not.

Sorting and submission

Prescription forms for unlicensed medicines and expensive items (those with an NIC or £100 or more) should be separated from the rest of the bundle and placed in the red separator for submission.

Prescriptions for other medicinal products only need to be separated if they also meet one of the other criteria for inclusion in the red separator.


FAQs

Q. What should I do if…

Potential problem

What needs to be done?

An item which is found on the Borderline Substances list (Part XV of DT) has NOT been endorsed with the letters “ACBS”. This product can still be dispensed – the “ACBS” endorsement isn’t a compulsory requirement.
A medicine which is found in the Selected List Scheme (Part XVIIIB of DT) has NOT been endorsed by the prescriber with the letters “SLS”. This script would need to be returned to the prescriber for amendment – pharmacy staff cannot make this endorsement themselves.
A drug which has been prescribed and endorsed by the prescriber with either “OC”, “CC” or “♀”. No patient charge is payable for this item – the prescriber is declaring that it is to be used for contraceptive purposes.
A product which is recognised as a special container has NOT been prescribed in an amount which is equal to a full pack. Although payment will automatically be based on the nearest pack or combination of sub-packs to the quantity prescribed, there is also a Drug Tariff requirement to endorse the amount dispensed.
The prescriber has NOT specified “sugar free” for an item which has both sugared and sugar free versions available.(not applicable for Schedule 2 and 3 Controlled Drugs) Can supply a sugar free medicine if the pharmacy doesn’t have the sugared version in stock – the prescription should also be endorsed accordingly. NB. If both the sugared and sugar-free versions are listed in Part VIII of the Drug Tariff, the pharmacy would only be paid for the one that was prescribed (even if endorsed to say otherwise).

Q. What should I do when faced with incomplete prescriptions for medicinal products?

Missing strength or pharmaceutical form for a medicinal product:

  • If this drug is only available in one strength or form, dispense it and endorse what was given.
  • If more than one strength or form exists, contact prescriber to ascertain form and quantity required and endorse “PC” (initial and date).

Missing quantity for a medicinal product:

  • Contact prescriber, add quantity required and endorse “PC” (initial and date).
  • If cannot contact prescriber, supply enough for 5 days of treatment only and endorse “PNC”.

Missing strength AND quantity for a medicinal product:

  • Contact prescriber, add strength and quantity required and endorse “PC” (initial and date).
  • If cannot contact prescriber, supply enough for 5 days of treatment only and endorse “PNC”.

Strength which doesn’t exist for a medicinal product:

  • Use professional judgement and make up required dose using lower strengths, if possible (e.g. dispense 250mg tabs to give 500mg per day).
  • If this cannot be done or if in any doubt, prescription should be returned to the prescriber for amendment.

For incomplete prescriptions for Schedule 2 and 3 Controlled Drugs, see our Controlled Drugs section.

Q. How do I endorse a licensed medicine not in the Drug Tariff?

Licensed medicine not in DT endorsementEndorse the quantity dispensed over the pack size used, and if the prescription has been issued generically, also endorse the brand name or the name of the supplier (see picture opposite).

The Pricing Authority reimburses using the NHS-listed reimbursement price, but if this is not known by them (i.e. the supplier does not list the product/price on the NHS database, dm+d*) then they will need to use your endorsed price (N.B. the following must be included: the pack size, and total net price for that pack before discount and ex VAT.) It is important to only include the necessary information in line with the endorsement requirement as any additional information could risk misinterpretation which could lead to an incorrect payment being made.

*For more information on dm+d, please visit this page.

Q. A patient has presented a non-repeatable prescription for '28 x 5mg tablets'. The 5mg strength is unavailable as it is in short supply; however, I do have '56 x 2.5mg tablets' in stock. As this is the same amount of drug i.e. 140mg which can be administered at the prescribed dose by doubling the number of tablets; can I dispense 56 x 2.5mg tablets against this prescription instead?

No. It is part of the Terms of Service that pharmacy contractors must, with reasonable promptness, “provide drugs so ordered” once a prescription has been presented. “Drugs” includes medicines e.g. the tablets. In this scenario, the patient has presented a non-repeatable prescription for 28 x 5mg tablets and therefore supplying 56 x 2.5mg tablets would not be providing the drugs “so ordered”.

If you intend to dispense 56 x 2.5mg tablets then the prescription would need to be amended or a new prescription would need to be issued by the prescriber at the prescriber’s discretion, It would also be essential to ensure the patient understands the different dosage to be taken if there were an amendment to their prescription.

Q. If I receive an FP10 prescription for Co-codamol 30mg/500mg caplets, how much will I be reimbursed?

The British Pharmacopoeia provides authoritative monographs for different dosage forms. There is no monograph that defines caplets; caplets are considered tablets (i.e. capsule-shaped tablets). A prescription for Co-codamol 30mg/500mg caplets would therefore be reimbursed based on the Part VIII price for Co-codamol 30mg/500mg tablets.

Q. If I receive an FP10 prescription for Salbutamol Easi-Breathe Inhaler 100mcg (i.e. where the order includes both a generic description and a trademarked name of a licensed product). What should I dispense?

If a generic prescription includes a trademarked name to describe the product then, legally and ethically, the pharmacy should dispense the proprietary product which meets this description.

In the above example, the prescriber is directing the pharmacist to dispense the proprietary drug Salamol Easi-Breathe. The prescription should ideally be endorsed with the full brand name and reimbursement will be based on the branded product’s list price.

Q. Can I dispense Regaine for Men Extra Strength 5% scalp foam against an NHS prescription written as 'Minoxidil 5% foam'?

Whilst the brand Regaine does appear in Part XVIIIA of the Drug Tariff (the ‘blacklist’), the generic description Minoxidil 5% foam has an Official Title (a rINN) and does not appear in the blacklist itself.

Therefore the blacklisted brand can be dispensed against an FP10 prescription as long as the item has been prescribed generically.


Related resources

REF: Drug Tariff Part VIII

Dispensing Factsheet: Prescription Endorsement

Dispensing Medicines (Service specification)

Controlled Drugs

Unlicensed Specials & Imports

Quantity

Split Pack Dispensing

Endorsement Guidance

Daily Dispensing Checks



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