Instalment dispensing

Instalment dispensing

Endorsing workshop promo

Please note: This page covers the dispensing of FP10MDA prescriptions for Controlled Drugs other than oral liquid methadone. For information on dispensing oral liquid methadone on FP10 or FP10MDA please see the ‘Methadone dispensing (FP10 and FP10MDA)‘ page  instead.

In England, only the following can be supplied in instalments against form FP10MDA:

  • Schedule 2 Controlled Drugs;
  • Buprenorphine;
  • Buprenorphine/naloxone (Suboxone); and
  • Diazepam

In Wales, Schedule 2, 3, 4 and 5 Controlled Drugs can be supplied in instalments on form WP10MDA.

Both FP10MDA and WP10MDA forms are limited to a maximum period of treatment of 14 days. The prescriber must  specify the instalment amount AND the interval between each instalment.

Further information on dispensing Controlled Drugs can be found on the ‘Dispensing Controlled Drugs‘ page. 


Endorsing

Pharmacists should use the right-hand side of the prescription to endorse with the volumes dispensed at each “pick-up” episode (i.e. each time the patient collects their drug from the pharmacy).  No other endorsement is required.

PSNC has produced guidance on how to endorse FP10MDA prescriptions (other than those prescribing oral liquid methadone): PSNC’s FP10MDA endorsing guidance

Worked example

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Payment

Payment is based on each occasion the pharmacist provides an instalment to the patient; i.e. each time the patient collects their drug from the pharmacy.

Below is a summary of the fees which are payable against an FP10MDA prescription for Controlled Drugs other than oral liquid methadone:

Applicable fee Endorsement requirement Payment
Single Activity fee Each interaction must be endorsed with the total volume supplied (and initialled) for each patient interaction/ “pick-up”. Paid per interaction or “pick-up”
Controlled Drug fee
Consumable allowance
Payment for containers 10p None required Paid based upon total quantity prescribed (see below)

For each interaction with the patient or “pick-up” for items prescribed on an FP10MDA form, contractors will receive a Single Activity fee, Controlled drug fee, the consumables allowance and any relevant volume related fees.  Where applicable, a payment for containers (split pack fee) of 10p will also be paid where the total quantity prescribed on the form (i.e. the sum of all doses) is outside of a pack size (or a multiple of the pack sizes) listed in Part VIIIA of the Drug Tariff.

Sorting and submission

FP10MDA forms should be placed together in the prescription bundle so they are easily located and can be looked at separately by a Pricing Authority exception handler.

Further information can be found on theSorting your prescriptions prior to submissionpage.


FAQs

Q. Is the quantity that can be prescribed on an FP10MDA prescription limited?

FP10MDA forms can only be used for the purpose of ordering a supply by instalments for Schedule 2 Controlled Drugs plus buprenorphine, buprenorphine/naloxone (Suboxone) and diazepam. The period of treatment is not to exceed 14 days, and the prescriber must specify the number of instalments to be dispensed and the interval between each instalment (Reference: NHS (General Medical Service Contracts) Regulations 2004; Part 3 Regulation 39 (4)).

Q. Can zopiclone 7.5mg tablets be prescribed on an FP10MDA?

Not in England, only Schedule 2 Controlled Drugs plus buprenorphine, buprenorphine/naloxone (Suboxone) and diazepam can be supplied in instalments against an FP10MDA form.

In Wales, Schedule 2, 3, 4 and 5 Controlled Drugs can be supplied in instalments on a WP10MDA form.

Q. Can Suboxone be prescribed on an FP10MDA Prescription?

Suboxone contains buprenorphine and naloxone. The Pricing Authority has confirmed that contractors will be reimbursed for dispensing Suboxone in instalments against Form FP10MDA.

Q. I have received a prescription for Suboxone 2mg tablets, how will this prescription be processed by the Pricing Authority?

Suboxone is available as both 2mg/500mcg and 8mg/2mg preparations. Therefore, a prescription stating a strength of “2mg” alone is not enough to indicate to processing staff which of these strengths has been dispensed, as “2mg” could relate to either of these products.

When a Schedule 2 or 3 Controlled Drug has more than one strength available and the prescribed strength cannot be easily identified from the prescription, it will be returned to you for confirmation of strength to enable correct reimbursement.

If a prescription such this is received, pharmacy contractors should send the prescription back to the prescriber for amendment to the full description of strength to avoid any delay in payment.

Q. Can a prescriber request that a product is dispensed in instalments using an FP10 prescription?

There remains no provision to dispense medicines in instalments on a standard FP10 prescription form. The prescriber may not be complying with the General Medical Services (GMS) contract requirements* by not using the form provided specifically for the purpose of supply in instalments. Ultimately, it is for NHS England to decide whether a general practitioner is compliant with their Terms of Service.

* The National Health Service (General Medical Services Contracts) Regulations 2015 specifies the prescribing requirements:

“Where prescriber orders the drug buprenorphine or diazepam or a drug specified in Part 1 of Schedule 2 to the Misuse of Drugs Regulations 2001 for supply by instalments for treating addiction to any drug specified in that Schedule, he shall—

(a) Use only the prescription form provided specially for the purposes of supply by instalments;

(b) Specify the number of instalments to be dispensed and the interval between each instalment; and

(c) Order only such quantity of the drug as will provide treatment for a period not exceeding 14 days.”

However, payments relating to dispensing additional packaged doses for liquid methadone prescribed on FP10 prescriptions have been introduced – please see the ‘Methadone dispensing (FP10 and FP10MDA) page for further information.

Q. How will I be reimbursed for dispensing in “daily dose containers”? (please note this question is only relevant for CDs eligible to be prescribed on FP10MDAs – excluding oral liquid methadone)

Paragraph 8(15) of the Terms of Service of NHS pharmacists* require that any drug which the pharmacist is required to provide should be in a “suitable container”. Whilst there are no specific provisions that allow prescribers to specify how a drug is supplied, on instructing supply in daily dose containers, the prescriber is not specifying a particular type of container (i.e. glass, plastic, multi-compartment compliance aid, etc.) and so it may be considered that this is not cutting across this Terms of Service requirement where the pharmacist determines what is a suitable container in which to supply the daily doses.

More generally, pharmacists must exercise their professional judgement as to any instruction written on a prescription, having regard to the prescriber’s views. As in all cases, if the pharmacist thinks it appropriate to deviate from the prescription, they should discuss with the patient and/or the prescriber. If a pharmacist does decide to deviate from the prescription, they should make a record of their reasons and if necessary request a new prescription or suggest the prescriber amend their records. Ultimately, it is the pharmacist’s professional obligation to ensure that the patient will be able to take their medicine appropriately and safely; consideration needs to be given to supporting the patients to take the correct daily dose whether this is by packaging in daily dose containers or supplying a suitable measuring device.

*The Terms of Service of NHS pharmacists are set out in Schedule 4 to the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013

Q. In the bottom left hand side of the FP10MDA form, there is a box to allow pharmacists to record the total number of items on the prescription. Is it mandatory to complete this box?

No, it is not mandatory to complete this box with the total items dispensed but it does serve as a useful check for prescription pricing staff so it is helpful if this box can be completed.

Please note: the number entered in this box should reflect the number of patient interactions/ “pick-ups” from the pharmacy only.

Q. Why is oral liquid methadone subject to different payment considerations to all other drugs which can be supplied on an FP10MDA such as buprenorphine?

The arrangements brought in for oral liquid methadone recognise the difference in workload involved in the dispensing of methadone compared to other drugs on an FP10MDA form. For example, the measurement of the liquid and the entering and maintaining of the controlled drugs register, thus the £2.50 item level fee is only paid against prescriptions for oral liquid methadone.

The “PD” endorsement is only eligible against prescriptions for oral liquid methadone to recognised the workload involved in ensuring the patient is able to measure their medicine appropriately, including interaction with the patient or prescriber to understand whether dispensing in daily packaged doses is appropriate, preparing the daily packaged doses or providing an appropriate measuring device.

For more information on the arrangements for oral liquid methadone prescriptions, please see the ‘Methadone dispensing (FP10 and FP10MDA) page.

Q. Will the changes affect supervised consumption arrangements?

No. Supervised consumption is an enhanced service agreed locally, the funding and subsequently the fees for supervision remain unaffected by these arrangements.


Related resources

REF: The Misuse of Drugs Regulations 2001 (16(2))

FP10MDA endorsing guide

Dispensing Controlled Drugs

Methadone Dispensing (FP10 and FP10MDA)

Daily Dispensing Checks

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