EPS endorsing and submission FAQs

EPS endorsing and submission FAQs

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Exemption Declaration and Tokens

Q. I have recently upgraded to EPS Release 2, do I need to record a patient’s exemption status in the electronic prescription claim message returned to the Pricing Authority?
A. Yes. In EPS Release 2, pharmacy staff must mark every electronic prescription to indicate whether a prescription charge was levied, and where relevant indicate the prescription charge exemption category and whether evidence of exemption was seen. Where the patient is not age exempt or has paid the prescription charge, the reverse of a prescription or dispensing token also needs to be completed and submitted to the Pricing Authority along with the monthly paper prescription submission.

The Pricing Authority base payment solely on information contained in the electronic prescription message, therefore it is essential that prescription charge exemption information is recorded accurately in the electronic message to ensure correct payment.

Pharmacy system suppliers have flexibility in the way that they develop systems to support pharmacy staff in entering this information. Different systems provide different levels of support to pharmacies. This is a key area for pharmacy contractors to engage with suppliers to ensure that systems meet user needs, for example:

If exemption information hasn’t been recorded in the local system, does your system automatically default to recording electronic prescriptions as ‘paid’ or before allowing a message to be sent for payment, does your system always prompt staff to confirm the prescription’s exemption status to ensure that this is entered correctly?

  • If pharmacy staff have already recorded details of a valid exemption certificate in the PMR system, for example a pre-payment certificate, the system could be set to pre-populate this information in the electronic reimbursement claim message, reducing workload. Note, the pharmacy would still be required to collect the patient’s exemption declaration on the prescription or dispensing token, where required.
  • Where a system supports auto-population of exemption information, are there controls to ensure that when an exemption certificate expires, pharmacy staff are prompted to check whether the patient remains exempt and input up-to-date information, as appropriate?
  • Is there a management screen or system report that allows, at a glance, a sense check that exemption information has been input by staff where required?

Guidance on other areas where pharmacy contractors have reported differences between PMR systems in the usability of the EPS R2 functionality can be found in the PMR Suppliers section of this website.

Q. If a patient brings in an EPS R2 prescription token from their GP Practice, can this be used to capture the patient’s exemption declaration where required?
A. Yes. Where a prescription charge exemption declaration is required, this could be captured on either a prescription token (the token printed by the GP Practice) or a dispensing token (the token printed by the pharmacy).

Q. I am dispensing an electronic prescription for a patient receiving income support. The patient needs to complete the prescription charge exemption declaration but I cannot print a token as my printer has run out of toner. How can I collect the patient exemption declaration in the interim until I can source a new toner cartridge?
A. The pharmacy has a number of options:

  • Pharmacy staff could handwrite the dispensing token and use this to capture the exemption declaration. It is important to ensure that as a minimum, the patient’s name and the prescription ID number are written on the form. There is no need to write the product information or prescriber details.
  • Some pharmacies have chosen to print additional dispensing labels and use these to support completing the token when the token printer is not available. If this approach is adopted, labels must include the prescription ID number. Whilst it is acceptable to place labels on tokens, labels should not be stuck on prescriptions as this could damage the high speed scanners at the Pricing Authority; unlike prescriptions, tokens are not scanned.
  • Another option is for pharmacy staff to record the patient’s exemption details, for example get the patient to write a note in a bound book with the name, date, prescription ID and their exemption details and then once the pharmacy is in a position to print tokens again, pharmacy staff complete the reverse of the token as the patient’s agent. The pharmacist would need to be sure that the patient understands that he has authorised the pharmacist to sign as his ‘agent’. However, this option is not recommended by NHS Protect and PSNC for a number of reasons. Primarily because the pharmacist is involved in the transaction, insofar as they benefit financially from the dispensing of the prescription, and to help avoid any potential discrepancies between the patient and the pharmacist regarding exemption status. It should be noted, any liabilities incurred by acting as an “agent” are in fact liabilities of the patient and not the pharmacist acting as the agent. Therefore all liabilities for penalties will always be that of the patient. Unfortunately, PSNC has been informed of cases where pharmacists or their staff have erroneously signed prescriptions on behalf of patients, where the patient was not present in the pharmacy at the time of dispensing, and the patients have received letters from the Counter Fraud officials seeking repayment where the patient was in fact not entitled to exemption from charges. To avoid any confusion between the pharmacist and patient, the signing of the exemption claim is therefore not recommended, unless the pharmacist or his staff see the proof of entitlement to exemption.

Printer problems such as a broken printer or running out of toner can create significant operational problems within pharmacies. It is important that pharmacies consider this in business continuity planning to minimise the risk of this occurring.

Q. I have received an electronic prescription for 4 items but when I’ve gone to print a token, it has printed over two tokens. Do I need to get the patient to complete the exemption declaration on both tokens?
A. It is not essential. It is sufficient to ask the patient to complete one token in this scenario. When the volume of text in an electronic prescription is greater than can fit on one token, there is provision for the electronic prescription to be printed over two tokens, for example 3 items on one token and 1 item on a second token. Both tokens link to the same electronic message and contain the same barcode and prescription identifier number. The patient declaration on the token is used to support prescription charge exemption fraud checks – asking the patient to complete one rather than both tokens is sufficient for this purpose – but both tokens should be submitted to the Pricing Authority.

The Pricing Authority base payment solely on information provided by the pharmacy and contained in the electronic reimbursement claim message, therefore it is essential that prescription charge exemption information is recorded accurately in the electronic message to ensure correct payment.

Q. In EPS Release 2, will my system be able to tell if a particular prescription includes ‘no charge’ items, for example a paid prescription for different strengths of the same drug?
A. This is no different to now. The number of fees and charges payable is calculated by the Pricing Authority – the same pricing processes will be used with paper prescriptions. Likewise, pharmacy system suppliers have flexibility, as now, in how they develop systems to support the process, for example to support the pharmacy for reconciliation purposes.

Q. I received an electronic prescription for a contraceptive. The prescription was incorrectly marked as ‘paid’ when the reimbursement claim was sent. Will a charge be deducted during prescription pricing?
A. Prescriptions for products listed in the ‘No Charge Contraceptives’ section of Part XVI of the Drug Tariff, prescriptions for contraceptive devices listed in Part IXA of the Drug Tariff, spermicidal gels, creams, films and aerosols are automatically exempt from the prescription charge. As with paper prescriptions, even if the claim is marked as ‘paid’, no charge will be deducted for these items.

Electronic prescriptions for other drugs will also be exempt from the prescription charge if the prescriber has made the endorsement ‘CC’ in the prescriber endorsement field in the electronic message. Even if the prescription has been marked as ‘paid’ by the pharmacy, no charge will be deducted if the ‘CC’ endorsement has been made in the prescriber endorsement field.

There is no exception from the requirement to obtain a completed exemption declaration on the grounds that the patient has been prescribed a contraceptive.

Endorsing

Q. I have part-dispensed an item and I’m waiting for the patient to collect the remainder. Can I claim for this item?
A. Pharmacist contractors would be expected to apply their judgement as to when and how much reimbursement to claim, as they do now.

Q. The local prescriber frequently issues prescriptions for ‘Ensure Plus’ with the instruction ‘assorted flavours’, will this remain possible in EPS Release 2?
A. Yes, for food supplement/food replacement products, prescribers will continue to be able to request that a variety of flavours are dispensed. The GP’s prescribing system will support the prescriber in issuing a prescription using the products ‘Virtual Medicinal Product’ name and the prescriber endorsement to request that ‘Assorted flavours’ are dispensed. The pharmacy will continue to receive one Single Activity Fee for each flavour endorsed and dispensed, where assorted flavours are requested by the prescriber.

Q. I have a prescription which states Ensure Plus milkshake style liquid 220ml (Flavour Not Specified) in the prescribing line. Can I dispense multiple flavours and claim for multiple dispensing fees?
A. No, as the Ensure Plus has been prescribed with an unspecified flavour rather than a direction to supply multiple flavours.

Only where the prescription specifically orders mixed, assorted or various flavours, and several flavours of the same preparation are dispensed and endorsed, will you receive dispensing fees equivalent to the total number of different flavours supplied.

The ‘flavour not specified’ listing is actually a way for prescribers to order a product which is available in multiple flavours, without specifying at the time of prescribing precisely which flavour is required. This enables the patient or the dispenser to decide which (single) flavour may be appropriate.

For electronic prescriptions, the prescriber can select ‘flavour not specified’ and then the Assorted Flavours (AF) option on their system. Multiple dispensing fees will only be paid on electronic prescriptions if the AF option has been ticked by the prescriber.

Q. I have had to dispense a prescription from 2 different packs to make up the requested quantity. In the past, I would just endorse this on the form (e.g. 14 tablets from the 28 pack and 14 tablets from the 56 pack) and this would be taken into consideration when calculating reimbursement. Can I make an electronic reimbursement claim in this way?
A. Yes, 2 different SNOMED codes can be added to a dispensed “event” so for example if 50 tablets of Drug A were prescribed and the pharmacist has dispensed this quantity from 2 different available packs then the message would state:

Prescribed – Drug A snomed code with quantity of 50

Dispensed – Drug A pack size 1 snomed code with quantity

Dispensed – Drug A pack size 2 snomed code with quantity

Q. I have received a prescription requesting “Levothyroxine Sodium 100mcg tablets (Actavis UK)”. Do I have to dispense the Actavis brand and what will I be reimbursed for?
A. Levothyroxine sodium 100mcg tablets are listed in Part VIII of the Drug Tariff. When a prescription requesting generic “levothyroxine 100 mg tablets” is received the pharmacist can dispense any brand and will be reimbursed according to the Drug Tariff price for the product.

However, where a prescription for a generic product specifies the name of a manufacturer or supplier, legally and ethically that manufacturer’s product must be dispensed, and the pharmacist would be reimbursed based on the manufacturer or suppliers list price rather. Out of pocket expenses in procuring the product may be claimed, where appropriate. Guidance on out of pocket expenses can be found here.

PSNC has received a number of reports of GPs inadvertently issuing prescriptions in this way because of the way products are listed in the picking-list of their prescribing system. This practice is not in the interests of patients, the NHS or community pharmacies. For example, this could lead to increased prescribing costs and delays in patients obtaining their medicine.

If contractors identify this as an issue in a locality, this is something that should be discussed with the prescriber.

Q. How will additional endorsements such as ‘XP’ be handled in EPS Release 2?
A. Information on the dispensed product, where required, will be provided to the Pricing Authority using the NHS dm+d SNOMED code for the product.

Other endorsements will also be required, in the same way as now, for example endorsements to claim broken bulk or out of pocket expenses or the NCSO concession. Pharmacy systems will support pharmacy staff in making these endorsements electronically. The guidance that has gone to system suppliers is in line with existing endorsement guidance.

Some pharmacy contractors currently make endorsements manually by hand without any support from their pharmacy systems. In these cases, pharmacy staff will in future be required to use their pharmacy system to make endorsements electronically.

Q. In EPS Release 2 can prescribers view whether an item has been dispensed to a patient?
A. Under normal circumstances, a prescriber would not be able to view whether an item has been dispensed however, if the prescriber attempted to cancel the prescription/item, they would receive an unsuccessful cancellation response which would indicate that the prescription could not be cancelled, the reason why e.g., “prescription/item was not cancelled – dispensed to patient “.

Q. Can I endorse a prescription ‘NCSO’ in advance of the NCSO Concession being agreed by the Department of Health?
A. Yes, where a Part VIII product cannot be obtained at the Drug Tariff price because of a supply problem and a more expensive product has had to be dispensed, the prescription could be endorsed in anticipation of the NCSO Concession being granted. The full endorsement required is the initials, ‘NCSO’, full details of the product dispensed and the endorsement must be initialled and dated.

The Pricing Authority will reimburse based on the standard Part VIII price where the product was not been granted the NCSO Concession in the month concerned. The Concession is only granted where there is a significant national shortage. Detailed guidance on the NCSO Concession can be found in the stock shortages section of the PSNC Website.

Submission

Q. Will the Pricing Authority (PA) allow me to amend a prescription (e.g. adjust an endorsement, or adjust the exemption status) after I have already sent it to them for pricing?
A. A paper prescription cannot be amended after the PA has received it for pricing.

However with electronic prescriptions, it may be possible to make a change (such as amending an incorrect endorsement or adjusting the patient exemption category) after the prescription claim message has been sent to the PA. This is subject to the following criteria:

  • your PMR system supplier must have added the functionality required to recall claim messages,
  • it must be before the deadline of the 5th day of the month following that in which supply was made.

After this time the PA’s pricing process will begin and the prescription can no longer be recalled.

If these criteria are met, your PMR system can allow you to recall, correct, and then resend the electronic script to PA.

Q. I have dispensed an electronic prescription for a special. Does the token with the patient’s exemption declaration need to go in a red separator?
A. No. Tokens are not used by the Pricing Authority to price prescriptions, they are used for audit purposes (patient prescription charge exemption fraud) therefore there is no need to place tokens in the red separators. Tokens should be filed separately from prescriptions and do not need to be sorted in GP order.

Q. Do the Pricing Authority begin pricing electronic prescriptions as soon as they are received in-month?
A. No. The Pricing Authority only begin pricing electronic prescriptions once they have received the end-of-month submission form (FP34C). This form covers both paper and electronic prescriptions and is submitted together with the paper prescriptions dispensed in the month concerned.

Q. How do I put EPS Release 2 Prescriptions into the red separator? What do I do with red separator items on EPS Release 2?
A.There is no virtual red separator for EPS Release 2 prescriptions. The items on paper prescriptions that are eligible to go in the red separator should be priced accordingly on electronic prescriptions. PSNC does advise however, that as part of the pharmacy’s reconciliation process, contractors should keep a log or generate report(s) from their PMR system for the following types of items:

  • Expensive items (items with a net ingredient cost of £100 or over);
  • Specials and unlicensed products; and
  • Items with broken bulk or out of pocket expense claims.

This report or log should then be used to reconcile items/values on the pharmacy’s FP34 Schedule of Payment which is sent by the Pricing Authority after the bundle has been priced. If you are unable or unsure as to how to generate a report which incorporates the above, contact your PMR system supplier for further information.

Pharmacy teams are also reminded that EPS tokens should not be placed in the red separator in the end of month prescription bundle. This is because these tokens are not used for payment of electronic prescriptions (payment is solely based on the information contained in the electronic claim message). As such, any tokens found to be in the red separator will be returned to the contractor with a disallowed code by the Pricing Authority.

Returns

Q. I dispensed an electronic prescription for a non-Part VIII generic last month. The Pricing Authority have just called me and asked about the invoice price for the dispensed product. Why have they done this?
A. Where the Pricing Authority have insufficient information to process an electronic prescription, the Pricing Authority staff will contact pharmacies by telephone. Early indications are that compared to paper prescriptions, significantly fewer items on electronic prescriptions require clarification. The most common reason for pharmacies to be contacted is where the prescription was for a non-Part VIII product and the prescription hasn’t been endorsed with the invoice price, where required, for example if it is less common and there is no price held by the Pricing Authority. One way to reduce the volume of these returns would be for system suppliers to ensure that where there is no indicative price for the dispensed product on dm+d, there is a system control to ensure an invoice price is entered before the prescription can be sent for reimbursement. This is an area for pharmacies to discuss with their suppliers.



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