How are your prescriptions processed?

Published on: 19th July 2013 | Updated on: 1st April 2022

The Pricing Authority CIP

To improve the efficiency of prescription pricing, the NHS Business Services Authority (NHSBSA), introduced an automated pricing system, known as the Capacity Improvement Programme (CIP) in 2007.

Since the introduction of CIP, PSNC’s auditing function (see this page for more details) has helped to identify some processing issues which had caused errors in payment for some prescription items. Error correction and system improvement work is ongoing, and both PSNC and NHSBSA continue scrutinising the system closely.

Download our new factsheet relating to Prescription Pricing Accuracy.


Prescription Pricing Accuracy


Pricing overview

NHSBSA’s pricing system uses high-speed scanning equipment and Intelligent Character Recognition (ICR) software to support the capture of printed information from prescription forms. This is supplemented by the information that is inputted manually by NHSBSA’s operators. Once information is captured, it is processed by the ‘rules engine’ to determine the payment due to contractors.

A summary of the key steps in the pricing process is outlined below. A diagram of this process can be downloaded here.

Batch Preparation

Prescription bundles received by NHSBSA must first be prepared for the scanning process which can be hindered by the way prescriptions have been submitted.

For information on how to properly sort your prescription bundle prior to submission please see our Sorting Your Prescriptions Prior to Submission page.

Once a prescription bundle is received, NHSBSA staff must make sure all clips, staples, and sticky labels have been removed as they can jam or damage the scanning equipment. The information that has been entered onto the FP34c submission document is inputted alongside the scanned images and this is used to calculate the pharmacy’s advance payment; therefore it is crucial that this has been completed accurately.

For more information/guidance on how to complete the submission document correctly, please see our Completing Your FP34c Submission Document & Dispatching Your Prescription Bundle page.

Prescription Information Data Capture

The scanning system is only used to support the capture of data from the prescription, for example, the prescriber ID, prescription form type, exemption status, and details of the prescribed items. If the scanning process cannot determine this information with confidence, for example, if the prescription is handwritten, then the prescription will be referred to a Type 1 Exception Handler who will enter the prescription details manually.

Switching

At this stage, if the system flags that a prescription may have been submitted in the incorrect charge group, it will be referred to a Type 1 Exception Handler for verification of whether the form was in fact submitted incorrectly or not. If it was submitted incorrectly then it will be switched. No forms are switched automatically by the system; they are only switched once verified by a trained member of staff.

Further guidance on switching is available on our Prescription Switching page.

Exception Process

Prescriptions that cannot be processed automatically by the system will be sent to an operator who will manually capture the relevant information required to price the prescription.

Prescriptions that have been placed in the red separator are processed by a specialist team of handlers who are trained to price these types of prescriptions. The following prescriptions are required to be submitted in a red separator:

  • Expensive items (items with a net ingredient cost of £100 or over);
  • Specials and unlicensed products;
  • Broken bulk ‘BB’
  • Out of pocket expense claims ‘OOP/XP’;
  • Where the prescribers signature encroaches into the prescribing area;
  • Items with supplementary product information; and
  • Items with prescriber handwritten amendments.

At this stage, items that still cannot be priced due to a lack of information must be referred back to the contractor for clarification. Payment will only be delayed for the item for which the clarification is required, and not for any other items which appear on the same prescription form. For more information on returned prescriptions and how to prevent these from being returned please see our Prescription Returns page.

Payment Calculation

Once the data on the prescription forms has been confirmed, the information will be processed automatically via the ‘rules engine’. This system will automatically apply the Drug Tariff rules for the month for which the prescriptions were submitted.

The total payment due for items dispensed will be calculated from the automatically captured data and the manually captured data. Any adjustments are made and the contractor’s final payment is calculated.

Common issues that can lead to pricing errors

QUICK LINKS

Endorsing and Submission Good Practice Workshop
Endorsement Guidance
Dispensing Factsheet: Prescription endorsements
Prescription payment and pricing accuracy factsheets

On this page we highlight common sorting and endorsing errors identified by PSNC’s Pricing Audit Centre team that can lead to pricing errors. One common issue identified is where items that meet the red separator inclusion criteria have not been included in the their relevant red separator. The NHSBSA issues contractors with three sets of red separators each month to sort certain types of paper prescription forms into their relevant exempt, paid or old charge rate groups. The prescription forms that meet the criteria set out below should be included in their relevant red separator red separator to ensure that these forms are subjected to additional checks by operators at the NHS Business Services Authority (NHSBSA).

The image below shows the different types of prescriptions that should be placed in the red separators.

Prescription forms containing the following are required to be placed into red separators:

For more information on the red separators including details of the recent changes to the inclusion criteria for red separators and submission guidance see our page Red Separators – end of month submission

Common endorsement issues leading to pricing errors/missed payments are:

Error type Common issue identified  Guidance 
Endorsing Area

Endorsements encroaching on to the main body of the prescription which can obscure the product and or the quantity ordered.

In example 1 the endorsement for the second item is printed partly over the quantity ordered which can lead to the quantity being misread. In example two the ticks have encroached in to the prescribing area obscuring the quantity prescribed, this could result in the quantity prescribed being misread.

Example 1

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Example 2

Endorsements should be correct and legible and in the left hand margin only. 

Do not tick or mark the anywhere within the prescribing area.

See our Endorsement guidance page

Flavours

Prescriptions endorsed for the supply of multiple flavours when the prescription has been prescribed in a way that only allows payments for a single item.

Paper prescriptions 

In the example below the item has been prescribed as ‘flavour not specified’, ‘flavour not specified’ is classed as a single item attracting only one fee. Only one fee would be paid regardless of how many flavours are endorsed.

EPS prescriptions

In the example below the item has been prescribed as ‘flavour not specified’. For EPS prescriptions prescribers must select ‘AF’ on their prescribing system to enable contractors to claim for dispensing multiple flavours. Unless ‘AF’ endorsement is selected by the prescriber, only one fee per item is paid regardless of how many flavours are endorsed.

Prescriptions for multiple flavours need to be endorsed correctly to ensure reimbursement for the appropriate number of Single Activity Fees (SAF), the SAF is paid automatically for all eligible items and, where a prescription orders multiple, assorted, various or mixed flavours, one SAF can be claimed for each flavour supplied and endorsed.

See our Items With Multiple Flavours page for guidance on the different scenarios of how prescribers will send prescriptions to pharmacy teams and how pharmacy teams should dispense and endorse them as well as covering how pharmacy contractors will be paid in these scenarios.

Not Dispensed

Incomplete endorsing can lead to incorrect pricing of products, fees and patient charges. In the examples below, not dispensed items should also be crossed through in the prescribing area.

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For items not dispensed on paper prescriptions, ‘ND’ should be endorsed and the item should be crossed through in the prescribing area.

For EPS, pharmacy teams are reminded to set the item to a status of ‘Not Dispense’ rather than endorse a quantity of zero dispensed

Please note: If the patient pays for their prescription, the pharmacy would be deducted a patient charge unless the pharmacy correctly endorses ‘ND’ and scores through the product

See our Endorsement guidance page

Specials & Imports – Sourcing Fee

SP has not been endorsed/ SP endorsed on an ineligible product.

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In order to claim the £20 fixed fee for the costs of postage, handling and delivery etc pharmacy teams must endorse prescriptions for an unlicensed special or import with ‘SP’

For more information on unlicensed specials and imports including endorsing and submission wee our page Unlicensed specials and imports.

 


Useful links

For endorsing guidance see our page here.

For endorsing guidance for prescriptions containing items available with multiple flavours see our page here.

For information on red separators see our page Red Separators – end of month submission and our Guidance on the use of red separators for end of month submission factsheet.

For information on prescription submission requirements see our page here.

For guidance on sorting paper prescriptions with old charge rates that meet red separator criteria see our story Correct submission of forms and items paid at the old charge rate.

For information on the end of month submission process for completed RB items see our Prescription returns page.

 


Related resources

Route of submission diagram

Claiming for EPS prescriptions on time factsheet

Payment Factsheet 5 – Prescription Pricing Accuracy

Prescription Switching

PSNC Prescription Pricing Audits

NHSBSA Information

Prescription Rechecks at the Pricing Authority

Prescription Submission

Monthly Payments

For more information on this topic please email info@psnc.org.uk

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