Prescription returns

Published on: 17th July 2013 | Updated on: 6th July 2022

Download our Understanding Prescription Returns factsheet.

Where the NHS Business Services Authority (NHSBSA) cannot process a prescription item for payment due to insufficient endorsed information, it is returned to the pharmacy for the missing information to be added so that it can be correctly reimbursed.

Part II Clause 9F of the Drug Tariff states ‘where insufficient information is available to enable the Pricing Authority to process the prescription, including where it was submitted for a SSP payment, the form (or a copy of the original form) shall be returned to the contractor who shall endorse the prescription form (or copy) with the information requested. Returned prescriptions shall be priced using the Drug Tariff relevant to the month in which the prescription form (or copy) is returned to the Pricing Authority.’

In 2021, just under 800,000 items were referred back (RB) to pharmacy contractors by the NHSBSA for further clarification. This works out to a monthly average of 66,458 items (0.07% of all prescriptions items processed) or ~6 items per pharmacy contractor per month.

Year Items processed Total items referred back
2021 1.139bn 798k

Why are prescription items referred back?

The NHSBSA apply a coding system to identify up to 19 possible reasons for items being RB to the pharmacy for further information. Each returned item is assigned an RB code to indicate the RB reason. A table of RB reason codes and what each code means can be found below or on the NHSBSA website.

The most common reason why an item is returned is due to an incomplete endorsement, where one or more of the following is missing:

  • manufacturer / brand name (if not in Drug Tariff and listed by more than one supplier)
  • pack size (if more than one pack size is available)
  • price (if NHSBSA does not hold a price for it)

An item could also be returned if too much information is included in the endorsement, for example more than one manufacturer endorsed.

Missing or incorrect patient exempt or paid declarations are not referred back to contractors – if patient declarations are missing this can lead to switching and potentially inappropriate charge deductions.

Returns code table

The following table explains what each return code means:

Receiving referred back items

At present, most contractors receive their monthly RB items for both EPS and paper prescriptions through the post. Currently, over a third of contractors receive their RB items via the Manage Your Service (MYS) portal.

Digital RBs received via Manage Your Service (MYS)

Contractors signed up to MYS can request to view and action their prescription returns digitally from their MYS accounts. Currently, using MYS for receiving RBs is optional, and contractors need to sign up to receive their prescription returns digitally by registering their interest with NHSBSA to have this feature turned on. Contractors wishing to access their digital RBs and disallowed items should contact the MYS team by emailing nhsbsa.mys@nhs.net to enable access to these features on their MYS portal. Once the MYS prescription returns feature is enabled, paper prescription returns will no longer be posted to the pharmacy.

The advantages of using MYS for RB items are:

  • it allows contractors to add information easily
  • contractors receive their RB items sooner
  • provides the relevant information required to process the items faster
  • track the progress of RB items throughout until the point they are processed
  • contractor can manage resubmission claims easily
  • completed RB can be submitted to the NHSBSA at any time
  • minimise any risks of losing paper RB items during transit
  • monthly status reports of refer RB items can be requested from the NHSBSA
  • reduction in phone calls from NHSBSA to pharmacies to clarify information provided

When the required additional information has been added to the relevant sections within MYS, contractors can submit RB items electronically to the NHSBSA for re-processing. If the submitted information is still insufficient to allow NHSBSA to process the prescription for payment, the item will be re-sent to the contractor.

It is important to note that prescription returns via MYS are only held in the system for a period of 18 months from the date they are first sent to the pharmacy for action; if contractors have not completed and returned any outstanding RBs before this deadline has passed, the RB items will be deleted from system.

Paper RBs received via post

Contractors that are not signed up to receive digital RB items via the MYS portal, receive a letter via the post from the NHSBSA with information on any RB items.

For any RB items on paper FP10 prescriptions, an image of the prescription is copied on to an A4 sheet identifying the RB item including any endorsed information and patient details such as name and address. EPS RB items received via the post are a text image of the prescribed and dispensed item and include the patient’s NHS number only.

Each RB prescription item returned via post has a specific RB code listed underneath the image of the prescription to inform the contractor why the item was returned and explains what information needs to be completed on the prescription returns form to allow the NHSBSA to process the item for payment. There is an additional information box at the bottom of the prescription returns form for pharmacy teams to populate the required information for each RB item.

Once the required information has been added for each RB item, the prescription returns form is ready to be submitted to the NHSBSA after the end of the dispensing month.

End of month submission process for completed RB items

During the end of month submission process, the total number of completed RB prescription forms and items being resubmitted should be declared in the relevant boxes in Part 1 of the paper FP34C submission document or by using the digital MYS submission form.

Please note only the number of items returned for clarification where payment has been delayed should be declared on the FP34C submission document. This is because payment will already have been received for any other items on the returned forms.

Any completed paper RBs should be sorted and placed securely at the top of the appropriate, ‘exempt’ or ‘charge paid’ groups.

How are re-submitted items processed by the NHSBSA?

Prescription items that are re-submitted for payment are priced using the Drug Tariff relevant to the dispensing month in which the prescription return is received by the NHSBSA. This can lead to a delay in payment and potential cash-flow risks if very expensive items, or many items are RB in a month.

The volume of RBs can be greatly reduced by adopting good endorsing practices and thorough end-of-month submission checks.

See examples below:

Example 1 – Supplier or manufacturer details missing – appliance
e.g. where a generic prescription is received for an appliance and multiple products meeting that description are listed in the appliances section of the Drug Tariff

Example 2 – Product name missing
e.g. where a generic prescription for an inhaler includes a trademarked name

Example 3 – No pharmaceutical form listed on the prescription

Action: Return to the prescriber to be amended to include pharmaceutical form.

Example 4 – Total quantity not stated but clear from dosage instructions

Example 5 – Endorsement of non-Part VIIIA generic products

Example 6 – Missing prescriber code

Please note: Where a contractor provides the drugs or appliances ordered on any NHS prescription form, except forms issued by a Dental Practitioner, the Pricing Authority may return the prescription form to the contractor (as a referred back) if there is no prescriber code(s) present on the prescription form and request that the contractor seek the appropriate code(s).

Disallowed prescriptions

Copies of prescriptions returned marked as ‘disallowed’ let pharmacy contractors know if an item has not been passed for payment by the Pricing Authority as it is not permitted on an NHS prescription. These copies can be used as learning opportunities for pharmacy staff to help prevent future disallowed items.

Guidance on whether a particular product can be dispensed on an NHS prescription is available from the Pricing Authority’s helpdesk (0300 330 1349) or from the PSNC Dispensing and Supply Team info@psnc.org.uk or 0203 1220 810.

Where a copy of a prescription has been returned incorrectly marked as ‘disallowed’, it should be returned to the Pricing Authority with the normal monthly prescription submission. The resubmitted item should be placed on the top of the bundle and clearly marked “Pricing Authority Error – resubmitted for reimbursement” (or equivalent).

PSNC closely monitors problems with copies of prescriptions being returned for clarification incorrectly. Please report suspected incorrect returns to the PSNC Dispensing and Supply Team who will ensure that this is fed back to the Pricing Authority.

PSNC Top Tips

  • Returned prescriptions are priced using the Drug Tariff relevant to the month in which the prescription return is re-submitted to NHSBSA this can delay payment and potentially cause cash-flow issues.
  • Reduce your volume of returns by ensuring that all prescriptions are appropriately endorsed. See our Endorsement guidance page for more information and links to our endorsing factsheet.
  • When preparing your prescriptions for submission double-check that all prescriptions have the appropriate endorsements, and that the endorsement is clear. See our Prescription Submission Factsheet for guidance.
  • Only include figures for the items requiring additional information on your FP34C all other products on the form have already been processed and reimbursed.
  • Missing or incorrect patient declarations are not referred back – if patient declarations are missing this can lead to switching and potentially inappropriate charge deductions.
  • To register for MYS contact mys@nhs.net

The NHSBSA Prescription Services helpline can be contacted for further advice if pharmacy staff are unsure as to why an item has been returned or if it is unclear as to what needs to be endorsed. Telephone: 0300 330 1349 or 0191 279 0568; email: nhsbsa.prescriptionservices@nhsbsa.nhs.uk

FAQs

Q. Where on a paper referred back prescription does it indicate if it has been processed as exempt or chargeable?

Photocopied prescriptions returned to contractors for further information contain a reference code underneath the image of the prescription. This reference code indicates the form type (for example FP10SS) and then either ‘C’ for chargeable or ‘E’ for exempt. Where a prescription was exempt from charges, a second letter, corresponding to the exemption categories on the back of the prescription form, will indicate which box the patient or their representative ticked. For example, from the reference code ‘FP10D E B’ on a returned photocopy, it is possible to tell:

  • the prescription form type, in this case an FP10D dental prescription
  • the exemption status, in this case, the ‘E’ indicates the prescription was considered exempt from the prescription charge. Prescriptions that are considered ‘Charge Paid’ will show the letter ‘C’
  • the patient’s exemption group, in this case, the ‘B’ indicates that the patient was exempt from the prescription charge because they were 16, 17 or 18 years of age and in full time education. If NHSBSA have been unable to determine the category, the second letter will be a ‘Z’.

Q. My referred back prescription has been damaged; how can I get a replacement?

A. If your referred back prescription is damaged or lost you can contact NHSBSA who can arrange for a copy to be sent out to you. NHSBSA can be contacted via telephone on 0300 330 1349 / 0191 279 0568 or by emailing nhsbsa.prescriptionservices@nhsbsa.nhs.uk

Q. How do I register for access to receive and complete my RB items using MYS?

A. Contractors wishing to access their digital RBs and disallowed items should contact the MYS team by emailing nhsbsa.mys@nhs.net to enable these features on their MYS portal. Once the MYS prescription returns feature is enabled, paper prescription returns will no longer be posted to the pharmacy.

Further information on the MYS registration and log-in process can be found on the NHSBSA website.

Q. Can I receive reports of items referred back to the pharmacy each month?

A. Contractors who access their RB items using MYS can view reports on the portal that show how many RBs were received from the NHSBSA, how many have been re-submitted, how many are awaiting action by the NHSBSA and how many have been successfully processed. The reports help to keep track of RBs and can be used as a learning tool for pharmacy staff to help reduce the number of RBs by endorsing prescriptions correctly.

Contractors can also check whether an item was referred back by checking their monthly Prescription Item (Px) reports. The product will be marked in column AP (column heading ‘RB’) if an item has been RB. Column AQ (column heading ‘RB value’) displays the RB code for which the item was RB. To access item reports, contractors should register for the Information Services Portal on the NHSBSA’s website.

Q. Do completed RB items need to be declared on my FP34C submission document?

A. Yes, the total number of completed RB prescription forms and items being resubmitted should be declared in the relevant boxes in Part 1 of the paper FP34C submission document or by using the digital MYS submission form. Please note only the number of items returned for clarification where payment has been delayed should be declared on the FP34C submission document. This is because payment will already have been received for any other items on the returned forms.

Related Resources

EPS returns

Using Your Schedule of Payment to Monitor Performance

Understanding Prescription Returns factsheet

Daily Dispensing Checks

Sorting You Prescriptions Prior to Submission

Monthly Payments

Prescription Pricing Accuracy

Digital Prescription Returns

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

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