Split pack dispensing
Split pack dispensing
There are reimbursement arrangements in place for times when pharmacy contractors need to split an original pack in order to dispense the prescribed quantity to recognise the need to obtain extra packaging and patient leaflets.
What is a 'split pack'?
For a Drug Tariff listed line, a “split pack” quantity is where the quantity prescribed on a prescription is not equal to or a multiple of the pack sizes listed in Part VIIIA of the Drug Tariff.
For non-Drug Tariff listed lines, a “split pack” quantity is determined by the contractor’s endorsement. Where the proprietary product is prescribed, the contractor is paid the NHS list price for the pack size endorsed. Where the prescription is written generically, the contractor will need to endorse the pack size and the brand name or the name of the manufacturer or wholesaler from whom the supply was purchased.
Payment for containers is at the rate of 10p for every prescription item supplied where a split pack quantity is dispensed to account for additional containers used.
As of 1st July 2012, only one pack size is listed for the majority of products in Part VIIIA of the Drug Tariff unless there is a clinical need for a range of quantities to be included e.g. analgesics or where the product is classified as a “special container”.
The listed pack size in Part VIIIA has been selected based on commonly prescribed/dispensed quantities and available pack sizes. This will enable contractors to supply in either the listed pack or multiples of the listed pack on most occasions.
Always supply the exact quantity prescribed (unless the products has special container status or is covered under Part II Clause 13b – Reconstitution of Certain Oral Liquids) (note: Calendar Packs have been removed and as such rounding up or down of such products is no longer permitted).
The Terms of Service require all pharmacists to supply a manufacturer’s original pack for every prescription where possible.
Drug Tariff listed lines:
- Category A and M – no endorsement.
- Category C – pack size if more than one pack size is listed.
Non-Drug Tariff listed lines:
- Pack size AND
- Brand name or manufacturer or wholesaler
The following fees will be paid per item prescribed:
- Single Activity fee
- Consumable allowance fee set at 1.24p
- Price of prescribed item pro rata*
- ‘Split pack’ or container fee where appropriate (see above)
*For readily available medicinal products only (special containers, items requiring reconstitution and appliances are treated differently):
Drug Tariff listed lines (Part VIIIA):
Payment will be pro-rata based on the Drug Tariff listed price.
Non-Drug Tariff listed lines (non-Part VIIIA):
Where a proprietary product is prescribed, the contractor is paid the NHS list price the pack size endorsed. For generically written prescriptions payment will be based on the endorsement.
Q. What do the 1st July 2012 changes to the Pharmaceutical Services Regulations (Terms of Service) mean?
Paragraph 8(10)(a)* of the Terms of Service requires a pharmacist who dispenses a prescription ordering a quantity that is available as a manufacturer’s original pack (within the UK), or multiple of such an available pack size should supply only original packs of medicines unless; either it is not possible to obtain the manufacturer’s packs with reasonable promptness, or where it is not practicable for the pharmacist to supply in such a way, (for example because the patient’s needs or the method of administration means that supplying in the manufacturer’s pack is not practicable.
This ensures that patients are supplied with an appropriate Patient Information Leaflet (PIL) with every supply (in line with long standing EU labelling directive which has been incorporated into UK law by the Medicines for Human Use (Marketing Authorisations Etc.) Regulations 1994). Contractors should endeavour to procure pack sizes reflective of prescribing practice in the locality, which may mean having more than one pack size if significant numbers are routinely prescribed in different pack sizes (e.g. both 28s and 30s)
*(10)(a) Where a drug is ordered by a prescriber on a prescription form or repeatable prescription in a quantity that is, or is a multiple of a quantity that is, readily available in a pack size manufactured for a holder of a marketing authorisation for the drug, the pharmacist must provide the drug in an original pack (or original packs) of that size which has been assembled by a manufacturer of the drug for such a holder of a marketing authorisation, unless
(a) it is possible for the pharmacist to obtain such a pack (or packs) with reasonable promptness in the normal course of business; or
(b) it is not practicable for the pharmacist to provide such a pack (or packs) in response to the order (for example, because of patient needs or the method of administration of the drug)
Q. If I receive a prescription for a quantity readily available in an original pack, am I obliged to dispense only this pack size or can I split an alternative pack and be paid the 'split pack' container allowance fee?
The Terms of Service require supply of a product in a manufacturer’s original pack where practicable. If a contractor does not have the prescribed pack size available but can supply the product from an alternative pack size, they could do so to ensure that the patient receives their medication with reasonable promptness. However, for Drug Tariff listed lines payment will only be based on the Drug Tariff listed pack size
The 10p container allowance payment for providing a split pack is payable where the quantity prescribed is outside of a Drug Tariff listed pack size. In this instance, as the quantity prescribed is readily available in an original pack, the 10p payment would not be made.
Q. I have a prescription for 224 x Paracetamol Tablets 500mg, which pack size can I use?
Paracetamol 500mg Tablets has two listed pack sizes; 32 and 100. 224 is an exact multiple of 32 and so this pack size should be provided, however; if the 32 pack size cannot be supplied with reasonable promptness, the contractor may dispense from the 100 pack size. In this scenario, the contractor would not receive the 10p payment as the quantity prescribed is a multiple of a readily available original pack.
Q. If I receive a prescription written as 1 x OP how can I determine the most appropriate pack size to supply?
Unless there is only one pack size available for the product, prescriptions where an original pack has been prescribed will require amendment to specify the pack size requested following confirmation from the prescriber.
Q. Does split pack dispensing apply to controlled drugs as well e.g. Oxycodone and Morphine Sulphate?
Yes, all items listed in Part VIIIA including controlled drugs are affected by the split pack dispensing rules.