Exemption status (EPS)
Exemption status (EPS)
EPS exemption factsheet
Download a factsheet about EPS and exemptions (produced by PSNC and NHS Digital)
Prescription charge/exemption status
In addition to the current endorsing information, pharmacy staff will also have to mark whether a prescription charge was levied for a prescription, and where relevant the prescription charge exemption category and whether evidence of exemption was seen. The exception to this is where the patient is age exempt and the patient’s date of birth is included in the electronic prescription message. For EPS prescriptions, systems may compare the date of birth with the date of the dispense notification to determine whether age exemption automatically will apply. If the declaration date takes place at a different time, systems can allow the pharmacy to determine age exemption manually.
Pharmacy system supplier enhancements to ease data input
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.
Frequently asked questions
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 NHS Prescription Services?
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.
Q. I have a prescription for a patient who was 59 when their prescription was written, however the patient did not declare age exemption until they were 60 at the time they collected the medicine. Is the patient exempt from paying a prescription charge?
A. Yes, subject to the prescription still being within the period of validity. Entitlement to prescription exemption can be based on the timing of the patient declaration rather than being based on the date the prescription was written. In this case, the patient was over 60 when they declared age exemption.
For EPS prescriptions, systems may compare the date of birth with the date of the dispense notification to determine whether age exemption automatically will apply. If the declaration date takes place at a different time, systems can allow the pharmacy staff to adjust age exemption manually.
The printed age on a prescription token or dispensing token may show the age at the time of the printing. Age exemption should be determined by the point at which the patient declares exemption rather than their printed age.
The Pricing Authority may issue penalty charge notices to patients where they determine there may be an issue. They should use the EPS token to help determine eligibility.
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 NHS Prescription Services; 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 NHS Prescription Services.
NHS Prescription Services 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 NHS Prescription Services – 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.
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 NHS Prescription Services 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.