This page explains what disallowed items are and the reasons why certain items may be disallowed by the NHS Business Services Authority (NHSBSA). It also highlights the checks that can be made during the dispensing process to try and minimise the risks of dispensing and/or endorsing items that are not permitted on the NHS.
What is a disallowed item?
A disallowed item is one that has NOT been passed for payment by the NHSBSA. Disallowed items should not be confused with items which are referred back to contractors for further clarification because insufficient information was available for the NHSBSA to process the prescription(s) for payment (for example, due to missing endorsements).
Why are prescription items disallowed?
Items issued on NHS prescription forms are disallowed by the NHSBSA for many reasons, including where the item is not permitted for prescribing on the NHS, items ordered by dentists or community nurse prescribers which are not listed in their respective drug formularies, or is an appliance or chemical reagent that is not listed in Part IX of the Drug Tariff. The pricing systems flag such items to NHSBSA staff, who then re-check affected prescriptions and mark relevant items as disallowed following Drug Tariff and prescription processing rules.
The NHSBSA apply a coding system to identify up to 19 possible reasons for disallowing items that are ordered on the NHS of which 7 are applicable to community pharmacies. Each prescription item disallowed by the NHSBSA is assigned a DA code followed by a number to indicate the reason for the disallowed item. The table below shows a list of Disallowed Reason Codes (pharmacy only) in order of % frequency (based on disallowed item figures between August 2019 – July 2020)
|Disallowed reason code||Disallowed reason||Item volume and % frequency (in descending order)|
|DA20||As it is a nominated EPS token incorrectly submitted for processing and reimbursement (excluding tokens used to claims for supplies made against SSPs)||30,941 (62.5%)|
|DA2||As it is not an appliance or chemical reagent listed in Part IX of the Drug Tariff||11,637 (23.5%)|
|DA4||As it is not a drug listed in the Dental Practitioners’ Formulary (DPF) in Part XVIIA of the Drug Tariff from which a dentist may order on a valid FP10D form||3,528 (7.1%)|
|DA3||As it is not a drug, appliance or chemical reagent listed in the Nurse Prescribers’ Formulary (NPF) in Part XVIIB(i) of the Drug Tariff from which a community nurse prescriber may order on a valid NHS prescription form||2,569 (5.2%)|
|DA1||As certain drugs and other substances listed in the Part XVIIIA of the Drug Tariff cannot be prescribed on the NHS||350 (0.7%)|
|DA19||As it is an item that is not prescribed on an authorised or valid form||323 (0.7%)|
|DA6||As it is not a drug or preparation which may be prescribed on a blue FP10MDA instalment dispensing form||149 (0.3%)|
How many items are disallowed by the NHSBSA?
According to information provided by the NHSBSA, nearly 50,000 items were disallowed in the 12 months between August 2019 and July 2020.
For the most recent month we have data for – July 2020 – a total of 3,256 items were disallowed of which 490 items (15%) were issued via EPS and the rest (85%) were paper prescriptions/tokens. However, if we exclude the number of disallowed EPS tokens that were incorrectly submitted for reimbursement (reason code DA20), then the total number of disallowed EPS items represents 40% (490) of the remaining total of all disallowed items (1,210) in July 2020.
How do I know if an item submitted for payment has been disallowed by the NHSBSA?
Manage Your Service (MYS) – contractors can now receive details of any disallowed items including the item number and disallowed reason via the MYS portal (see image below). Disallowed items via MYS can arrive daily. Contractors wishing to access their digital referred back and disallowed items using MYS should contact the MYS team by emailing email@example.com to enable these features on the MYS portal.
Paper – contractors that are not signed up to receive digital disallowed items via the MYS portal, receive a letter via the post from the NHSBSA with information of any disallowed items. An image of the prescription is copied on to an A4 sheet (see example below) identifying the disallowed item, with a DA reason code to inform the contractor why the item was disallowed. A contractor will normally receive any postal disallowedFP10 items within the first 2 weeks of the month once a bundle is received by the NHSBSA.
Prescription Item (Px) report – contractors can check whether a product has been disallowed by also checking their Px report. The product will be marked in column W (column heading ‘DA’) if a product has been disallowed. Column X (column heading ‘DA value’) displays the reason code for the prescription being disallowed. To access item reports, contractors should register for the Information Services Portal on the NHSBSA’s website.
What if I disagree with the reason(s) given by the NHSBSA for disallowing an item?
If it is believed that an item has been incorrectly disallowed by the NHSBSA, contractors may submit a challenge to the NHSBSA, who will investigate the issue and rectify any missing payments if a processing error is identified.
To challenge disallowed items returned via MYS, contractors can click on a link available under the disallowed item displayed on the portal. A free-text box is provided for a contractor to provide a reason as to why they believe the item has been disallowed in error, and to provide a contact email address. Once a challenge is successfully submitted, the information is sent directly to the NHSBSA Helpdesk to action, removing the need for contractors to send a separate email or make a telephone call.
Contractors wishing to challenge any disallowed items that are received through the post, can contact the NHSBSA Helpdesk (0300 330 1349) or email firstname.lastname@example.org for further advice.
Any communication to inform the contractor of the outcome of their challenge is handled by the NHSBSA Prescription Services Helpdesk, outside of MYS. The outcomes of a challenge from an MYS perspective would either be for the item to remain as a disallowed item if it was deemed that the item was correctly disallowed, or the status of the item would be changed in MYS from a disallowed item to a referred back item to allow the contractor to provide any additional information required by the NHSBSA to process the item for payment.
If a pharmacy contractor remains unsatisfied with outcome of a disallowed item challenge, they can contact PSNC’s Dispensing & Supply team on 0203 1220 810 or email their query to email@example.com for further advice on the matter.
Top tips to avoid disallowed items:
- Ensure systems are kept up to date – to reduce the risks of users inadvertently prescribing/dispensing products that have recently been amended/deleted from the Drug Tariff and or dm+d, users should ensure their systems are kept up to date. PSNC recommends that EPS suppliers synchronise to the dm+d and Drug Tariff changes frequently (note that the dm+d is updated weekly by the NHSBSA). Frequent mapping, particularly at the start of each month, is critical to ensuring systems reflect recent Drug tariff and dm+d changes in a timely manner (for example, new/deleted items etc). Where in doubt, pharmacy staff should check the latest online Drug Tariff or search the NHS Dictionary of medicines and devices (dm+d) to confirm if an item will be passed for payment
- Establish nature of product – check if the drug (medicinal or non-medicinal substance including food supplements or cosmetic items) is permitted on the NHS or is the appliance (medical device) listed in Part IX of the Drug Tariff. Some PMR suppliers have configured their systems to help minimise or remove the risk of users inadvertently dispensing a disallowed drug or appliance, for example, by generating warning prompts when a disallowed product is prescribed/selected or endorsed.
- For drugs: A drug is only allowed if it is NOT listed in Part XVIIIA (Drugs, Medicines and Other Substances that may not be ordered under the NHS) of the Drug Tariff. Additionally, certain drugs or appliances on the Selected List Scheme (SLS) can only be prescribed in certain circumstances, for the specified patient groups listed in Part XVIIIB of the Drug Tariff.
- For appliances: The presence of a CE mark, (normally found on the outer packaging, information leaflet, or on the device itself) indicates that a product is an appliance. Only devices listed under the Appliances section in Part IX (Parts IXA, IXB and IXC) of the Drug Tariff are allowed on NHS prescriptions. Up to 3 months advance notice of deletion is given before an appliance is deleted from the Drug Tariff.
- Check prescriber type/qualification – does the prescriber hold relevant registration(s) to issue prescriptions for the items ordered? Some prescribers are restricted by their qualifications to prescribe certain products only. For example, dentists, are limited to prescribing for their NHS patients only those drugs listed in the Dental Practitioners’ Formulary (DPF) in Part XVIIA of the Drug Tariff when using FP10D forms.
- Are the prescribed items listed in the relevant prescriber’s formulary? – If the prescription is issued by a Community Nurse Prescriber or Dentist, check that the item is listed in the Nurse Prescribers’ Formulary or Dental Practitioners’ Formulary, respectively
- Is the product prescribed on a valid NHS form? – Pharmacy staff must check if the prescribed product has been prescribed on a valid NHS form. Form types can be identified by the code on the bottom right of a paper prescription form. A table of valid NHS prescriptions forms that can be dispensed by community pharmacies is available to view on the Is this prescription form valid? page. The NHSBSA website also has information on current and out of date forms for different prescriber types.
- Prescriber endorsements – check if the prescriber has annotated the prescription with the correct endorsements for e.g. ‘SLS’ for items on the Selected List Scheme that may only be ordered in certain circumstances.
- Follow correct end of month sorting and submission processes – EPS tokens for non-payment should not be mixed in with paper prescriptions submitted for payment each month. Pharmacy teams are reminded that only tokens used to claim for supplies made against SSPs should be placed in the red separator.
If pharmacy contractor identifies a prescription for a disallowed item, it should not be dispensed. Instead, the prescription cancellation process should be followed, and the prescriber should be alerted so that an alternative product permitted on the NHS can be considered, or where appropriate, a private prescription can be obtained.
Q. NHSBSA has returned a photocopy of an FP10D dental prescription for ‘Ibuprofen 100mg/5ml oral suspension’ marked as disallowed. Why was this prescription not passed for payment?
A. Only items listed in the Dental Practitioners’ Formulary (DPF) in Part XVIIA of the Drug Tariff can be prescribed on an FP10D prescription. There is a sugar-containing and sugar-free formulation of this product available. However, only the sugar-free formulation is listed in the DPF; therefore, only ‘Ibuprofen 100mg/5ml oral suspension sugar free’ can be prescribed on NHS dental prescriptions. If a pharmacy receives a FP10D for the standard ‘Ibuprofen 100mg/5ml oral suspension’, the prescription should be returned to the dentist for the words ‘sugar free’ to be added.
Q. NHSBSA has returned a photocopy of a green FP10 prescription for Nytol 25mg tablets marked as disallowed. Why was this prescription not passed for payment?
A. Nytol 25mg tablets is covered by the ’Nytol Tablets’ listing in Part XVIIIA of the Drug Tariff for ‘Drugs, Medicines and other Substances not to be ordered under a General Medical Services Contract’ and will therefore not be passed for payment by the NHSBSA if it issued on an NHS prescription form regardless of prescriber type.
Q. I have a prescription for ‘Olive oil ear drops 10ml’, can I dispense Cerumol olive oil ear drops?
A. No. Cerumol olive oil ear drops is classed as a medical device (as it has a CE mark) and would not be passed for payment because the item is not listed in the Appliances section in Part IXA of the Drug Tariff. Other brands or suppliers of olive oil ear drops are listed in Part IXA of the Drug Tariff which will be passed for payment, if endorsed accordingly.
Q. How can I identify the prescribing rights of different types of nurse prescribers?
A. To identify a nurses’ prescribing qualifications, pharmacy contractors are advised to check the register held by the Nursing & Midwifery Council. The qualifications can help determine what a nurse is able prescribe and if the prescription will be passed for payment. See our Who can prescribe what? page for information of the prescribing rights for different types of prescriber.
Q. An item has been returned as disallowed because ‘it is not a drug, appliance or chemical reagent listed in the Drug Tariff Part XVIIB from which a Nurse Prescriber may order on a prescription form’. Can this disallowed item be challenged if the prescription was issued by a Nurse Independent Prescriber?
A. Nurse Independent Prescribers are not restricted to prescribing items listed in the Nurse Prescribers’ Formulary (NPF) listed in Part XVIIB of the Drug Tariff. Nurse Independent Prescribers can prescribe any medicine (except for those listed in Part XVIIIA of the Drug Tariff) for any medical condition, within their own professional competence and expertise. This includes any Controlled Drugs listed in Schedules 2-5, except diamorphine, dipipanone, or cocaine for treating organic disease or injury but not for treating addiction. If an item prescribed by a Nurse Independent Prescriber has been incorrectly disallowed, contractors may submit a disallowed item challenge to the NHSBSA who will investigate the issue and rectify any missing payments if a processing error is identified.
Q. I successfully challenged NHSBSA on an incorrectly disallowed prescription, which months Drug Tariff will reimbursement be based on?
A. If a successful challenge is made to a disallowed item, the product will be priced according to the month in which the item was re-processed by the NHSBSA for example, if a product was first submitted with a contractor’s January 2021 bundle and was successfully challenged in March 2021, the pricing of the prescription would be paid based on the March 2021 Drug Tariff.
Q. The letter of disallowed items posted by the NHSBSA has been lost or damaged; what should I do?
A. You will need to contact NHSBSA’s helpline who can investigate the issue for you and arrange for replacement copies to be sent. NHSBSA’s telephone number is 0300 330 1349 or 0191 279 0568 or email firstname.lastname@example.org