Prescription Rechecks

Prescription Rechecks

Pharmacy contractors concerned about prescription pricing errors may request the NHS Business Services Authority (NHSBSA) to carry out a recheck of prescription(s) (or entire monthly prescription bundles) if it is believed that they have been priced incorrectly. This factsheet explains how contractors can make a request to have a specific month or months’ prescriptions  rechecked by the NHSBSA. Part XIVB of the Drug Tariff outlines the current prescription recheck arrangements for contractors.

Download our factsheet relating to Prescription re-checks.

Identifying payment discrepancies

Each month, contractors are encouraged to reconcile their Schedule of Payment (SoP) against a copy of the associated FP34C submission form sent to NHSBSA. The SoP provides a monthly summary of payments for drugs and appliances dispensed, total of fees, breakdown of expensive items, and details of any local and other payments authorised.

If contractors believe they have been paid incorrectly by the NHSBSA, PSNC advises pharmacy contractors to first check their monthly SoP, as soon as possible upon receipt, to identify any anomalies, unusual trends or potential errors. If the summary of payments outlined in the SoP do not indicate the possible source(s) of error, pharmacy contractors can drill down into their item-level payments by accessing and viewing the relevant monthly Prescription Item (Px) reports available from NHSBSA’s Information Services Portal.

Reasons why pharmacy contractors may request an item-level or entire prescription bundle recheck relate to issues involving:

  • Item counts – discrepancy between the number of items declared by the contractor and those processed for payment by the NHSBSA – refer to PSNC’s factsheets on EPS 5-day window and Number of items – getting your declaration right for further information
  • into their processing systems
  • Endorsements – certain prescription item endorsements that appear to have been missed by the NHSBSA
  • Missing payments and/or other payment errors – expected total monthly payment or item-level payment is lower than that received by the contractor
  • Expensive items – missing or incorrectly reimbursed expensive items
  • Out of pocket expenses – incorrect or missing payments for any out of pocket expense claims submitted
  • Prescription charges – discrepancy between the number of prescription charges declared by the contractor and those deducted by the NHSBSA
  • Switching – higher than usual number of paper prescriptions switched between exempt and chargeable groups
  • EPS Release 2 – any EPS related-issue including missing or incorrectly paid items, items marked as ‘’Not Dispensed’ or where items are submitted with incorrect exemption reason/paid category

PSNC has created a factsheet on ‘Understanding your Schedule of Payments’ to help contractors identify any payment discrepancies and consider if a recheck is required.

Requesting a prescription or bundle recheck

If after checking through monthly SoPs and/or Px reports, a contractor believes a pricing error has been made by the NHSBSA, a recheck of a month or specific months’ prescriptions can be requested following the process outlined below:

  • Fill out a prescription pricing enquiry form (see image below) indicating the nature of the enquiry (for e.g. number of items, expensive items, switching etc) which has affected payment and providing any additional information which may help NHSBSA to process the recheck request.
  • Once completed, the enquiry form must be signed and date, and submitted via email to repricingrequest@nhs.net or alternatively the form can be posted to the Customer Payments Team, NHS Business Services Authority, Bridge House, 152 Pilgrim Street, Newcastle upon Tyne, NE1 6SN.
  • All requests must be submitted no later than eighteen months from the end of the month of dispensing month (e.g. for prescriptions dispensed in September 2020, the request must be submitted before end of 31 March 2022). After the eighteen-month deadline has passed, for example: 1 October 2021 for prescriptions dispensed in March 2020, no further requests can be made for that dispensing month. Complete a separate form for each month being requested for a recheck.
  • Contractors with more than one pharmacy need to complete separate request forms for each pharmacy and month they wish to have rechecked.

Pharmacy contractors should be aware that where they have requested rechecks of one or more complete monthly bundle(s), NHSBSA has indicated that it will select an equivalent number of additional months to check, where appropriate. This to ensure that any adjustments made fairly reflect both underpayments and overpayments.

Payment adjustments and notification of recheck results by NHSBSA

Following the re-check:

  • where a net underpayment is revealed, the contractor will be paid the value of the underpayment.
  • where a net overpayment is revealed, the NHSBSA will recover the value of the overpayment.

 Any adjustments made can be broadly split into the following categories:

  • Drugs credit/debit: This is the net adjustment taking into account drug costs and payments for containers (‘split pack fees’) for items wrongly priced, missed (i.e. not priced at all initially) or priced in error.
  • Fees credit/debit:This is a net adjustment in relation to single activity fees, expensive item fees and prescription charges. Again, such adjustments may be necessary in the case of accounts where there have been items wrongly priced, missed (i.e. not priced at all initially) or not dispensed (ND) items priced in error as well as for prescriptions that have been ‘switched’ in error, or conversely, not switched during the initial pricing but should have been.

Following completion of a recheck, the NHSBSA issue a letter to the contractor indicating the number of forms and items counted during the recheck and provide certain information regarding errors and adjustments made including details on the most common errors found in the batch; this information is provided so that the contractors can adjust their processes to prevent the same error from recurring. Accounts are adjusted to reflect any over or under-payment by the NHSBSA at the next available opportunity.

If contractors are unhappy with the outcome of a recheck or would like further details on a recheck, they can contact the NHSBSA helpdesk on 0300 330 1349. Alternatively, the relevant team at NHSBSA can be reached by emailing nhsbsa.repricingrequest@nhs.net.

If contractors still disagree with the outcome of a recheck following contact with NHSBSA helpdesk,  PSNC’s Dispensing and Supply team can be contacted for further advice by emailing info@psnc.org.uk or by phoning 0203 1220 810

If contractors are unhappy with the outcome of a recheck or would like further details on a recheck, they can contact the NHSBSA helpdesk on 0300 330 1349. Alternatively, the relevant team at NHSBSA can be reached by emailing nhsbsa.repricingrequest@nhs.net.

If contractors still disagree with the outcome of a recheck following contact with NHSBSA helpdesk,  PSNC’s Dispensing and Supply team can be contacted for further advice by emailing info@psnc.org.uk or by phoning 0203 1220 810


Further resources

Prescription re-check Factsheet

NHSBSA’s Prescription Recheck Request Form

Understanding your FP34 Schedule of Payments

Factsheet: Using Your Schedule of Payments to Monitor Performance 

Number of items – getting your declaration right

Prescription Switching

Prescription Submission

 



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