Prescription charge refund procedure
Prescription charge refund procedure
|REF: Drug Tariff Part XVI, Clause 7|
Full details of the prescription charge refund procedure can be found in Part XVI of the Drug Tariff.
When to issue Prescription refund and receipt forms
- If the patient (or representative) requests one; or
- If the patient (or representative) is unsure whether they are entitled to free prescriptions; or
- If the patient (or representative) has applied or will be applying for a prescription charge exemption certificate or prepayment certificate.
If proof is required by the patient or representative to show that the charge was paid or for any reason other than the above, a till receipt may be sufficient.
Where to obtain the Prescription refund and receipt forms (FP57)
FP57 can be obtained from the Primary Care Support England (PCSE) portal. For a full list of what other stationary can be ordered from the PCSE portal then please see the Dispensing Factsheet – NHS stationery for community pharmacy obtainable from the Primary Care Support England (PCSE) portal (June 2016).
Issuing prescription refund and receipt forms
Prescription refund and receipt forms must be issued at the time the prescription charge is paid as later requests may be a fraudulent attempt to obtain another refund. Only authorised pharmacy staff should proceed to issue prescription refund and receipt forms as follows:
- Part A must be fully completed by the dispenser or an authorised member of staff.
- Alterations and mistakes to the amounts or the quantities in Part A are not allowed, if a mistake is made, then the you need to start again with a new form and cross through the discarded form with, “CANCELLED” written diagonally across it. These should be kept for audit purposes. The dispenser can initial any other alterations elsewhere on the form.
- The pharmacy stamp and date of payment must be on the form with the patient’s name and address, the prescription charge paid per item, the number of charges paid and the total charges paid.
Processing prescription refund and receipt forms in the pharmacy
Pharmacists in England may process refunds for prescription refund and receipt forms issued in England, Scotland or Wales.
Pharmacists in Wales can only make prescription refunds on Welsh receipt and refund forms (WP57).
Authorised member of staff should accept prescription refund and receipt forms:
- If it was issued at another pharmacy; or
- If the form was issued by a hospital or other NHS organisations including a dispensing doctor or appliance contractor.
Refund claim procedure
Patients who do not have an FP57 but still claim they have grounds to a refund should be should be advised to write to:
Help with Health Costs
152 Pilgrim Street
Newcastle Upon Tyne
Or telephone 0300 330 1343, to explain why they were unable to obtain an FP57. The claim will be reviewed and either a refund will be authorised by sending form LIS04(P) or the patient will be advised if they do not qualify.
When a patient presents a prescription refund and receipt form for payment, pharmacy staff should proceed as follows:
- Check the serial number on the form to ensure it is in the same format as the forms held by that pharmacy (old style FP57/WP57 (0403) versions of the form may also still be processed);
- Check that there are no alterations to the amounts or quantities in Part A and the form appears genuine;
- Check if the patient is included in an award of Universal Credit – if they are, they should tick box 11 for income-based jobseeker’s allowance, until the prescription forms are updated, and show their Universal Credit award notice as evidence (see Part XVI Notes on charges in the most current Drug Tariff for full requirements of pharmacy staff — for patients claiming a refund based on the Universal Credit exemption arrangements);
- Check that the claim is being made within three months of the date the charge was paid, (e.g. if charge is paid 1 January, the refund must be claimed by 31 March), or the patient has an authorised form (LIS04(P)) from the NHS Business Services Authority (NHSBSA), Help with Health costs;
- Request evidence of entitlement to exemption or sight of form LIS04(P) authorising payment;
- Check that the evidence relates to the patient;
- Check that the evidence covers the date on which the charge was paid;
- Note on the form what evidence was produced (e.g. tax credit exemption certificate);
- Where applicable, note on the form the reference number on the exemption document;
- Where applicable, note on the form the LIS04(P) form reference number and date;
- Ask the person claiming the refund to print their name and address on the form (or the representative’s details where appropriate).
If the above is all is in order, the pharmacy should pay the amount shown in Part A of the form and ask the patient or their representative to sign and date the form. A member of staff authorised to make refunds should also sign and print their name on the form. If the form is not in order the pharmacist should telephone the prescription , NHS Protect fraud line number on 0800 028 4060 (England) or CFS Wales on 01495 745844 (Wales).
Form FP57 is valid for three months from the date of issue. If more than three months have elapsed and they do not have an LIS04(P) form, patients will need to send the FP57 form to:
Help with Health Costs,
152 Pilgrim Street,
Newcastle upon Tyne,
They must also send a letter explaining why they did not claim the refund within the three month time limit. The claim will be reviewed and either a refund will be authorised by sending form LIS04(P) or the patient will be advised if they do not qualify.
Submission to the Pricing Authority
In England, pharmacy contractors are required to submit forms to the Pricing Authority at the end of each month along with their prescription bundles being submitted for payment. Contractors should declare the number of FP57 refunds submitted each month and the total amount refunded on the FP34c using either the paper document or MYS.
In Wales, paid forms should be sent to Powys LHB via the Business Services Centre local offices in the normal way.
Contractors are reimbursed for the amount refunded to the patient, one month after the FP57 refund has been declared on the FP34c paper document or MYS portal. For example, if a refund was made during April and submitted to the Pricing Authoritybefore the 5th of May, the contractor would be reimbursed for that refund on the 1st June.
Additionally, the Department of Health and Social Care added £200k to the total contract sum, to fund the administration workload of issuing prescription charge refunds. The funding is distributed in proportion to prescription volume rather than as a specific fee per refund.
Q. Where can I obtain FP57 Refund and Receipt Forms?
FP57 can be obtained from the Primary Care Support England (PCSE) portal. For a full list of what other stationary can be ordered from the PCSE portal then please see the Dispensing and Supply factsheet: NHS stationary for community pharmacy obtainable from the PCSE portal.
Q. Where can I obtain form LIS04(P)?
Form LIS04(P) is sent to the patient by NHSBSA, Help with Health Costs and issued to allow authorised pharmacy staff to process late refund claims. In the event of late claims, patients will need to send the FP57 form to:
Help with Health Costs,
152 Pilgrim Street,
Newcastle upon Tyne,
They must also send a letter explaining why they did not claim the refund within the three-month time limit. The claim will be reviewed and either a refund will be authorised by sending form LIS04(P) or the patient will be advised if they do not qualify
Q. Do all NHS pharmacies in England have to issue refunds against Form FP57?
Yes. Regulation 96 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (the Regulations) states: “Where any person who is entitled to a repayment of any charge paid under the Charges Regulations presents an NHS pharmacist with a valid claim for the repayment within three months of the date on which the charge was paid, the NHS pharmacist must make the repayment.”
Q. My pharmacy is based in England, a patient has brought in Form WP57 (Welsh Prescription Charge Refund Form). Should I make the refund?
The Regulations require pharmacy teams to make refunds against prescription charge receipts issued in England (FP57 Forms). Part XVI Notes on charges in the Drug Tariff* states “Pharmacists in England may process refunds for prescription refund and receipt forms issued in England, Scotland or Wales”. The paid FP57 form will be sent to the Prescription Pricing Authority in the normal way.
(* August 2016 Drug Tariff)
Q. My pharmacy is based in Wales, a patient has brought in Form FP57 (English Prescription Charge Refund Form), should I make the refund?
No. Welsh pharmacies will not be reimbursed for issuing cross-border refunds. If a patient presents a completed FP57 claim form for refunding at a Welsh pharmacy, then the community pharmacist must inform the patient that they are unable to make a refund and that they should present the FP57 form at a community pharmacy in England for refunding.
Q. A patient has visited my pharmacy with an FP57 receipt for payment of prescription charges. The patient did not have their prepayment certificate to show but they had the prepayment certificate reference number and the date issued. They had bought their certificate from the Pricing Authority over the phone using their credit card but were waiting for the actual card to be sent to them. Can I issue a refund?
To issue a refund, it is necessary for you to see the actual prepayment certificate. The reference number and date issued is not definitive proof of exemption. FP57 forms are valid for three months and if the patient has recently applied for the certificate they should wait for the certificate to be received and then return to the pharmacy for a refund. The patient should receive the certificate well before the three months have expired.
Q. Are dispensing doctors required to issue refunds?
No. Whilst Regulation 96 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 refers to a requirement for NHS pharmacists to issue refunds, there is no corresponding provision relating to dispensing doctors.