21 products reclassified as special containers

21 products reclassified as special containers

June 5, 2020

Following a review of the special container status of certain products, the Department of Health of Social Care (DHSC) has determined that 21 products now meet the special container criteria as set out in Part II Clause 10 of the Drug Tariff. A special container indicator for the relevant pack size (complete pack or sub-pack) has been applied to the respective product entries in dictionary of medicines and devices (dm+d) and in the Drug Tariff, where listed.

Generic drug name (dm+d descriptor) Brand and/or Manufacturer Pack size Special container Change effective from 
Ascorbic acid powder J M Loveridge Ltd 100g Complete pack May
Aspirin powder J M Loveridge Ltd 250g Complete pack May
Boric acid powder J M Loveridge Ltd 500g Complete pack May
Clomethiazole 157.5mg/5ml oral solution sugar free

Heminevrin (Cheplapharm Arzneimittel GmbH)

All available generics

300ml Complete pack June
Desmopressin 100 microgram tablets

DDAVP 0.1mg tablets (Ferring Pharmaceuticals Ltd)

All available generics

90 Complete pack June
Desmopressin 200 microgram tablets

DDAVP 0.2mg tablets (Ferring Pharmaceuticals Ltd)

All available generics

30 and 90 Complete pack June
Doravirine 100mg tablets Pifeltro (Merck Sharp & Dohme Ltd) 30 Complete pack June
Emtricitabine 200mg / Tenofovir alafenamide 10mg tablets Descovy (Gilead Sciences International Ltd) 30 Complete pack June
Emtricitabine 200mg / Tenofovir alafenamide 25mg tablets Descovy (Gilead Sciences International Ltd) 30 Complete pack June
Lamivudine 300mg / Tenofovir disoproxil 245mg / Doravirine 100mg tablets Delstrigo (Merck Sharp & Dohme Ltd) 30 Complete pack June
Levofloxacin 100mg/ml nebuliser liquid ampoules Quinsair (Chiesi Ltd) 56 Complete pack June
Sodium bicarbonate powder J M Loveridge 300g Complete pack May
Sodium valproate 100mg tablets Epilim 100mg crushable tablets (Sanofi)

100 (10 x 10)

30 (3 x 10)

Sub-pack of 10 June
Sodium valproate 200mg gastro-resistant tablets

Epilim 200 gastro-resistant tablets (Sanofi)

All available generics

100 (10 x 10)

30 (3 x 10)

Sub-pack of 10 June
Sodium valproate 200mg modified-release tablets Epilim Chrono 200 tablets (Sanofi)

100 (10 x 10)

30 (3 x 10)

Sub-pack of 10 June
Sodium valproate 300mg modified-release tablets Epilim Chrono 300 tablets (Sanofi)

100 (10 x 10)

30 (3 x 10)

Sub-pack of 10 June
Sodium valproate 500mg gastro-resistant tablets

Epilim 200mg gastro-resistant tablets (Sanofi)

All available generics

100 (10 x 10)

30 (3 x 10)

Sub-pack of 10 June
Sodium valproate 500mg modified-release tablets Epilim Chrono 500 (Sanofi)

100 (10 x 10)

30 (3 x 10)

Sub-pack of 10  June
Tartaric acid powder J M Loveridge Ltd 500g Complete pack May
Urea 10% lotion Eucerin Intensive 10% lotion (Beiersdorf UK Ltd) 250ml Complete pack June
Zinc oxide powder J M Loveridge 500g Complete pack May

The special container status of a product can be viewed by entering the relevant product details into the dm+d browser.

FAQs

Why have all tablet formulations of Epilim been reclassified as special containers?
Drugs that are hygroscopic are granted special container status as part of the criteria listed in Part II Clause 10 of the Drug Tariff. All tablet formulations (gastro-resistant, modified-release and crushable) of Epilim have been re-classified as special containers as the SPC’s of these products clearly state that ‘Epilim is hygroscopic. The tablets should not be removed from their foil until immediately before they are taken. Where possible, blister strips should not be cut.’

What quantity would I be reimbursed for supplying against a prescription ordering 28 x Epilim 100mg crushable tablets?
Epilim 100mg crushable tablets have been re-classified as a special container in sub-packs of 10. If a prescription calls for 28 tablets, you would dispense and be reimbursed for 30 tablets (3 x 10 sub-packs).

What quantity would I be reimbursed for supplying against a prescription ordering 15 x Epilim 100mg crushable tablets?
Epilim 100mg crushable tablets are widely available in packs of 30 and are classed as a special container in sub-packs of 10. Where the quantity ordered falls exactly between two special container pack sizes, the contractor should round down the quantity dispensed to the nearest complete special container pack size. In this case, if a prescription calls for 15 tablets, a contractor would round down to dispense and be reimbursed for 10 tablets (1 x 10 sub-pack).

What quantity would I be reimbursed for supplying against a prescription ordering 112 x Epilim 200mg gastro-resistant tablets?
Epilim 200mg gastro-resistant tablets have been re-classified as a special container in sub-packs of 10. If a prescription calls for 112 tablets, you would dispense and be reimbursed for 110 tablets (11 x 10 sub-packs).

Can I dispense the exact prescribed quantity if this is different to the special container pack size?
Where the quantity ordered does not coincide with that of the special container pack size you are required to supply the nearest complete pack or sub-pack(s) nearest to the quantity ordered. However, in a small number of cases, where there is an over-riding clinical requirement to dispense the exact quantity ordered rather than the nearest complete pack or sub-pack size (for example, if the drug is required to be packaged into a weekly compliance aid), pharmacists would need to assess the clinical appropriateness of splitting the pack to dispense the exact quantity bearing in mind the impact on the stability of the drug once removed from its original packaging. There may be patient safety issues to consider if a pharmacist decides to dispense the exact quantity ordered (if not a multiple of the sub-pack size). For example, if a hygroscopic drug is not stored and used correctly, exposure to moisture could affect the integrity of the drug by potentially decreasing its stability and/or efficacy.

Can Epilim tablets be dispensed in a Monitored Dosage System (MDS)?
Pharmacists dispensing small but frequent quantities (e.g. weekly) of Epilim tablets will need to assess the clinical appropriateness of cutting the blister to dispense the exact quantity bearing in mind the impact on the stability of the drug once removed from its original packaging. As Epilim tablets are hygroscopic and therefore sensitive to the effects of moisture, any water ingress may result in the chemical and/or physical stability of the drug being compromised. Given the nature of these products and the special precautions for storage as outlined in the SPC, it may be advisable for prescribers to review the prescribing of these products away from split packs, where clinically appropriate.

For further guidance on stability of drugs in Monitored Dosage Systems (MDS) please refer to the Specialist Pharmacy Service guidance on Usage of Medicines in Compliance Aids.

Will my payment be based on endorsement if I dispense the exact quantity ordered of a drug (which is not a multiple of a special container pack size)?
Using their professional discretion, if a pharmacist dispensed the exact prescribed quantity of a product classed as a special container, contractors will be reimbursed according to special container rules, regardless of any endorsement. The payment rules for special containers may mean that in some cases contractors are reimbursed more than the prescribed quantity and, in other cases, it may be less.

What quantity should I dispense against a prescription ordering Heminevrin 250mg/5ml syrup x 100ml?
Clomethiazole 31.5 mg/ml oral solution sugar-free (Heminevrin 250mg/5ml syrup) has been re-classified as a special container as it is not practicable to dispense the exact prescribed quantity where this is different from the original pack size (300ml) or its multiple. The reason for this is that the SPC for Heminevrin 250mg/5ml syrup states the following: ‘Store in the original container. Do not transfer the syrup to another container since it may not be compatible with the container material’.  Therefore, for a prescription ordering 100ml of Heminevrin 250mg/5ml syrup, you would dispense and be reimbursed for supplying the complete pack size of 300ml. The patient should be advised to only take the drug for prescribed duration of treatment and return any residual balance to the pharmacy for safe disposal.


Background

Part II Clause 10 of the Drug Tariff sets out the rules for the quantity to be supplied of a prescribed product. Under the normal rules, pharmacy contractors are reimbursed for supplying the exact quantity ordered by the prescriber unless the preparation has been recognised as being packaged in a special container; for example, where the product is sterile or hygroscopic.

Part II CLAUSE 10 B of the Drug Tariff ‘Drugs and Chemical Reagents in Special Containers’ states the following:

“Where the quantity ordered by the prescriber does not coincide with that of an original pack and the drug or chemical reagent is: 

(i) Sterile 

(ii) Effervescent or hygroscopic, or 

(iii) (a) Liquid preparations for addition to bath water 

       (b) Coal Tar preparations 

       (c) Viscous external preparations 

(iv) Packed in a castor, collapsible tube, drop-bottle, pressurised aerosol, puffer pack, roll-on bottle, sachet, shaker, spray, squeeze pack, container with an integral means of applications, or any other container from which it is not practicable to dispense the exact quantity: 

the contractor shall supply in the special container or containers the quantity nearest to that ordered and endorse the prescription form with the number and size of those containers. Although payment will normally be based on the quantity nearest to that ordered, some items are available in a larger size pack or container than that normally required pursuant to orders on prescription forms. Where the amount ordered on a prescription form, or the frequency of supply, justifies supply from such larger size pack or container, payment will be based on the cost of that larger size in the absence of endorsement.” 

If you identify any particular product(s) which are not currently classed as special containers but you believe satisfy the criteria (as set out in Part II CLAUSE 10 B of the Drug Tariff), please notify PSNC’s Dispensing and Supply Team (0203 1220 810 or info@psnc.org.uk) who will investigate and assess if it meets the relevant criteria. Where appropriate, PSNC will make application to the NHSBSA and DHSC seeking for the special container status of the product(s) to be re-determined.



Posted in: ,


More Latest News >