Use of ‘FS’ endorsement for free supply of COVID-19 trial treatments

The Department of Health and Social Care (DHSC) has published guidance for prescribers and community pharmacy teams on the correct use of ‘FS’ endorsement on NHS prescriptions (FP10 or EPS) to enable free supply of certain COVID-19 trial medicines to patients participating in either the HEAL-COVID or the STIMULATE-ICP clinical trial platforms.

Arrangements have been in place since December 2021 for eligible patients to receive free-of-charge (FOC) antiviral medicines after testing positive for COVID-19. The prescription charge waiver has been extended to other therapeutic trial treatments available through the HEAL-COVID and STIMULATE-ICP clinical trial platforms through use of the ‘FS’ endorsement. These arrangements will remain in place until 31 March 2023.

The trial medicines are usually supplied directly to eligible participants by the clinical trial team. However, because some participants in these trials will be required to take the drugs for up to 12 months and the treatments are being used outside their normal licensed indications, the Medicines and Healthcare products Regulatory Agency (MHRA) have advised that GPs should prescribe the trial medicines to patients using a FP10 prescription form or the EPS service. The trial medicines used in HEAL-COVID are Apixaban and Atorvastatin. STIMULATE-ICP currently uses a combination of Famotidine and Loratadine (in combination), Rivaroxaban and Colchicine.

The key points within the guidance are outlined below:

  • Prescribers must write the COVID-19 trial treatments on a separate prescription from any other prescribed medicines the patient is taking.
  • Prescribers must apply the ‘FS’ endorsement correctly to ensure that it is apparent to pharmacy teams that the trial medicines are to be dispensed free-of-charge (FOC).
  • Patients should not pay a prescription charge for any items endorsed ‘FS’.
  • In EPS, prescribers should confirm ‘FS’ by selecting the appropriate flag, so that the prescription carries the ‘FS’ endorsement correctly. The ‘FS’ endorsement must not be manually added by a prescriber to the free text field EPS dosage area or other free text sections of the prescription as this will not be recognised by the NHS Business Services Authority (NHSBSA) during processing.
  • On FP10’s, prescribers must endorse the front of the paper prescription form by writing ‘FS’ and signing next to each item prescribed for participants in the HEAL-COVID or STIMULATE-ICP clinical trials.
  • The ‘FS’ endorsement cannot be applied or endorsed on prescriptions by pharmacy staff or patients.
  • To ensure that ‘FS’-endorsed medicines are treated as FOC items by the NHSBSA, pharmacy teams must ensure the correct exemption reason is selected before the prescription is submitted for payment (see guidance below for dealing with ‘FS’-endorsed EPS and paper prescriptions)
  • Paper prescriptions with items endorsed ‘FS’ should be placed in the red separator for exempt prescriptions when submitted to the NHSBSA for processing.

The ‘FS’ prescriber endorsement was introduced in January 2020, to enable prescribers to indicate that a product is being prescribed for the treatment of a sexually transmitted infection (STI) and therefore can be provided to the patient FOC on a FP10 form. To enable free supply of COVID-19 trial treatments, DHSC took the decision to exceptionally use the ‘FS’ endorsement for this purpose as it is already available to prescribing systems and meets the requirements for this particular service.


Dispensing ‘FS’-endorsed prescriptions

EPS prescriptions

The ‘FS’ endorsement has now been configured on prescribing systems for EPS. Prescribers should revert to issuing paper prescriptions with the ‘FS’ endorsement manually added against each item to be supplied FOC, if ‘FS’ isn’t working as expected.

Where configured into EPS, the message code ‘Y’ (0017) should be used for prescriptions containing only ‘FS’ endorsed items. The message code ‘Y’ (0017) should be populated before an EPS claim is submitted for payment (some PMR systems may automatically apply this code if an ‘FS’ endorsed item is prescribed).

Please note the ‘FS’ endorsement should NOT be manually added to the EPS dosage instructions field as this would not allow a pharmacy contractor to supply any item(s) FOC against NHS prescriptions. Addition of any free-typed supplementary information to the dosage instruction field or other fields such as ‘additional instructions’, will not be taken into account for reimbursement purposes as this information is not captured by the NHSBSA during processing. If an electronic prescription is received with the prescriber ‘FS’ endorsement contained within the dosage area, the prescriber should be contacted to cancel the prescription, and a correctly endorsed prescription re-issued. See psnc.org.uk/dosearea.

Paper prescriptions

The initials ‘FS’ and the prescriber’s signature should be annotated by hand alongside the item(s) being prescribed. ‘FS’ CANNOT be endorsed by the patient or a pharmacist.

Where a prescriber has endorsed ‘FS’ against an item on a prescription, the patient does not need to make a declaration and sign the reverse of the FP10 form or provide any evidence.

All paper FP10 prescription with the prescriber ‘FS’ endorsement should be placed in the red separator for end of the month submission.

The NHSBSA will recognise the ‘FS’ endorsement where it is correctly applied by the prescriber and treat the marked item(s) as FOC accordingly.


Prescriptions that include ‘FS’ endorsed item and chargeable item on the same form

Prescribers should NOT include items classed as FOC on the same prescription form as a chargeable item. If other items that are not FOC are prescribed on the same form, they would be chargeable unless the patient is exempt from prescription charges for other reasons. See psnc.org.uk/exemptions.

The table below highlights how to treat ‘FS’ only and mixed prescriptions for both exempt and non-exempt patients, and how to correctly submit these prescriptions for payment:

Patient status   Items on prescription   Patient declaration and prescription submission guidance 

Not exempt from prescription charges 

‘FS’ item only 

Paper: No patient tick box on paper FP10 form and Token. The reverse of the FP10 form or Token does not need to be completed and a patient’s signature is not required.
The form must be placed
 in a red separator with the exempt section in the end of month prescription bundle. 

EPS: If configured into EPS and your PMR system, use new message code ‘Y’ (0017). 

Note: some pharmacy systems may automatically apply this code if only ‘FS’ endorsed items are prescribed using EPS.

‘FS’ item and other FOC item e.g. contraceptives 
Note: Items annotated with ‘FS’ and therefore classed as FOC should NOT be included on the same prescription form as items for which a prescription charge is usually applicable. 

Paper: No patient tick box on paper FP10 form and Token. The reverse of the FP10 form or Token does not need to be completed and a patient’s signature is not required.
The form must be placed
 in a red separator with the exempt section in the end of month prescription bundle. 

EPS:  Use code ‘X’ (0010) or “was prescribed free-of-charge contraceptives”; or 

If configured into EPS and your PMR system, use new message code ‘Y’ (0017). 

‘FS’ item and other chargeable items 

Note: Items annotated with ‘FS’ and therefore classed as FOC should NOT be included on the same prescription form as items for which a prescription charge is usually applicable.

Paper: The prescription form or Token must be signed with a declaration applied to clearly indicate the total amount of prescription charges collected.
The form must be placed
in a red separator with the chargeable section in the end of month prescription bundle. 
EPS: Select the appropriate prescription message code (0001) (or 0000 charge paid at old rate where applicable) to indicate that the patient has paid the appropriate charges and clearly indicate the total amount of prescription charges collected. 

Exempt from prescription charges 

‘FS’ item and other chargeable items 

Note: Items annotated with ‘FS’ and therefore classed as FOC should NOT be included on the same prescription form as items for which a prescription charge is usually applicable.

Paper: The prescription form or Token must be signed with a declaration applied based on the patient’s actual reason for exemption from prescription charges for e.g. medical exemption certificate.
The form must be placed
 in a red separator with the exempt section in the end of month prescription bundle. 

EPS: Select the appropriate message code relating to the patient’s actual reason for exemption from prescription charges for e.g. if the patient holds a valid medical exemption certificate use message code ‘E’ (0006). 

 


FAQs

Q. Is there a list of drugs to which the ‘FS’ prescriber endorsement can be applied to?

A. No, the ‘FS’ endorsement will operate by way of guidance, prescribers should exercise their clinical discretion in accordance with their professional duties and obligations.

Q. Are all items on the prescription exempt from prescription charges if a prescriber has added ‘FS’ endorsement to an item?

A. No, only those items endorsed ‘FS’ should be treated as FOC. All other items would be chargeable unless the patient is exempt from prescription charges for other reasons. Note: Items annotated with ‘FS’ and therefore classed as FOC should NOT be included on the same prescription form as items for which a prescription charge is usually applicable.

How do I submit paper prescriptions with items endorsed ‘FS’ at the end of the month?

A. All paper prescriptions with the prescriber ‘FS’ endorsement should be placed in a red separator when submitted to the NHSBSA for processing.

How will the NHSBSA process prescriptions with ‘FS’ endorsed item(s)?

A. The NHSBSA will recognise the ‘FS’ endorsement when it is correctly applied by the prescriber and treat the marked items as free-of-charge, accordingly.


Useful links

For further information on the ‘FS’ endorsement please see our factsheet*.

See our PSNC Briefing 002/20: Changes to FP10 NHS prescription form and EPS Tokens*

*these resources were produced prior to the extension of use for the ‘FS’ endorsement and therefore refer only to the use of ‘FS’ for “free supply of sexual health treatment”.