Specials Endorsing Guidance

Are you eSPECIALly confused?

Unravelling the specials complexities

By Philip Koopowitz

I have been getting increasingly confused by the latest regulations regarding Specials. This may be because I am lucky enough to run both a Dispensary and a Pharmacy.

I have spent some time trying to unravel the complexities of the situation.

For Dispensing Doctors:

1. Specials listed in Part VIIIB of the Drug Tariff

Will be re-imbursed at the price listed in the Tariff - note that the prices will increase if greater volumes of the Special are dispensed as set out in the Tariff. In practical terms, using Bendroflumethiazide as an example, if you dispensed 200ml, then the re-imbursement would work out as Tariff price for 150ml plus additional price for 50ml

= £125.48 (for 150ml) plus 50(ml) X £0.60( per additional ml)
= £125.48 + 30.00
= £155.48

NHS Prescription Services has also confirmed that items in Part VIIIB of the Drug Tariff for quantities greater than the listed Tariff size will be split and itemised as two parts (i.e. the Tariff pack size and a second item comprising of any quantity requested over that pack size) Items listed in Part VIIIB will be processed as a single item with payment from the relevant pack sizes listed in Part VIIIB as appropriate to the quantity prescribed.

Dispensing doctors cannot claim any Out of Pocket expenses for this and will have clawback (normally 11.18%) taken off.

Following discussion, dispensing doctors are  now able to claim a £20 specials dispensing fee (applies to all specials) by endorsing the claim 'XP'.

You should be able to obtain these medications for less than the tariff price and hopefully make up the loss from the clawback. St Thomas Court Buying Group has negotiated a set price for these Specials from a specials manufacturer. More details can be obtained via their website http://www.stthomascourtgroup.co.uk/

2. For Specials not listed in Part VIIIB of the Drug Tariff

Will be re-imbursed at the cost price minus any discounts. You will need to send invoices as proof of costs and discounts.

Dispensing doctors cannot claim any Out of Pocket expenses for this and will have clawback (normally 11.18%) taken off. Dispensing doctors will make a loss on all of these products.

For Pharmacies:

1. Specials listed in Part VIIIB of the Drug Tariff

Will be re-imbursed at the price listed in the Tariff - note that the prices will increase if greater volumes of the Special are dispensed as set out in the Tariff. In practical terms, using Bendroflumethiazide as an example, if you dispensed 200ml, then the re-imbursement would work out as Tariff price for 150ml plus additional price for 50ml

= £125.48 (for 150ml) plus 50(ml) X £0.60( per additional ml)
= £125.48 + 30.00
= £155.48

Pharmacist cannot claim any Out of Pocket expenses for this and will have pharmacy clawback (dependent upon cost of all items dispensed in a month) taken off.  Pharmacists must endorse these products SP and will be given £20 per item.

2. For Specials not listed in Part VIIIB of the Drug Tariff

Pharmacists will be re-imbursed at the cost price minus any discounts. They will need to send invoices as proof of costs and discounts.

Pharmacists cannot claim any Out of Pocket expenses for this and as these are Zero discounted products, will have no clawback taken off. In addition, they will receive £20 per item. They need to be endorsed SP for those products manufactured under an MHRA licence and EP if they fall into the Section 10 -Exemption from Medicines Act 1968 category - please check the Drug tariff for further details.

Also see: DDA Midazolam endorsing guidance
Specials FAQs