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The Scottish Drug Tariff
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The Scottish Drug Tariff

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  • 1. The Scottish Drug Tariff Don Page, ISD
  • 2. Plan of talk
    • NHS Scotland: organisation
    • Prescribing, Dispensing & Reimbursement
    • The Scottish Drug Tariff
    • Prescription Charges (section 2)
    • Endorsing & other matters (section 2)
  • 3. NHS Scotland
    • Providers (14)
    • Ayr & Arran HB
    • Borders HB
    • Fife HB
    • Grampian HB
    • Etc.
    • Special Boards (8)
    • Scottish Ambulance
    • NES
    • QIS
    • Health Protection
    • NSS
    • Etc.
  • 4. National Services Scotland
    • Central Legal office
    • SNBTS
    • Health Facilities Scotland
    • National Procurement
    • Information & Statistics Division
    • Practitioner Services Division
    • National Services Division
  • 5. Practitioner Services Division
    • Evaluates and pays for work done by contractors providing services to NHS Scotland
    • Dental
    • General Medical Services
    • Ophthalmic
    • Pharmacy
  • 6. PSD Pharmacy
    • Bain Square, Livingston (scanning)
    • Bridge View, Aberdeen
    • Meridian Court, Glasgow
    • Gyle Square, Edinburgh
    • Prescriptions are sent to Livingston
    • Evaluation is done at the three bureaus
  • 7. Information & Statistics Division
    • Collects, analyses and published all data regarding NHS Scotland
    • Data Intelligence Group
    • Epidemiology & Statistics Group
    • Healthcare Information Group
      • Evadis team
      • Prescribing Team
  • 8. Prescribing, Dispensing & Reimbursement
    • Prescribing Act of mandating treatment
    • Dispensing Act of fulfilling prescription
    • Reimbursement Payment for prescription
    • Remuneration Overall payment for services
    • Remuneration = Sum of reimbursement + fees
  • 9. Who can prescribe?
    • Medical practitioners
    • Dental practitioners
    • Nurse prescribers
    • Pharmacists
    • Allied Health Professionals
    • All prescribers must be recognised by their home health board
  • 10. Who can dispense?
    • Community Pharmacy
    • Dispensing Doctor
    • Dispensing Appliance Contractor
    • The person or body must hold a contract to supply dispensing services with the Health Board where the premises are situated.
  • 11. Reimbursement & remuneration
    • All prescriptions are sent to PSD for evaluation
    • Payment is based on calendar month of dispensing
    • PSD will work out the sum of all work done, and calculate the sum to be paid
    • Payment is made direct to contractor bank account by BACS
  • 12. Reimbursement process
    • Ingredient cost for each prescription
    • Prices are based on published NHS prices, or on agreed Drug Tariff rate
    • Prices are updated from first working day of the month
    • At end of processing, the sum of ingredient costs are evaluated
    • Discounts are deducted
  • 13. Remuneration
    • Final net ingredient cost calculated
    • Additional payments based on overall national pharmacy contract are added in
    • Additional claims and allowances will be added in
    • Adjustments made for locally negotiated services
    • Final sum is evaluated and paid
  • 14. Pharmaceutical Care contract
    • Negotiated between Scottish Government and contractor negotiators
    • Minor Ailment Scheme
    • Acute Medication Scheme
    • Chronic Medication Scheme
    • Public Health services
    • Additional elements (Oxygen, Stoma etc.)
  • 15. Prescription Types
    • GP10 GP
    • GP14 Dentist
    • GP 10 N Nurse
    • GP10 A Stock Order
    • CP2, CP-US Pharmacy forms
    • HBP, HBPA Hospital issues
    • FP10, WP10, HS21 Rest of UK
  • 16. Commodities
    • Medicinal Products
    • Medical Devices
    • Borderline Substances
    • Pay & Report (Scotland only)
  • 17. Medicinal products
    • Defined as when ingested, inhaled or applied produces a medicinal effect
    • Defined here as holding a full marketing authorisation issued by MHRA or EMEA
    • Will be paid on GP10 unless listed in the blacklist
  • 18. Medical Devices
    • An inert product which when applied to the body will produce a medicinal effect
    • Product must be listed in Drug Tariff
    • Listing is usually specific regarding description, dimensions and specification
  • 19. Borderline Substances
    • Lists as foods, cosmetics and other items that produce a medicinal effect
    • Defined by the Advisory Council on Borderline Substances (ACBS)
    • List can be found in BNF appendix 7
    • Will be paid on GP10 prescriptions
  • 20. Pay & Report
    • Only applies to Scotland
    • Occurs in the GMS regulations
    • Covers products outside the above
    • Includes food & vitamin supplements, herbal products, unlicensed items
    • PSD pays the contractor, and a report is sent to the Health Board
  • 21. THE SCOTTISH DRUG TARIFF
    • Founded in Regulation 9 of the Pharmaceutical Regulations in the NHS (Scotland) Act
    • Compiled and published by ISD
    • www.isdscotland.org
    • Updated at start of month
    • Web-site has a mini-Google search engine attached
  • 22. Basic Structure
    • Statutory Notices
    • Lists of allowed medical devices
    • List of drugs & preparations with tariff prices
    • Formularies
    • Discount Scale
    • Restricted products
  • 23. Part 1: General Information
    • Statutory Notices & definitions
    • Ground rules for price determination
    • Ground rules for payment
    • Annex 1: Zero Discount List
    • Annex 2: Prescription charges
    • Annex 3: Remuneration letter
  • 24. Part 2: Dressings
    • Note the table of contents at front
    • Set out in commodity order
    • Dressings split into plain dressings and wound management products
    • All products have a pack size of ONE
    • Note that not all dressing sizes available are listed
    • Includes most sterile irrigations
    • The list does not include sticking plasters
  • 25. Part 3: Appliances
    • Note the table of contents
    • Urinary catheters: default prices
    • Hypodermic equipment
    • Sutures
    • Products for erectile dysfunction
  • 26. Part 4: Elastic Hosiery
    • Specifications: three grades of compression are listed
    • Flight socks, anti-embolism stockings and support tights are not allowed
    • Can be measured and fitted
    • Ensure patient has leaflet on care of product: each garment can last up to 6 months
    • Prescription charge is one piece per garment
  • 27. Part 5: Incontinence
    • Items sorted by
      • Commodity
      • Manufacturer
      • Brand Name (if applicable)
    • Quote manufacturer code for correct payment
    • Trade name index at end of part
  • 28. Stoma products
    • Formerly called part 6: accessible from tariff web page
    • Similar structure to Part 5
    • Contractor MUST be registered as stoma provider to be paid
    • Check with patient as to product needed
    • Use the manufacturer code
  • 29. Part 7: Drugs & preparations with tariff prices
    • List of medicines with agreed prices
    • Is on the web in Excel
    • Supplement A covers flu vaccines
    • Supplement B covers smaller packs used in the Minor Ailment Scheme
    • In case of short supply, contact Community Pharmacy Scotland
  • 30. Part 8a: Dental Practitioner Formulary
    • Medicines Act gives dentists same prescribing rights as doctors
    • BDA instructs that dentists prescribe within their area of practice & training
    • Part 8a covers items allowed on GP14
    • BNF also lists allowed items by monograph
    • MUST USE FORMULARY TITLE
  • 31. Part 8b: Nurse prescriber formulary
    • For Practice Nurses & Health Visitors
    • Medicines must be prescribed by formulary title
    • Allowed all medical devices unless marked “Nx” in left hand column
    • Not allowed most POM lines, unlicensed medicines and borderline substances
  • 32. Independent Prescribers
    • Will have taken 3 months training including one month supervised by a doctor
    • Allowed most products in the BNF
    • Allowed most devices in tariff (not Nx)
    • Restrictions on Schedule 2 & 3 Controlled Drugs
    • Not allowed unlicensed products and borderline substances
  • 33. Supplementary prescribers
    • The prescriber enters an agreement with a primary prescriber (doctor or dentist) and the patient under a defined Clinical Management Plan (CMP)
    • Allowed virtually any item, provided that it is in the CMP
  • 34. Part 9: Reagents
    • Restricted to lines in Part 9
    • Covers mainly blood glucose test strips
    • Meters and calibration products are not allowed
    • Multiple test urine sticks not allowed
    • Urea breath test kits for Helicobacter are medicinal products, and will be paid
  • 35. Part 10: Oxygen
    • Pharmacy contractor must be approved by Health Board to be paid
    • Contains specifications for cylinders and associated equipment
    • Requests for unusual requirements must be referred to the Board
    • Oxygen concentrators: refer to Health Facilities Scotland
  • 36. Part 12: Selected List Scheme
    • List of specific items for specified patients for specific conditions
    • Prescriber must indicate SLS on the prescription to denote correct prescribing
    • Part 12B is the EC Transparency Notice
    • Part 12C is the current blacklist (web only)
  • 37. Part 13: Shortages List
    • Published on web only
    • List of products for given month where part 7 rules are suspended due to proven shortages
    • Contractor can claim the invoice price if agreed that the product cannot be obtained at the Part 7 price
  • 38. Part 14: Business rules
    • This part is on the web only
    • This is a summary of basic rules for prescription processing
    • This part will be re-written at some stage to cover electronic prescription requirements
  • 39. HELP!
    • Contact local pricing office (group leader)
    • Community Pharmacy Scotland
    • PSD Help-desk
    • National Pharmaceutical Association
    • ISD Customer Help Desk
  • 40. Web sites
    • www.isdscotland.org
    • www.psd.scot.nhs.uk/pharmacists/index.html
    • www.sehd.scot.nhs.uk
    • www.show.scot.nhs.uk
    • www.communitypharmacyscotland.org.uk
    • www.npa.co.uk