The Scottish Drug Tariff Don Page, ISD
Plan of talk <ul><li>NHS Scotland: organisation </li></ul><ul><li>Prescribing, Dispensing & Reimbursement </li></ul><ul><l...
NHS Scotland <ul><li>Providers (14) </li></ul><ul><li>Ayr & Arran HB </li></ul><ul><li>Borders HB </li></ul><ul><li>Fife H...
National Services Scotland <ul><li>Central Legal office </li></ul><ul><li>SNBTS </li></ul><ul><li>Health Facilities Scotla...
Practitioner Services Division <ul><li>Evaluates and pays for work done by contractors providing services to NHS Scotland ...
PSD Pharmacy <ul><li>Bain Square, Livingston (scanning) </li></ul><ul><li>Bridge View, Aberdeen </li></ul><ul><li>Meridian...
Information & Statistics Division <ul><li>Collects, analyses and published all data regarding NHS Scotland </li></ul><ul><...
Prescribing, Dispensing & Reimbursement <ul><li>Prescribing Act of mandating treatment </li></ul><ul><li>Dispensing Act of...
Who can prescribe? <ul><li>Medical practitioners </li></ul><ul><li>Dental practitioners </li></ul><ul><li>Nurse prescriber...
Who can dispense? <ul><li>Community Pharmacy </li></ul><ul><li>Dispensing Doctor </li></ul><ul><li>Dispensing Appliance Co...
Reimbursement & remuneration <ul><li>All prescriptions are sent to PSD for evaluation </li></ul><ul><li>Payment is based o...
Reimbursement process <ul><li>Ingredient cost for each prescription </li></ul><ul><li>Prices are based on published NHS pr...
Remuneration <ul><li>Final net ingredient cost calculated </li></ul><ul><li>Additional payments based on overall national ...
Pharmaceutical Care contract <ul><li>Negotiated between Scottish Government and contractor negotiators </li></ul><ul><li>M...
Prescription Types <ul><li>GP10 GP </li></ul><ul><li>GP14 Dentist </li></ul><ul><li>GP 10 N Nurse </li></ul><ul><li>GP10 A...
Commodities <ul><li>Medicinal Products </li></ul><ul><li>Medical Devices </li></ul><ul><li>Borderline Substances </li></ul...
Medicinal products <ul><li>Defined as when ingested, inhaled or applied produces a medicinal effect </li></ul><ul><li>Defi...
Medical Devices <ul><li>An inert product which when applied to the body will produce a medicinal effect </li></ul><ul><li>...
Borderline Substances <ul><li>Lists as foods, cosmetics and other items that produce a medicinal effect </li></ul><ul><li>...
Pay & Report <ul><li>Only applies to Scotland </li></ul><ul><li>Occurs in the GMS regulations </li></ul><ul><li>Covers pro...
THE SCOTTISH DRUG TARIFF <ul><li>Founded in Regulation 9 of the Pharmaceutical Regulations in the NHS (Scotland) Act </li>...
Basic Structure <ul><li>Statutory Notices </li></ul><ul><li>Lists of allowed medical devices </li></ul><ul><li>List of dru...
Part 1: General Information <ul><li>Statutory Notices & definitions </li></ul><ul><li>Ground rules for price determination...
Part 2: Dressings <ul><li>Note the table of contents at front </li></ul><ul><li>Set out in commodity order </li></ul><ul><...
Part 3: Appliances <ul><li>Note the table of contents </li></ul><ul><li>Urinary catheters: default prices </li></ul><ul><l...
Part 4: Elastic Hosiery <ul><li>Specifications: three grades of compression are listed </li></ul><ul><li>Flight socks, ant...
Part 5: Incontinence <ul><li>Items sorted by </li></ul><ul><ul><li>Commodity </li></ul></ul><ul><ul><li>Manufacturer </li>...
Stoma products <ul><li>Formerly called part 6: accessible from tariff web page </li></ul><ul><li>Similar structure to Part...
Part 7: Drugs & preparations with tariff prices <ul><li>List of medicines with agreed prices </li></ul><ul><li>Is on the w...
Part 8a: Dental Practitioner Formulary <ul><li>Medicines Act gives dentists same prescribing rights as doctors </li></ul><...
Part 8b: Nurse prescriber formulary <ul><li>For Practice Nurses & Health Visitors </li></ul><ul><li>Medicines must be pres...
Independent Prescribers <ul><li>Will have taken 3 months training including one month supervised by a doctor </li></ul><ul...
Supplementary prescribers <ul><li>The prescriber enters an agreement with a primary prescriber (doctor or dentist) and the...
Part 9: Reagents <ul><li>Restricted to lines in Part 9 </li></ul><ul><li>Covers mainly blood glucose test strips </li></ul...
Part 10: Oxygen <ul><li>Pharmacy contractor must be approved by Health Board to be paid </li></ul><ul><li>Contains specifi...
Part 12: Selected List Scheme <ul><li>List of specific items for specified patients for specific conditions </li></ul><ul>...
Part 13: Shortages List <ul><li>Published on web only </li></ul><ul><li>List of products for given month where part 7 rule...
Part 14: Business rules <ul><li>This part is on the web only </li></ul><ul><li>This is a summary of basic rules for prescr...
HELP! <ul><li>Contact local pricing office (group leader) </li></ul><ul><li>Community Pharmacy Scotland </li></ul><ul><li>...
Web sites <ul><li>www.isdscotland.org </li></ul><ul><li>www.psd.scot.nhs.uk/pharmacists/index.html </li></ul><ul><li>www.s...
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The Scottish Drug Tariff

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The Scottish Drug Tariff

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

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