From Mr F. L. B. Yantin, MRPharmS
SIR,-With a fellow pharmacist, I recently considered the quantities which could be properly dispensed and the reimbursment by the Prescription Pricing Authority in respect of prescriptions for (1) Ventolin Rotacaps, (2) 28 Neoral capsules and (3) 112 Ikorel tablets.
In example 1 we agreed that provided the item was endorsed "prescriber approved (pa)" a complete pack of 112 could be dispensed and would be paid for. On considering example 2, we disagreed. One of us would dispense only 28 and the other would dispense 30. One of us felt that, if 30 were dispensed, the prescription pricing authority would only pay for the 28 ordered, ignoring any endorsement made. The other was not prepared to split the pack as the carton was well sealed with tamper evident strips and the capsules themselves were packaged in a foil envelope. The Pharmaceutical Services Negotiating Committee states that in this case if 28 capsules were ordered and 30 dispensed the PPA would reimburse the 30 supplied if endorsed as such.
In example 3, we both agreed that the individual strips of 10 tablets should not be divided, since each strip incorporated a dessicant unit. However, one of us would supply only 110 tablets and the other 120. The PSNC advice in this case is that payment would only be made for 110 tablets even if 120 were endorsed and a claim for broken bulk would not apply to the remaining 10 tablets as each strip is considered es a special container and the broken bulk rules do not apply.
The most worrying aspect of the above examples is that two pharmacists, both of whom have many years of experience, differed in their interpretation of the rules and I suggest that pharmacists and contractors urgently request the PSNC to investigate this situation and provide a definitive and easily understood reference manual which will ensure that in situations such as these all pharmacists can perform their duties with a maximum degree of conformity.
Frank Yantin
Harrow, Middlesex
Dr GORDON L. GEDDES (head of information and technical services, PSNC) replies: To answer the specific points raised in the letter, references to Ventolin Rotacaps and Neoral capsules which relate to the prescriber approved (PA) facility are to be found in the PSNC booklet ‘Product related guide to dispensing and endorsing' issued in October, 1998. A list of items which are covered by the PA convention has been published in PSNC News (June 4, 1998). Ikorel 10mg and 20mg tablets are contained in the current special container and calendar pack list indicating that a strip of 10 tablets constitutes a special container. According to Clause 11 of Part II of the Drug Tariff, a broken bulk claim for 120 tablets when 110 are ordered should be allowed. The PSNC is in dispute with the Department of Health as to the interpretation of Clause 11 (i) when a pack consists of a number of special containers and (ii) when the minimum quantity which can be obtained is an outer.
In illustrating some practical problems associated with the dispensing and endorsing of NHS prescriptions, Mr Yantin raises an important point of principle. I agree that there is no one document or system which answers all the questions which may arise when dispensing NHS prescriptions. In my view such a requirement can only be met by the construction of a Drug Tariff relational database which would not only contain the Drug Tariff in a searchable form but would add in all the associated rules and minutiae which can be gleaned from other documents. Such a relational database would need to supported by the Department of Health, the PPA and the PSNC. However, before embarking on such an exercise it would be appropriate for all three bodies to collaborate in a fundamental revision of the Drug Tariff rules, which at times seem unnecessarily labyrinthine.