Pharmacy First Rejected Items

Community Pharmacy Scotland (CPS) have recently communicated an increased number of disallowed items for the NHS Pharmacy First Scotland service resulting in claims for these items rejected for reimbursement. The majority of these rejections were due to a technical issue and further information can be found on the CPS website. Items may also have been rejected due to selection of branded items on the PMR.

EMIS Health Community Pharmacy (EHCP) have been working with the relevant organisations to clarify this issue. This guidance document will help provide further information and assist contractors in ensuring the correct items are selected for the Pharmacy First service.

Branded Items Reimbursement Issue

The claim message for Pharmacy First includes details of the “Prescribed Item” and the “Dispensed Item”. Due to the way the “Prescribed Item” is selected in the PMR, disallowed items are being sent in the claim message, leading to rejections. This issue is more prevalent with the selection of branded items.

Whitelist and Branded Items

The Pharmacy First Scotland approved list of products, also known as the Whitelist, details the items allowed for supply under the service.

A branded item can be supplied however, if an item is listed generically or by VMPP on the approved list it must be prescribed generically. If an item is listed as a brand or AMPP it can be prescribed by brand.

An example of this is Peptac Liquid Aniseed which can be prescribed as a brand as it is listed in the approved list by AMPP. However, if Mucogel Oral Suspension is prescribed then the claim will be rejected as it is only written generically in the approved list. Therefore, the item must always be prescribed generically (as Co-magaldrox 195mg/220mg/5ml oral suspension sugar free).

Dispensing Branded Items on ProScript Connect

To ensure claims are reimbursed correctly it is imperative that branded items are only prescribed if they are written by brand (AMPP) on the Whitelist. In all other cases, the generic (VMPP) must be prescribed, whether a brand is then subsequently dispensed is at the pharmacist’s discretion. If an item is listed generically on the approved list and you wish to supply a brand, please ensure the following steps are taken:

In ProScript Connect (PSC) after selecting the Pharmacy First service a prescribed item must be selected. The item selected at this stage must be an item listed on approved list. If the item is listed as a VMPP then the generic item should be selected.

F3 – Product choice can then be used to select a brand

By dispensing a brand in this manner, the claim message will correctly display a VMP as the “Prescribed Item”. If the brand was selected at the “Select Prescribed Item” stage in PSC, an AMP will display in the claim message which may be rejected.

Not Allowed Items

We are aware that there have been some discrepancies regarding items displaying the “NOT ALLOWED” tag on PSC. These items are undergoing review and any necessary amendments will be made in due course. Items in the Dispensed Product Choice may display the “NOT ALLOWED” tag because:

• The pack size is not listed in the approved list
• The item is a “Prescription Only Medicines” and only “Pharmacy Only” and “General Sales List” packs can be supplied under this service

Please note items flagged as “NOT ALLOWED” can still be dispensed on PSC but reimbursement is not guaranteed.