Original Pack Dispensing

In October 2023, amendments were made to the Human Medicines Regulations (HMRs) to allow pharmacies to dispense up to 10% more or less than the quantity prescribed (OPD +/- 10% dispensing) for private prescriptions for prescription-only medicines (POMs).

However, when the HMRs were amended in October 2023, there was a transitional provision for OPD +/- 10%, so that the flexibility to dispense 10% more or less than the prescribed quantity did not automatically apply in NHS pharmaceutical services in England. This was to allow the Department of Health and Social Care (DHSC) and Community Pharmacy England to find a solution for how OPD +/-10% would apply to NHS dispensing in England. Following discussions with DHSC, changes were made to The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations (PLPS) to allow pharmacies to use OPD +/-10% rules from 1st January 2025 for NHS dispensing.

For NHS dispensing, the PLPS amendments:

• require the supervising pharmacist to consider, using their professional judgement, whether it is reasonable and appropriate to dispense +/-10% of the prescribed amount, having regard to the benefits to patients where they are provided with products in the manufacturer’s original outer packaging. Arguably there may be a professional imperative to dispense an original pack for safety reasons (as the patient information leaflet (PIL) will be supplied) but professional judgment should be exercised to assess the suitability of applying OPD +/- 10% dispensing, as it is not expected to be appropriate in all cases.
• give the pharmacist the flexibility to supply up to 10% more or less than the prescribed quantity, if that would mean the medicine could be dispensed in the manufacturer’s original pack, and other prescription requirements are fulfilled.

Exercising professional judgement

Except where a product falls outside the scope of OPD +/-10% rules, professional judgment should be exercised to assess the suitability of applying +/- 10% quantity flexibility for dispensing as it may not be appropriate to use it in all cases.

Examples of circumstances where pharmacists may continue to dispense the prescribed quantity even if it requires splitting a pack includes:

• if the supervising pharmacist considers that the patient should be supplied with the exact quantity prescribed to be able to follow the medication regimen or to support patient safety. For example, antibiotics where it is clinically important for a patient to complete the full course of medicine as prescribed, or for certain pain relief medicines where there is a risk of reliance or addiction.
• If the pharmacy cannot obtain the whole pack with reasonable promptness or there is a patient need reason e.g. delay to patient treatment.
• Where the patient refuses to accept a lesser quantity than the quantity prescribed, e.g. where a patient is required to pay a prescription charge.
• IT system suppliers may not introduce the necessary changes to the pharmacy IT system to support OPD until after 1 January 2025.

Please note: DHSC acknowledges that some IT system suppliers may not be ready to implement OPD functionality into their systems from 1st January 2025. System suppliers had requested at least six months for IT development but were provided the information to support the changes within much shorter timelines. DHSC and Community Pharmacy England say it is reasonable for pharmacy teams to decide to opt out of using the OPD provisions until the clinical support software supports OPD​. 

OPD is one of a number of legislative changes intended to transform the supply and delivery of medicines that were envisaged in the 2019, 5-year deal agreed between Department of Health and Social Care (DHSC) and NHS England (NHSE) to help make dispensing more efficient and support capacity for the provision of clinical services. Further information on the these regulatory changes can be found in our briefing on New Pharmacy Regs: What you need to know.

Prescription types covered by OPD arrangements

For NHS dispensing, the OPD +/-10% rules can only be applied to EPS prescriptions issued in England and Wales and dispensed in England. All NHS paper prescriptions from England, Wales, Scotland and Northern Ireland are excluded from the OPD arrangements so pharmacists will only be able to supply the prescribed quantity (unless the product is classed as a special container). DHSC believe that even though the percentage of paper prescriptions is small, it still represents a significant volume, and as such would require manual intervention and require a disproportionate amount of resource for the NHS Business Services Authority (NHSBSA) to read the quantity endorsements on paper prescriptions.

Products covered by OPD arrangements

All POMs, non-POMs (P medicines, GSL medicines, non-medicines) and Schedule 5 Controlled Drugs (CDs) are within scope of OPD +/-10% rules for supply against NHS prescriptions. However, there are a number of products excluded from the OPD +/-10% rules for NHS dispensing. For example, all Schedules 1-4 CDs, Part IX appliances, unlicensed specials and products classed as special containers fall outside the scope of OPD +/-10% rules.

See the table below for an overview of products included and excluded under the OPD provisions for NHS dispensing:

Products outside the scope of OPD +/-10% rules

Controlled Drugs (except Schedule 5 CDs)

The OPD +/-10% rules can be applied to prescriptions for Schedule 5 Controlled Drugs (CDs), where appropriate. However, the rules do not apply to any CDs in Schedules 1 to 4 Schedules of the Misuse of Drugs Act and Regulations. Any prescriptions for Schedule 1 to 4 CDs will need to be supplied as the exact quantity ordered.

Special Containers

The +/-10% OPD rules do not apply to products classed as special containers. Where the product is classed as a ‘special container’ in NHS dictionary of medicines and devices (dm+d), pharmacies may (as before) supply more than 10% (or more than 10% less) to dispense the nearest complete/sub-pack (i.e. in the special container) and reimbursement will continue to be based on the nearest complete/sub-pack size. More information on special containers can be found on our special containers page.

Valproate-containing products

Following amends to the Human Medicines Regulations 2012, valproate-containing products are subject to separate dispensing rules which came into force in October 2023. Subject to certain exceptions, the changes mandate whole pack dispensing of all valproate-containing products after they were reclassified as special containers. More information on special containers can be found on our special containers page.

Unlicensed medicines

The +/-10% OPD rules do not apply to unlicensed medicines commonly known as “specials”. These must continue to be supplied in the exact quantity ordered (unless the product is classed as a special container). More information on unlicensed medicines can be found on our Unlicensed specials and imports page.

Products supplied in accordance with Serious Shortage Protocols (SSPs) and Patient Group Directions (PGDs)

For the time being, the OPD +/-10% rules only extend to supplies made against NHS prescriptions. Pending further legislative amendments, products supplied in accordance with SSPs and PGDs remain outside the scope of OPD +/-10% rules. Community Pharmacy England will issue any further updates once the necessary changes to legislation are in place to enable pharmacists to apply the OPD +/-10% rules for supplies made against SSPs and PGDs.

When applying the OPD+/-10% rules where the prescribed quantity it does not result in a whole number, pharmacists must round up or down to the nearest whole number.

• Where the quantity is above halfway pharmacists should round up to the nearest whole number.
• Where the quantity is exactly halfway or less, pharmacists should round down to the nearest whole number.

The table below shows how the rounding limits should be applied:

Community Pharmacy England accepted +/-10% OPD arrangements for NHS dispensing on the basis that:

• pharmacy owners will be reimbursed for the dispensed quantity rather than the prescribed quantity
• no additional endorsements will be required to indicate to the NHSBSA that OPD rules have been followed by the pharmacy.

However, other existing prescription endorsement requirements remain unchanged. Pharmacy teams must continue to endorse prescriptions as per Clause 9B, Part II of the Drug Tariff for example, to endorse the supplier/brand and/or invoice price if a product is not listed in the Drug Tariff or to specify the pack size of a Category C product if more than one pack size is listed in the Tariff.​ For more information on prescription endorsements please refer to our Endorsement Guidance.

Where the OPD +/-10% rules are applied to an eligible prescription item to enable whole pack dispensing, NHS reimbursement will be calculated as follows:

NHSBSA processing

NHSBSA will utilise the existing quantity field in the Electronic Reimbursement Endorsement Message (EREM) or EPS claim message to check for the quantity supplied and reimburse accordingly (provided OPD +/-10% rules have been followed correctly).

Before utilising OPD +/-10% rules for NHS dispensing, pharmacy owners are advised to await confirmation from your IT system supplier regarding the availability of OPD functionality in their system.

Your PMR system will need to able to reflect the correct quantity dispensed value, which is per your input and expectation, into the EPS claim message (EREM), so that NHSBSA receive the correct dispensed quantity information and reimburse accordingly.

IT system suppliers have been encouraged to communicate to their users once the systems are OPD-ready (additional information can be found within the IT section).

Broken Bulk (BB) claims and OPD supplies

The broken bulk (‘BB’) endorsement enables pharmacy teams to claim payment for a complete pack of an eligible product where only a part-pack has been dispensed and assuming the remaining quantity is unlikely to be dispensed again within the next 6 months.​ Broken bulk claims (in line with Clause 11, Part II of the Drug Tariff) can carry on as usual for non-OPD supplies. However, broken bulk claims would not be accepted if the dispensed quantity is +/- 10% of the prescribed quantity as this would imply that a complete pack was supplied to the patient.

Container allowance

Following the introduction of OPD, pharmacies will no longer receive the 10p container allowance if an original pack is supplied following OPD +/-10% rules. For example, if the dispensed quantity is +/- 10% of the prescribed quantity, then it will be assumed that an original pack was supplied, in which case the container allowance will not be paid. However, the 10p allowance will continue to be paid for all non-OPD supplies – where a split pack quantity is dispensed because the quantity ordered does not correspond to an available pack size.

Price concessions

If the OPD +/-10% rules have been correctly applied to an eligible prescription item to enable whole pack dispensing, any monthly price concession granted for this item will be applied to the dispensed quantity.

Checking payments received for supplies made using the OPD +/- 10% rules

Pharmacy owners are encouraged to sign-up and access their prescription item report through NHSBSA’s Information Services Portal. The prescription item report is a monthly data report showing reimbursement and renumeration for each item submitted for payment. The report allows a pharmacy owner to identify any payment discrepancies or endorsements errors. The pharmacy can sign up to access the prescription item report by following the steps in our How to access your Prescription Item Reports factsheet. It would be sensible to consider spot checking that reimbursement is as expected for supplies made using OPD +/-10% rules. See https://cpe.org.uk/reconciling.

Compliance aids

The OPD +/-10% rules cannot be applied to prescriptions dispensed in compliance aids such as blister packs. To utilise the OPD +/-10% provisions the original pack must be given. As patients will not be receiving the original pack the pharmacist cannot use the OPD +/-10% rules for prescriptions being dispensed into compliance aids.

There is no requirement to do so. However, if a patient is receiving up to 10% less than the prescribed quantity on a repeatable prescription item, the patient may need to re-order their next prescription earlier the following month. Good communication between the pharmacist, the GP and the patient will help to avoid any disruption to the patient’s treatment.

Unless the patient holds a valid exemption reason or the item is free-of-charge on the NHS, prescription charges are payable for supplies made under +/-10% OPD rules even if this means that a patient is supplied with a smaller quantity of a medicine than was originally prescribed. It is only with quantity restriction Serious Shortage Protocols (SSPs) where a patient is exempted from paying prescription charges for receiving less than the original quantity prescribed. For more information on prescription charges, please visit our page What does the patient pay?

Patient Medical Record (PMR) supplier timelines to implement OPD

There is no fixed deadline for IT system suppliers to have functionality in place for PMR systems to fully support utilisation of OPD +/-10% rules. Therefore, not all IT system suppliers were fully ready to implement OPD functionality into their systems from 1st January 2025. System suppliers had requested at least six months for IT development but were provided with much less notice than this.

Community Pharmacy England has encouraged all Electronic Prescription Service (EPS) system suppliers to inform their customers once OPD functionality has been fully tested and enabled for use by pharmacies.

Some suppliers may opt to roll out in stages, to an increasing number of their pharmacy customers, to support testing that the functionality works as expected.

Use of OPD if your PMR is not OPD-ready

As mentioned above, pharmacists must consider OPD but do not have to utilise it if for example, IT systems do not have the functionality in place for allow claiming payment for up to 10% more or less than the prescribed quantity.

Using OPD within your PMR system

Your PMR system’s help and guidance can provide details about how it will support you to consider OPD arrangements. As mentioned above, no additional endorsements will be required to indicate to the NHSBSA that OPD rules have been followed by the pharmacy.

OPD PMR escalation

For information on escalation processes of any PMR issues please see our one-page NHS IT/EPS escalation guide.

PMR validation of dispensed quantity input

Some EPS suppliers are enhancing how they support pharmacy teams with validating quantity input, taking the OPD arrangements into account. This could prevent inadvertent selection of products outside the scope of OPD +/-10% rules or a quantity that exceeds 10% of the prescribed quantity (except for special containers).

The EPS dispensing system specification encourages suppliers to use validation support, such as warnings for unusual dispensed quantities being input. To help pharmacy teams apply the OPD +/- 10% rules correctly, IT systems can prompt users if the product or quantity selected falls outside the scope of the OPD arrangements. There may be variation in the level of built-in validation offered by different IT systems to support pharmacies in applying the OPD +/- 10% rules correctly. Some IT suppliers may seek to introduce functionality immediately whereas others may choose a later date to release the changes across their estate.

PMR scope recognition

Some system suppliers are introducing OPD scope recognition.  This could help prevent input of dispensing using OPD for items that are out of scope, such as Schedule 2 Controlled Drugs.

Q. I have received a prescription for unlicensed Flunarizine 10mg tablets x 28, however the specials supplier can only supply in pack sizes of 30. Can I use the OPD +/-10% rules to supply and claim for a complete pack of 30 tablets? 

A. Flunarizine 10mg tablets is an unlicensed medicine listed in Part VIIID of the Drug Tariff. The OPD +/-10% rules do not apply to any specials. Unlicensed medicines must continue to be supplied in the exact quantity ordered (unless the product is classed a special container).

Q. I have received a prescription for a Schedule 2 Controlled Drug, Dexamfetamine 10mg tablets x 28 tablets. As this product is only available in packs of 30, can I supply and claim for a complete pack of 30 tablets following OPD +/-10% rules? 

A. No, a pharmacist can only supply and claim for 28 tablets in accordance with quantity stated on the prescription. This is because Dexamfetamine is a Schedule 2 CD and the OPD +/-10% rules do not apply to any CDs in Schedules 1 to 4 of the Misuse of Drugs Act and Regulations. The OPD +/-10% rules can be applied to prescriptions for Schedule 5 Controlled Drugs (CDs), where appropriate

Q. I have received a prescription for BD Viva hypodermic insulin needles for pre-filled / reusable pen injectors screw on 4mm/32gauge x 100 needles. As this product is only available in packs of 90 needles, can I use OPD +/-10% rules supply a complete pack of 90 needles? 

A. No, this is because any appliance listed in Part IXA in the Drug Tariff falls outside the scope of OPD arrangements.  The OPD +/-10% rules do not apply to Part IX appliances so these must continue to be supplied in the exact quantity ordered, unless the product is classed as a special container. As BD Viva hypodermic insulin needles for pre-filled / reusable pen injectors screw on 4mm/32gauge is not a special container, the pharmacy should supply and be reimbursed for supplying 100 needles as ordered on the prescription.

Q. I have received a prescription for Estradiol 500microgram transdermal gel sachets x 14 sachets. As this products come in packs of 28, can I supply and claim for a complete pack of 28 tablets?  

A. No, this would fall outside of the OPD +/- 10% rules. Following the rounding down rules a quantity of 14 would only allow for the supply of 1 more or 1 less sachet. This is because 10% of 14 sachet works out to 1.4 tablets and following rounding rules a pharmacist can supply up to 1 more sachet or 3 less sachet than the prescribed quantity if it allows whole pack dispensing.  As Estradiol 500microgram transdermal gel sachets are only available in a pack of 28 and the item is not classed as a special container, pharmacists should dispense 14 sachets as prescribed and will be reimbursed accordingly.

Q. I have received a prescription for Paroxetine 40mg tablets x 30. This product comes in packs of 28 and 30. Can I supply a complete pack of 28 tablets using OPD +/- 10% rules?   

A. If a prescription is received for a pack a 30 x Paroxetine 40mg tablets, the pharmacy should supply this pack size if it is readily available. If the 30 pack size is not readily available, a pharmacist can use the +/-10% OPD rules to supply two less tablets in order to provide a complete pack of 28 tablets. Reimbursement would be calculated based on the dispensed quantity using the Part VIII price listed in the Drug Tariff.​ ​In some cases where a much lower quantity is supplied (i.e. more than 10% less than the prescribed quantity), for example the patient only needed 14 tablets out of 28 ordered, the pharmacy would be reimbursed for 14 tablets dispensed. Please note, a patient receiving less than the prescribed quantity may need to re-order their next prescription earlier the following month. Good communication between the pharmacist, the GP and the patient will help to avoid any disruption to the patient’s treatment.

Q. I have received a prescription for Levothyroxine 50microgram tablets x 30. The only available pack size is 28 tablets. Can I use the OPD +/- 10% rules to supply the patient with a complete pack of 28 tablets?

A. Yes, as a pack of 28 is the only pack size available, the OPD +/-10% rules would allow you to supply and claim for a complete pack size of 28 tablets against a prescription ordering 30 tablets. This is because 10% of 30 tablets works out to 3 tablets to enable a pharmacist to supply up to 3 more tablets or 3 less tablets than the prescribed quantity if it allows whole pack dispensing.  Please note, a patient receiving up to 10% less than the prescribed quantity may need to re-order their next prescription earlier the following month. Good communication between the pharmacist, the GP and the patient will help to avoid any disruption to the patient’s treatment.

Q. I have received a prescription for Co-careldopa 12.5mg/50mg tablets x 84. The only available pack size is 90. Can I use the OPD +/-10% rules to supply the patient with a complete pack of 90 tablets?  

A. Yes, the OPD +/-10% rules would allow you to supply 6 more tablets and claim for a complete pack size of 90 tablets against a prescription ordering 84 tablets. This is because 10% of 84 tablets works out to 8.4 tablets, which once rounded down would enable a pharmacist to supply up to 8 more tablets or 8 less tablets than the quantity prescribed if it allows whole pack dispensing.

Q. I have received a prescription for Evra® transdermal patches x 8 patches. Can I use OPD +/-10% rules to supply and claim for a complete pack size of 9 patches?  

A. Yes, as Evra® patches are available in packs of 9, the OPD +/-10% rules would allow pharmacists to supply 1 more patch and claim for a complete pack of 9 patches. 10% of 8 patches works out to 0.8 and following the rounding rules, pharmacists can supply up to 1 more or less patch if it allows whole pack dispensing.

Q. I have received a prescription for a Schedule 5 Controlled Drug (CD), Dihydrocodeine 30mg tablets x 28 tablets. Can I apply OPD +/-10% rules to supply and claim for a complete pack size of 30 tablets? 

A. Yes, the OPD +/-10% rules can be applied to prescriptions for Schedule 5 Controlled Drugs (CDs), where appropriate. If a prescription orders 28 tablets, the pharmacy should supply this pack size if it is readily available. If the 28 pack size is not readily available, the pharmacist could apply OPD +/-10% rules to provide 2 extra tablets and claim for a complete pack size of 30 tablets. This is because 10% of 28 tablets works out to 2.8 tablets and following the rounding rules, pharmacists can supply up to 3 more tablets or 3 less tablets if it allows whole pack dispensing.  For supplying a pack of 30, the pharmacy would be reimbursed based on Part VIII price listed in the Tariff. Please note as Dihydrocodeine is a Schedule 5 CD, pharmacists must apply their professional judgement to decide if it is clinically appropriate for the patient to receive more than the prescribed quantity particularly if there are any concerns of reliance or addiction.

Q. I have received a prescription for Aspirin 300mg tablets x 128. This product comes in packs of 30 and 100. Can I use OPD +/-10% rules to supply and claim payment for a total of 130 tablets using a combination of the two different pack sizes available?

A. Yes, OPD +/-10% rules would allow you to claim for 130 tablets (by supplying two different pack sizes of 30 and 100) against a prescription ordering 128 tablets. This is because 10% of 128 tablets works out to 12.8 tablets, which once rounded up would enable a pharmacist to supply up to 13 more or 13 less tablets than the quantity prescribed if it allows whole pack dispensing.

Q. I have a received prescription for Colecalciferol 10,000units/ml oral drops sugar free x 15ml. This product is a special container in a pack size of 10ml.   Can I apply OPD +/-10% rules to supply and claim payment for two complete packs of 10 ml?   

A. No, as the prescription orders 15ml x Colecalciferol 10,000units/ml oral drops sugar free, the pharmacy would only be reimbursed for one complete pack of 10ml.  This is because Colecalciferol 10,000units/ml oral drops sugar free in 10ml pack size is listed as a special container in Part VIIIA of the Drug Tariff. For Colecalciferol 10,000units/ml oral drops sugar free, payment is based on the 10ml pack size because the quantity ordered of 15ml falls exactly halfway between the two pack sizes. If 16ml was ordered, this would allow a pharmacist to round up to the nearest pack size (or multiples of) to provide 20ml (2 packs of 10ml). Products classed as special containers are excluded from the OPD +/-10% rules so pharmacy owners can supply and will be reimbursed for the nearest pack size (complete pack or sub pack) or combination of containers nearest to the quantity ordered.

Q. I have received a prescription for Pyridostigmine bromide 60mg tablets x 168 tablets. This product is a special container in a pack size of 200 tablets. Can I supply and claim payment for a complete pack of 200 tablets against a prescription ordering 168 tablets? 

A. Pyridostigmine bromide 60mg tablets in a pack size of 200 is listed as a special container in Part VIIIA of the Drug Tariff. If a prescription orders 168 x Pyridostigmine bromide 60mg tablets, the pharmacy would be reimbursed for a complete pack of 200 tablets. This is because products classed as special containers are excluded from the OPD +/-10% rules so pharmacy owners can supply and will be reimbursed for the nearest pack size (complete pack or sub pack) or combination of containers nearest to the quantity ordered.

For more information on special containers, please see our page Special containers and products requiring reconstitution.