Referred back and disallowed items

When the NHS Business Services Authority (NHSBSA) cannot process a prescription item due to insufficient endorsed information, it is returned to the pharmacy team, and this is known as a referred back item.

Referred back items are returned to the pharmacy via the MYS portal for the missing information to be added so that it can be correctly reimbursed.

Part II Clause 9F of the Drug Tariff states ‘where insufficient information is available to enable the Pricing Authority to process the prescription, including where it was submitted for a SSP payment, the form (or a copy of the original form) shall be returned to the contractor who shall endorse the prescription form (or copy) with the information requested. Returned prescriptions shall be priced using the Drug Tariff relevant to the month in which the prescription form (or copy) is returned to the Pricing Authority.’

The most common reason why an item is returned is due to an incomplete endorsement, where one or more of the following is missing:

• manufacturer/brand name (if not in Drug Tariff and listed by more than one supplier)
• pack size (if more than one pack size is available)
• price (if NHSBSA does not hold a price for it)
• formulation (commonly seen with handwritten prescriptions for products which are available in multiple presentations).

An item could also be returned if too much information is included in the endorsement, for example more than one manufacturer endorsed.

The NHSBSA apply a coding system to identify up to 19 possible reasons for items being referred back to the pharmacy for further information. Each referred back item is assigned a referred back code to indicate the referred back reason. The table below shows referred back codes used for community pharmacy:

Referred back (RB) code	Referred back reason
RB1A	For prescribed items not listed in Part VIIIA of the Drug Tariff all of the following endorsements are required: Brand name, supplier or manufacturer Pack size Basic price excluding VAT
RB1B	For prescribed items not listed in Part VIIIA of the Drug Tariff all of the following endorsements are required: Brand name, supplier or manufacturer Pack size Basic price excluding VAT This reason code is usually used where the pack size and price have been endorsed on initial submission, but the supplier or manufacturer or brand name was not stated.
RB1C	For prescribed items not listed in Part VIIIA of the Drug Tariff all of the following endorsements are required: Brand name, supplier or manufacturer Pack size Basic price excluding VAT This reason code is often used where the supplier, manufacturer or brand name has been endorsed on initial submission, but the pack size and price were not stated.
RB1D	For prescribed liquid items that are unlicensed medicines without the pharmaceutical form specified or defined as liquid. Either solution or suspension needs to be stated.
RB1E	For prescribed items available from more than one manufacturer with the same brand name the manufacturer of the item supplied needs to be endorsed.
RB2A	For prescribed items missing the presentation, strength or quantity, these must be endorsed.
RB2B	The presentation details for the item are not included in the prescribed order or in the endorsement. You need to endorse the presentation dispensed.
RB2C	The strength details for the item are not included in the prescribed order or in the endorsement. You need to endorse the strength dispensed.
RB2D	The quantity details for the item are not included in the prescribed order or in the endorsement. You need to endorse the quantity dispensed.
RB2E	The full product name is not included in the prescribed order or in the endorsement. You need to endorse the exact product dispensed. This reason code is often used where a brand name indicates a range of products rather than a single product. You need to endorse which product from the range was dispensed.
RB3A	The size length or width, quantity, type or manufacturer’s catalogue number details for the item are not included in the prescribed order or in the endorsement.
RB3B	The size details for the item are not included in the prescribed order or in the endorsement. You need to endorse the size.
RB3C	The quantity details for the item are not included in the prescribed order or in the endorsement. You need to endorse the quantity dispensed. This reason code is often used when appliances are ordered as a number of ‘boxes’. You need to endorse the total quantity dispensed.
RB3D	The type or brand of appliance dispensed is not included in the prescribed order or in the endorsement. You need to endorse the type or brand dispensed. This reason code is often used when an appliance item is ordered generically but is only listed as branded items in Part IX of the Drug Tariff. You need to endorse the brand supplied.
RB3E	The catalogue number is not included in the prescribed order or in the endorsement. You need to endorse the catalogue number. The catalogue number, as listed in the Drug Tariff may be required to identify the exact product dispensed for catheters, incontinence appliances, stoma appliances or lymphoedema garments.
RB4	Each account type is restricted in which form types can be submitted within it. Form types which are not allowed in a particular account type are referred back so they can be resubmitted in the correct account type. This reason code is often used for private Controlled Drug forms and Out of Hours Non FP10 Supply forms which are submitted in pharmacy contractor NHS accounts.
RB5	The size of the vial, ampoule or cartridge dispensed is not included in the prescribed order or in the endorsement. You need to endorse the size dispensed. This reason code is used where there are numerous sizes of vial, ampoule or cartridge available for the prescribed product and the size dispensed is not indicated.
RB6	The strength, quantity or presentation of the Controlled Drug dispensed is not included in the prescribed order. This information needs to be included in accordance with The Misuse of Drugs Regulations 2001.
RB7	The prescribed order and endorsement do not contain enough information for NHSBSA to determine the item intended. You need to endorse the exact item dispensed so reimbursement can be made for the item. You may also need to endorse any other relevant information. This could include the supplier, invoice price, pack size, strength, quantity or presentation. This reason code is often used if there are contradicting printed and handwritten endorsements against an item or if handwritten prescribed orders or endorsements are illegible.

Pharmacy teams will receive notification of a referred back item electronically, as paper referred back forms are no longer issued. The NHSBSA will send a notification email to the pharmacy NHSmail account if any new referred back items have been generated in the Manage your service (MYS) portal. Pharmacy teams can then access referred back items including the item number and referred back reason code in the MYS portal under the ‘Unpaid items’ tab. The image below shows how referred back items appear in MYS.

Once the required additional information has been added to the relevant sections within MYS, pharmacy teams can submit the referred back item electronically to the NHSBSA from MYS for processing. Managing referred back prescriptions through MYS allows the pharmacy team to:

• provide information required to processes referred back items faster;
• track the progress of any referred back items throughout until the point they are processed;
• generate monthly reports showing the status of any referred back items (see below).

All prescription items that have been referred back must be completed and returned to the NHSBSA no later than 18 months from the date they are first sent to the pharmacy.

Pharmacy owners can also view referred back reports on the MYS portal. The portal shows:

• the number of referred back items the pharmacy team received from the NHSBSA
• the number of referred back items which have been re-submitted
• the number of referred back items which are awaiting action by the NHSBSA
• the number of referred back items which have been successfully processed.

The reports help to keep track of referred back items and can be used as a learning tool for pharmacy teams to help reduce the number of referred back items by endorsing prescriptions correctly.

During the end of month submission process, the total number of completed referred back prescription forms and items being resubmitted should be declared in the relevant boxes in of the digital FP34C submission form.

Please note only the number of items returned for clarification where payment has been delayed should be declared on the digital MYS submission form. This is because payment will already have been received for any other items on the returned prescription forms.

On the digital MYS submission form:

• Include the number of prescriptions being resubmitted in with your end of month figures in the appropriate exempt or paid box.
• Include the number of items being resubmitted in with your end of month figures in the appropriate exempt or paid box.
• Ensure that figures for any resubmitted prescriptions/items charged at the old charge rate are declared with your end of month figures.
• Add the total number of items and prescriptions being resubmitted to your end of month prescription totals.

Referred back items re-submitted for payment are priced using the Drug Tariff relevant to the dispensing month in which the referred back item is received by the NHSBSA. Delays in the completion of missing information for referred back items can affect the timing of payments. This can create potential cash-flow risks for pharmacy owners if very expensive items are referred back, or a large number of items are returned to the pharmacy team for more information. If the submitted information is still insufficient to allow NHSBSA to process the prescription for payment, the item will be re-sent to the pharmacy owner.

We have listed below examples of missing information and what is required to allow the item to be reimbursed.

Example 1 – Supplier or manufacturer details missing – appliance
The pharmacy team receive a generically written prescription for an appliance and there are multiple products listed in the appliances section of the Drug Tariff which meet that description.

Example 2 – Product name missing
The pharmacy receive a generic prescription for an inhaler including a trademarked name (Accuhaler)

Example 3 – No pharmaceutical form listed on the prescription

Action: If the pharmacy receive a prescription with the pharmaceutical form missing the prescription, If a prescription is presented with a missing presentation and the prescriber cannot be contacted, the presentation can be endorsed and dispensed if you have sufficient information to make a professional judgement. More information can be found here. If not, the prescription should be returned to the prescriber to be amended to include the pharmaceutical form.

Example 4 – Total quantity not stated but clear from dosage instructions

Example 5 – Endorsement of non-Part VIIIA generic products

Example 6 – Missing prescriber code

A disallowed item is one that has NOT been passed for payment by the NHSBSA.

Disallowed items should not be confused with referred back items. Disallowed items are not passed for payment by the NHSBSA whereas referred back items are returned for further clarification to enable the NHSBSA to process the item for payment.

Items issued on NHS prescription forms are disallowed by the NHSBSA for many reasons, some examples include where:

• the item is not permitted for prescribing on the NHS
• A product is ordered by a dentist or community nurse prescriber which is not listed in their respective drug formularies
• the prescribed product is an appliance or chemical reagent which is not listed in Part IX of the Drug Tariff.

The pricing systems flag such items to NHSBSA staff, who then re-check affected prescriptions and mark relevant items as disallowed, following Drug Tariff and prescription processing rules.

The NHSBSA apply a coding system to identify up to 19 possible reasons for disallowing items that are ordered on the NHS. Each prescription item disallowed by the NHSBSA is assigned a DA code indicate the reason for the disallowed item. The table below shows a list of Disallowed Codes which are applicable to community pharmacies.

Disallowed (DA) indicator	Disallowed reason
DA1	As certain drugs and other substances listed in the Drug Tariff Part XVIIIA cannot be allowed in these circumstances.
DA2	As it is not an appliance or chemical reagent listed in the Drug Tariff. See Drug Tariff Part I, Clause 2 and Clause 3.
DA3	As it is not a drug, appliance or chemical reagent listed in the Drug Tariff Part XVIIB(i) from which a Nurse Prescriber may order on prescription form FP10P.
DA4	As it is not a drug listed in the Drug Tariff Part XVIIA from which a Dental Practitioner may order on prescription.
DA6	As it is not a drug or preparation which may be prescribed on form FP10MDA in accordance with the NHS (General Medical Services Contracts) Regulations 2015 Paragraph 56 (10).
DA19	As this is not an authorised or valid form.
DA20	As it is a nominated EPS token submitted for processing and reimbursement.

Pharmacy owners will not receive payment for disallowed items, which can result in financial losses. For instance, dispensing a product that has recently been removed from the Appliances section (Part IX) of the Drug Tariff may lead to the pharmacy owner incurring losses. Implementing checks to ensure that only reimbursable prescriptions are dispensed can help prevent such losses.

The NHSBSA send a notification email to the pharmacy NHSmail account when a new disallowed item is generated. Pharmacy teams can access their disallowed items in the Manage your service (MYS) portal which includes the item number and disallowed reason code under the ‘Disallowed Items’ tab.

The image below is an example of how a disallowed item appears in the MYS portal:

If it is believed that an item has been incorrectly disallowed by the NHSBSA, pharmacy owners may submit a challenge, via MYS, to the NHSBSA, who will investigate the issue and rectify any missing payments if a processing error is identified.

To challenge disallowed items, pharmacy owners can follow the steps below:

• Select the ‘Disallowed items’ tab from the MYS landing page,
• Select the item you believe has been disallowed incorrectly,
• Under the image of the item, select ‘Challenge this disallowed item’,
• In the ‘Reason for your challenge box’ enter the reason you believe the item was disallowed incorrectly,
• Enter an email address,
• Select ‘Submit’.

Once a challenge is successfully submitted, the information is sent directly to the NHSBSA Helpdesk to action, removing the need for pharmacy owners to send a separate email or make a telephone call.

After challenging a disallowed item, the outcome can either be the item remains disallowed (as the NHSBSA determined the item was correctly disallowed) or the status of the item is updated in  MYS from a disallowed item to a referred back item, allowing the pharmacy team to submit the additional information required by the NHSBSA to process the item for payment.

It is important to note that disallowed items are only held on MYS for a period of 18 months from the date they are first sent to the pharmacy; if you have not reviewed and challenged any disallowed items before this deadline has passed, these items will be deleted from the system and the pharmacy will be unable to submit a challenge, if applicable.

The NHSBSA Prescription Services helpline can be contacted for further advice if pharmacy teams are unsure as to why an item has been disallowed or if the required information is unclear. Telephone: 0300 330 1349; email: nhsbsa.prescriptionservices@nhsbsa.nhs.uk

If a pharmacy owner remains unsatisfied with the outcome of a disallowed item challenge, they can contact Community Pharmacy England’s Dispensing & Supply team on 0203 1220 810 or email their query to ds.team@cpe.org.uk for further advice on the matter.

Pharmacy owners can also check whether an item was referred back or disallowed by checking their monthly Prescription Item reports (PIRs). The product will be marked in column AP (column heading ‘RB’) if an item has been referred back. Column AQ (column heading ‘RB value’) displays the RB code for which the item was referred back.

Similarly, the product will be marked in column W (column heading ‘DA’) if a product has been disallowed. Column X (column heading ‘DA value’) displays the reason code for the prescription being disallowed.

To access item reports, pharmacy owners should register for the Information Services Portal on the NHSBSA’s website.

• Pharmacies should regularly check MYS for referred backs and should check if any items are awaiting completion before they expire. It is important to note that referred back items are only held in the system for a period of 18 months from the date they are first sent to the pharmacy for action; if pharmacy owners have not completed and returned any outstanding referred backs before this deadline has passed, the referred back items will be deleted from system.
• Reduce your volume of returns by ensuring that all prescriptions are appropriately endorsed. See our Endorsement guidance page for more information and links to our endorsing factsheet.
• Follow correct end of month sorting and submission processes 

Pharmacy teams should also sign up to receive the quarterly  NHSBSA Hints and Tips Bulletin to receive information, support and best practice guidance.

• Ensure you are referring to the latest edition of the Drug Tariff as changes are implemented monthly which will influence whether a product is disallowed. The following resources are available to help pharmacy teams avoid disallowed items:
  • Community Pharmacy England’s monthly Drug Tariff Watch will help identify key changes to look out for. The latest month’s Drug Tariff changes can be found in the Drug Tariff Watch page
  • Community Pharmacy England publishes a list of all appliances flagged with a three-month notice of deletion in the Drug Tariff Appliance Watch: Notice of Deletion page. Pharmacy teams are advised to keep track of appliances which are due to be deleted from the Drug Tariff to manage stock ordering and to run down any excess stock ahead of the planned month of deletion.
• Check prescriber type/qualification – does the prescriber hold relevant registration(s) to issue prescriptions for the items ordered? Some prescribers are restricted by their qualifications to prescribe certain products only. For example, dentists, are limited to prescribing for their NHS patients only those drugs listed in the Dental Practitioners’ Formulary (DPF) in Part XVIIA of the Drug Tariff when using FP10D forms.
• Are the prescribed items listed in the relevant prescriber’s formulary? – If the prescription is issued by a Community Nurse Prescriber or Dentist, check that the item is listed in the Nurse Prescribers’ Formulary or Dental Practitioners’ Formulary, respectively. Pharmacy owners can experience losses when dispensing prescriptions issued by community nurse prescribers for items not listed in Drug Tariff Part XVIIB(i) Nurse Prescribers’ Formulary (NPF) for Community Practitioners. Where in doubt, pharmacy teams are advised to search the NMC register to confirm if a nurse holds the appropriate additional qualifications (supplementary/independent prescriber) to prescribe a product that is not listed in the NPF. Visit our Who can prescribe what? page for information on items different types of prescribers are allowed to prescribe on NHS prescription forms.
• Is the product prescribed on a valid NHS form? – Pharmacy staff must check if the prescribed product has been prescribed on a valid NHS form. Form types can be identified by the code on the bottom right of a paper prescription form. A table of valid NHS prescriptions forms that can be dispensed by community pharmacies is available to view on the Is this prescription form valid? page. The NHSBSA website also has information on current and out of date forms for different prescriber types.
• Ensure systems are kept up to date – to reduce the risks of users inadvertently prescribing/dispensing products that have recently been amended/deleted from the Drug Tariff and or dm+d, users should ensure their systems are kept up to date. Community Pharmacy England recommends that EPS suppliers synchronise to the dm+d and Drug Tariff changes frequently (note that the dm+d is updated weekly by the NHSBSA). Frequent mapping, particularly at the start of each month, is critical to ensuring systems reflect recent Drug tariff and dm+d changes in a timely manner (for example, new/deleted items etc). Where in doubt, pharmacy staff should check the latest online Drug Tariff or search the NHS Dictionary of medicines and devices (dm+d) to confirm if an item will be passed for payment
• Establish nature of product – check if the drug (medicinal or non-medicinal substance including food supplements or cosmetic items) is permitted on the NHS or is the appliance (medical device) listed in Part IX of the Drug Tariff. Some PMR suppliers have configured their systems to help minimise or remove the risk of users inadvertently dispensing a disallowed drug or appliance, for example, by generating warning prompts when a disallowed product is prescribed/selected or endorsed.
  • For drugs: A drug is only allowed if it is NOT listed in Part XVIIIA (Drugs, Medicines and Other Substances that may not be ordered under the NHS) of the Drug Tariff.
  • For appliances: The presence of a CE mark, (normally found on the outer packaging, information leaflet, or on the device itself) indicates that a product is an appliance. Only devices listed under the Appliances section in Part IX (Parts IXA, IXB and IXC) of the Drug Tariff are allowed on NHS prescriptions. Up to 3 months advance notice of deletion is given before an appliance is deleted from the Drug Tariff.

Q. NHSBSA has returned a photocopy of an FP10D dental prescription for ‘Ibuprofen 100mg/5ml oral suspension’ marked as disallowed. Why was this prescription not passed for payment?

A. Only items listed in the Dental Practitioners’ Formulary (DPF) in Part XVIIA of the Drug Tariff can be prescribed on an FP10D prescription. There is a sugar-containing and sugar-free formulation of this product available. However, only the sugar-free formulation is listed in the DPF; therefore, only ‘Ibuprofen 100mg/5ml oral suspension sugar free’ can be prescribed on NHS dental prescriptions. If a pharmacy receives a FP10D for the standard ‘Ibuprofen 100mg/5ml oral suspension’, the prescription should be returned to the dentist for the words ‘sugar free’ to be added.

Q. NHSBSA has returned a photocopy of a green FP10 prescription for Nytol 25mg tablets marked as disallowed. Why was this prescription not passed for payment?

A. Nytol 25mg tablets is covered by the ’Nytol Tablets’ listing in Part XVIIIA of the Drug Tariff for ‘Drugs, Medicines and other Substances not to be ordered under a General Medical Services Contract’ and will therefore not be passed for payment by the NHSBSA if it issued on an NHS prescription form regardless of prescriber type.

Q. I have a prescription for ‘Olive oil ear drops 10ml’, can I dispense Cerumol olive oil ear drops?

A. No. Cerumol olive oil ear drops is classed as a medical device (as it has a CE mark) and would not be passed for payment because the item is not listed in the Appliances section in Part IXA of the Drug Tariff. Other brands or suppliers of olive oil ear drops are listed in Part IXA of the Drug Tariff which will be passed for payment, if endorsed accordingly.

Q. How can I identify the prescribing rights of different types of nurse prescribers?

A. To identify a nurses’ prescribing qualifications, pharmacy contractors are advised to check the register held by the Nursing & Midwifery Council. The qualifications can help determine what a nurse is able prescribe and if the prescription will be passed for payment. See our Who can prescribe what? page for information of the prescribing rights for different types of prescribers.

Q. An item has been returned as disallowed because ‘it is not a drug, appliance or chemical reagent listed in the Drug Tariff Part XVIIB from which a Nurse Prescriber may order on a prescription form’. Can this disallowed item be challenged if the prescription was issued by a Nurse Independent Prescriber?

A. Nurse Independent Prescribers are not restricted to prescribing items listed in the Nurse Prescribers’ Formulary (NPF) listed in Part XVIIB of the Drug Tariff. Nurse Independent Prescribers can prescribe any medicine (except for those listed in Part XVIIIA of the Drug Tariff) for any medical condition, within their own professional competence and expertise. This includes any Controlled Drugs listed in Schedules 2-5, except diamorphine, dipipanone, or cocaine for treating organic disease or injury but not for treating addiction. If an item prescribed by a Nurse Independent Prescriber has been incorrectly disallowed, pharmacies may submit a disallowed item challenge to the NHSBSA who will investigate the issue and rectify any missing payments if a processing error is identified.

Q. I successfully challenged NHSBSA on an incorrectly disallowed prescription. Which months Drug Tariff will reimbursement be based on?

A. If a successful challenge is made to a disallowed item, the product will be priced according to the month in which the item was re-processed by the NHSBSA for example, if a product was first submitted with a pharmacies January 2025 bundle and was successfully challenged in March 2025, the pricing of the prescription would be paid based on the March 2025 Drug Tariff.

Q. Can I receive reports of items referred back to the pharmacy each month?

A. Pharmacy owners can view reports on the MYS portal. The portal shows how many referred back items were received from the NHSBSA, how many have been re-submitted, how many are awaiting action by the NHSBSA and how many have been successfully processed. The reports help to keep track of RBs and can be used as a learning tool for pharmacy staff to help reduce the number of RBs by endorsing prescriptions correctly.

Pharmacy owners can also check whether an item was referred back by checking their monthly Prescription Item reports (PIRs). The product will be marked in column AP (column heading ‘RB’) if an item has been RB. Column AQ (column heading ‘RB value’) displays the RB code for which the item was RB. To access item reports, contractors should register for the Information Services Portal on the NHSBSA’s website.

Q. Do completed referred back items need to be declared on my digital FP34C MYS submission form?

A. Yes, the total number of completed RB prescription forms and items being resubmitted should be declared in the relevant boxes on the digital MYS submission form. Please note only the number of items returned for clarification where payment has been delayed should be declared on the digital MYS submission form. This is because payment will already have been received for any other items on the returned forms.

Q. If a prescription contains multiple items but only one item is referred back to the pharmacy, are all items on the prescription considered referred back awaiting payment?

A. If only one item is referred back to the pharmacy for missing information, only that item is withheld from payment until the NHSBSA receive the required information.