COVID cost process – update of review and appeals process

The Pre- and Post- Payment Verification (PPV) of contractors’ COVID cost claims has been continuing. PSNC does not have sight of all the community pharmacy contractors who have been going through the process, which is being led by the NHS Business Services Authority (NHSBSA), but understands it to be a relatively small number of pharmacies.

Although most contractors that have been audited have been paid in full, a number have had part of their claim disallowed by NHSBSA as a result of PPV.

The details of how these contractors can dispute any unpaid amounts have been now finalised. Affected contractors can ask for their claim to be reconsidered by an independent internal review panel, which will go through correspondence to date and consider any new information contractors would like to submit. NHSBSA will review the advice from the independent internal review panel, and then write to contractors setting out any additional amount payable as a result of this.

Following this, if contractors still want to dispute the unpaid claim amount (or part of it) they can formally appeal to NHS Resolution, which will follow its usual processes including publishing its findings. Contractors wishing to appeal are not able to bypass the internal review stage.

This means that if you want to appeal to NHS Resolution, you must go through the independent internal review process first. It is not possible to appeal to NHS Resolution without first going through this internal process.

Contractors that are in this position following PPV will be individually emailed by NHSBSA who will set out both the process and the deadline for requesting the independent internal review which will be 30 days from the date of that email. They will have the opportunity to provide further evidence alongside their review request.

If contractors have not had their PPV finalised by NHSBSA, they should continue providing information and evidence as requested. The review and appeal process will apply only once there is a finalised PPV amount and assuming this is less than their original claim.

The formal Drug Tariff notification is in Part VIA, section 12.10, of the April 2022 Drug Tariff and the revisions to the relevant directions on appeals are within the National Health Service Litigation Authority (Pharmaceutical Remuneration – Payment Disputes) (England) Directions 2022, in Part XVIIID of the April 2022 Drug Tariff.

PSNC guidance on the process, developed with the Department of Health and Social Care, is available via the link below.

PSNC Briefing 010/22: COVID Cost Claims – Independent Internal Reviews and Appeals

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