Dispensing disallowed items
A high percentage of disallowed items are appliances or chemical reagents not listed in Part IX (the Appliances section) of the Drug Tariff or products ordered by dentists or community nurse prescribers which are not listed in their respective formularies. Recently, Community Pharmacy England has received queries from pharmacy owners concerned about the losses incurred after unintentionally dispensing disallowed items ordered on NHS prescriptions.
In one recent example, a pharmacy owner lost over £700 dispensing a prescription for ‘Zetuvit Plus Silicone Border dressing 20cm x 25cm rectangular’ x 120 dressings. This item was deleted from the Appliances section in Part IXA of the Drug Tariff in July 2024 (following a three-month advance notice of deletion given in April 2024). However, the pharmacy team mistakenly ordered and dispensed this item in the dispensing month of July 2024 (when it was deleted from the Tariff) which resulted in the item being disallowed by the NHSBSA.
Appliances can only be prescribed on NHS prescription forms if the product is listed in Part IX of the Drug Tariff. The prescriber must prescribe the appliance as it appears in the Drug Tariff. For appliances that are prescribed generically, pharmacies should endorse the brand/supplier of the appliance listed in the Drug Tariff. Any prescriptions for appliances deleted from the Drug Tariff will not be passed for payment by the NHSBSA.
A three-month advance notice of deletion is given by the NHSBSA, before any appliances are deleted from the Drug Tariff. Appliances flagged with a notice of deletion are annotated with a symbol against the Part IX listing with a footnote and a date of deletion. Each month, Community Pharmacy England also publishes a list of all appliances flagged with a three-month notice of deletion in the Drug Tariff Appliance Watch: Notice of Deletion page. The latest month’s Drug Tariff changes can be found in the Drug Tariff Watch 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.
Pharmacy owners also 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.
The table below lists other recent examples of common disallowed items reported to Community Pharmacy England:
| Item ordered | Ordered by | Reason for disallowed item |
|
Dermol® 200 shower emollient Dermol® 500 lotion Dermol® 600 bath emollient Dermol® cream |
Community Nurse prescriber | Not listed in the Nurse Prescribers’ Formulary (NPF) for Community Practitioners |
| Octenisan® Wash | Community Nurse prescriber | Not listed in the Nurse Prescribers’ Formulary (NPF) for Community Practitioners |
|
Flucloxacillin 250mg capsules Flucloxacillin 500mg capsules |
Dentist | Not listed in the Dental Prescribers’ Formulary (DPF) |
| Oralieve® moisturising mouth spray | Dentist | Not listed in the Dental Prescribers’ Formulary (DPF) |
| Glandasone® synthetic saliva spray (natural, lemon or peppermint) | GP | Appliance no longer listed in Part IX of the Drug Tariff |
| Mepilex® Border dressing | GP | Appliance no longer listed in Part IX of the Drug Tariff |
| Softclix® lancets 0.4mm/28gauge (Roche Diabetes Care Ltd) | GP | Appliance no longer listed in Part IX of the Drug Tariff |
| Neilmed® Sinus Rinse | Hospital prescriber | Appliance not listed in Part IX of the Drug Tariff |
| Hycosan® Eye Drops | GP | Appliance not listed in Part IX of the Drug Tariff |
Community Pharmacy England is encouraging pharmacy owners to check their disallowed items history on the Manage Your Service (MYS) portal to identify any unpaid items and check the reasons why these were disallowed by the NHSBSA. If an item is believed to have been incorrectly disallowed, pharmacy owners should submit a challenge to the NHSBSA, who will investigate the issue and rectify any missing payments if a pricing error is identified. Click here for more information on how to check and challenge disallowed items on MYS.
Why do IT systems enable non-reimbursable EPS prescriptions to be processed?
By using the latest dm+d extract, IT prescribing systems can support prescribers by preventing the selection of non-Part IX appliances for ordering on NHS prescription forms. Dispensing systems, also map to dm+d, can help pharmacy teams prevent the dispensing of non-Part IX appliances by mapping to the latest dm+d extract. At present, given the need for these mapping processes, some systems will not always take into account of the most recent Drug Tariff changes. Note that prescribing systems are mapped less frequently compared to dispensing systems.
How to ensure systems are kept up-to-date
To minimise the risk of EPS users inadvertently prescribing or dispensing products that have been recently amended or deleted from the Drug Tariff and/or dm+d, users should ensure their systems are always up-to-date.
Using the latest dm+d extract, IT prescribing systems can support prescribers by preventing the selection and ordering of non-Part IX appliances on NHS prescription forms. Similarly, dispensing systems, which also map to dm+d, can help pharmacy teams prevent the dispensing of non-Part IX appliances by mapping to the latest dm+d extract.
Regular dm+d mapping by suppliers, particularly at the beginning of each month, is crucial for ensuring systems reflect recent changes in the Drug Tariff and dm+d (e.g. new or deleted items). If you encounter technical issues or have queries related to system and dm+d mapping, please utilise the Reporting medicine ‘mapping errors’ process found on our NHS medicines database (dm+d) webpage.
Further Information
Community Pharmacy England Briefing 020/22: Understanding prescription returns and disallowed items
