Endorsement guidance and FAQs for HRT SSPs now live – update

PSNC’s Dispensing & Supply team have created easy to use flow charts to assist pharmacists in selecting the correct SSP for HRT medicines. These charts also remind contractors of the correct SSP endorsement requirements (with examples) and charge status to apply to the Electronic Reimbursement Endorsement Messages (EREMs) before SSP claims are submitted for payment to the NHSBSA. See below for top tips and helpful reminders on correct endorsement and submission requirements.

For supplies made in accordance with HRT SSPs, PSNC is aware that NHSBSA has received several claims endorsed with an incorrect/invalid SSP number. Incorrect endorsements will affect pharmacy payments. The prescription must be endorsed with SSP followed by the correct three-digit reference number for e.g. SSP 022. Due to the number of different HRT SSPs available for affected HRT medicine, pharmacists must ensure that they follow the correct endorsements requirements as per the supporting guidance published for each SSP on the dedicated page of the NHSBSA’s website. Contractors should check with their PMR system supplier on the correct use of the SSP endorsement functionality available on their system.


Following the announcement that a further ten new Serious Shortage Protocols (SSPs) were issued on 20 May 2022, the NHS Business Services Authority (NHSBSA) have now published the endorsement guidance for the new SSPs on the NHSBSA’s website.

Due to the number of different HRT SSPs available for affected HRT medicine, pharmacists must ensure that they follow the correct endorsements requirements as per the supporting guidance published for each SSP on the dedicated page of the NHSBSA’s website. Incorrect endorsements will affect pharmacy payments.

In addition, to support pharmacy teams, PSNC has also put together some helpful reminders and top tips on the correct SSP endorsement and submission requirements.

Top tips:

  • Always double check that endorsements reflect the requirements outlined in the supporting guidance published for each SSP on the dedicated page of the NHSBSA’s website.
  • Check whether your PMR system enables complete and correct SSP endorsements (please contact your system supplier if you are unsure of how to apply endorsements correctly). If you have suggestions about how system usability and functionality could be improved, feed these back to your PMR supplier.
  • When endorsing using EPS, select the SSP endorsement on your system and input the correct three-digit reference number leaving a space in between ‘SSP’ and the three-digit reference number for example, SSP 022. Remember to insert the leading zero in the three-digit reference number.
  • When endorsing an SSP for a reduced quantity in line with an SSP ensure you endorse the SSP product dispensed and the reduced quantity supplied.
  • When endorsing an SSP for a substitution with a specific alternative product in line with an SSP ensure you endorse the specific alternative product dispensed and the quantity supplied.
  • When endorsing an SSP for a reduced quantity and substitution in line with an SSP ensure you endorse the specific alternative product dispensed and the reduced quantity supplied.
  • When endorsing an SSP for a substitution or a reduced quantity and substitution where a specific alternative brand has been dispensed contractors must endorse the brand supplied to ensure correct reimbursement. If a specific brand is supplied but the corresponding generic name is endorsed on the prescription, reimbursement would be in accordance with the price listed in Part VIIIA of the Drug Tariff which may result in underpayment.
  • For SSPs involving substitution from gel/spray to patch formulation, or from Ovestin cream to Estriol 0.1% cream, there should not be a need to mark the prescribed product as ND (Not Dispensed). Please speak to your system supplier if you are unable to select and endorse a different product to what was originally prescribed.
  • Ensure your endorsements are accurate and clear – NHSBSA processing staff must be able to determine what has been supplied.
  • SSP claims submitted using EPS tokens are no longer permitted.
  • No prescription charge is payable if a patient receives a smaller quantity of the medicine than the quantity originally ordered on the prescription if it was supplied in accordance with a SSP for a reduced quantity. Prescription charges apply as usual for supplies made in accordance with SSPs permitting substitution only (without quantity restriction).
  • If a patient normally pays for their prescriptions, the paid status should be selected even though no charge is taken for the three months’ worth of HRT medicine supplied in accordance with the SSP.  Once submitted for payment, the NHSBSA will recognise the SSP endorsement and process the prescription as a no-charge item i.e. no prescription charges will be deducted by the NHSBSA.
  • NHSBSA will continue to apply charge deductions for any other chargeable items dispensed on the same prescription form with mixed items (affected HRT medicine prescribed with other items).
  • If patient is exempt from prescription charges, the correct exemption reason should be selected.
  • If any claims for SSPs have been endorsed incorrectly and before a claim is submitted for payment, where PMR systems allow, contractors may be able to retrieve any submitted EPS dispense notification messages by using the claim amend functionality.
  • SSPs cannot be supplied past the period of SSP validity. Any other items on the prescription (such as an owing) can continue to be dispensed as usual but must be submitted for payment within three months of expiry of the SSP.

Declaration of monthly SSP claims using the FP34C form on MYS:

  • There is a separate declaration of monthly SSP claims on the digital FP34C submission form via the Manage Your Service (MYS) portal.
  • Here, contractors should endorse the number of SSP claims made each month and not the number of items supplied in accordance with the SSPs.
  • The number of items supplied in accordance with SSPs are to be declared along with the usual item totals.
  • Please note that the NHSBSA will not be using the SSP declaration made on the FP34Cs for reimbursement purposes. Instead the SSP declaration is to provide the NHSBSA with an indication that SSP claim(s) are expected in that month.
  • The SSP declaration is to support contractors when reconciling the number of SSP fees on their payment schedules against the number of SSP claims declared on the FP34C.

FAQs

General

Q. Do the SSPs for HRT apply to cross-border prescriptions?

A. Yes. Patients from England, Scotland, Wales or Northern Ireland who present their prescriptions for either Premique® Low Dose 0.3mg/1.5mg modified-release tablet, Ovestin® 1mg cream, Oestrogel® Pump-Pack 0.06% gel, Lenzetto® 1.53mg/dose transdermal spray or Sandrena® 0.5mg and 1mg gel sachets are eligible to receive supply under the terms of the specific appropriate SSP.

Q. Do patients have to consent/agree to SSP supplies?

A. Yes, patient consent/agreement is required for supply of an alternative product and/or quantity in accordance with an SSP.

Q. Do the SSPs for HRT apply to private prescriptions?

A. Yes. The scope of the SSPs for HRT applies to valid prescriptions that meets the requirements of the Human Medicine Regulations 2012, so it would cover both NHS and private prescriptions, unless where it stated otherwise on the SSP itself.

Quantity restriction SSPs

Q. Will prescription charges apply for quantity restriction SSPs?

A. No prescription charge is payable if a patient receives a smaller quantity of the medicine than the quantity originally ordered on the prescription if it was supplied in accordance with an SSP for reduced quantity.

If patient is exempt from prescription charges, the correct exemption reason should be selected.

If a patient normally pays for their prescriptions, the paid status should be selected even though no charge is taken for the three months’ worth of HRT medicine supplied in accordance with the SSP.  Once submitted for payment, the NHSBSA will recognise the SSP endorsement and process the prescription as a no-charge item i.e. no prescription charges will be deducted by the NHSBSA.
NHSBSA will continue to apply charge deductions for any other chargeable items dispensed on the same prescription form with mixed items (affected HRT medicine prescribed with other items).

Q. How would pharmacists determine a three-month supply?

A. Where it is not clear from the prescription what constitutes a three-month supply, the pharmacist will need to discuss with the patient and use their professional judgment.

Q. If the prescription states less than three months’ supply should be dispensed does it fall within scope of a quantity restriction SSP?

A. No. If the prescription states that either three months’ supply or less is to be supplied to the patient, this would not fall within scope of a quantity restriction SSP. The pharmacist should dispense the medication in accordance with the prescription.

Substitution SSPs

Q. Will prescription charges apply for substitution SSPs?

A. Yes, for prescriptions with a quantity less than three-months, patients who are not exempt from prescription charges would continue to pay for this as usual.

Q. Can pharmacists supply more than three months’ supply for a substitution SSP?

A. No, in accordance with the substitution SSPs, pharmacists will only be able to dispense the substituted product when the prescribed duration of treatment is three months’ or less.

Q. Is there any difference between the substituted products recommended?

A. Yes. Pharmacists should be mindful of the different dosing regimens of the substituted products specified on the supporting guidance. For example, whether the patches are administered once or twice weekly.

Pharmacists should use their professional judgement to select the appropriate substitution on the basis of the brands available to them.

Q. How will I be reimbursed when supplying a substitution with a specific alternative product in line with an SSP?

A. Reimbursement will be for the the medicine supplied in accordance with an SSP, not the originally prescribed medicine.

Where a specific alternative brand has been dispensed contractors must endorse the brand supplied to ensure correct reimbursement. If a specific brand is supplied but the corresponding generic name is endorsed on the prescription, reimbursement would be in accordance with the price listed in Part VIIIA of the Drug Tariff which may result in underpayment.

Substitution AND quantity restriction SSPs

Q. Will prescription charges apply for substitution and quantity restriction SSPs?

A. No prescription charge is payable if a patient receives a smaller quantity of the medicine than the quantity originally ordered on the prescription if it was supplied in accordance with an SSP for reduced quantity.

If patient is exempt from prescription charges, the correct exemption reason should be selected.

If a patient normally pays for their prescriptions, the paid status should be selected even though no charge is taken for the three months’ worth of HRT medicine supplied in accordance with the SSP.  Once submitted for payment, the NHSBSA will recognise the SSP endorsement and process the prescription as a no-charge item i.e. no prescription charges will be deducted by the NHSBSA.
NHSBSA will continue to apply charge deductions for any other chargeable items dispensed on the same prescription form with mixed items (affected HRT medicine prescribed with other items).

Q. Is there any difference between the substituted products recommended?

A. Yes. Pharmacists should be mindful of the different dosing regimens of the substituted products specified on the supporting guidance. For example, whether the patches are administered once or twice weekly.

Pharmacists should use their professional judgement to select the appropriate substitution on the basis of the brands available to them.

Q. How would pharmacists determine a three-month supply?

A. Where it is not clear from the prescription what constitutes a three-month supply, the pharmacist will need to discuss with the patient and use their professional judgment.

Q. If the prescription states less than three months’ supply should be dispensed does it fall within scope of a substitution and quantity restriction SSP?

A. No. If the prescription states that either three months’ supply or less is to be supplied to the patient, this would not fall within scope of a substitution and quantity restriction SSP. The pharmacist should dispense the medication in accordance with the prescription.

Q. How will I be reimbursed when supplying a substitution with a specific alternative product in line with an SSP?

A. Reimbursement will be for the the medicine supplied in accordance with an SSP, not the originally prescribed medicine.

Where a specific alternative brand has been dispensed contractors must endorse the brand supplied to ensure correct reimbursement. If a specific brand is supplied but the corresponding generic name is endorsed on the prescription, reimbursement would be in accordance with the price listed in Part VIIIA of the Drug Tariff which may result in underpayment.

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