Reminder: Check your disallowed/referred back prescriptions on MYS before they expire
Last month, the Drug Tariff was updated to include a deadline for submission of any outstanding referred back (unpaid) prescriptions to the NHS Business Services Authority (NHSBSA) for payment. Following this update, NHSBSA has seen a spike in the number of referred back prescriptions submitted by pharmacies in the past month.
Community Pharmacy England would like to remind pharmacy teams to complete and submit required information for all outstanding referred back prescriptions as soon as possible to avoid any delays in payment. All outstanding referred back prescriptions must be completed and returned to the NHSBSA no later than 18 months from the date they are first sent to the pharmacy via the Manage Your Service (MYS) portal.
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 prescriptions are returned to the pharmacy to complete the missing information.
Pharmacy owners are also urged to review any disallowed items and submit a challenge to the NHSBSA if it is believed any have been incorrectly disallowed.
Next steps
Referred back items
Outstanding referred back prescriptions can be found by checking the ‘Unpaid items’ tab on the MYS landing page. 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 for processing. If pharmacy owners have not completed and returned any outstanding referred backs prescriptions before this deadline has passed, they will be deleted from system and pharmacy owners will no longer have an opportunity to claim payment for these.
All paper referred back forms sent to pharmacies in the post ceased in July 2022 when referred backs became fully digital via MYS. Therefore, pharmacies with any outstanding paper referred back forms will need to complete and submit these to the NHSBSA no later than the 5th February 2024 (the prescription submission deadline for the dispensing month of January 2024).
Disallowed items
Disallowed items can be found by checking the ‘Disallowed Items’ tab on the MYS landing page. If you believe an item has been incorrectly disallowed, you should submit a challenge to the NHSBSA, who will investigate the issue and rectify any missing payments if a processing error is identified.
It is important to note that disallowed items are also 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.
To challenge disallowed items returned via Manage Your Service portal, pharmacy owners can click on a link available under the disallowed item displayed on the portal. This will bring up a free-text box in which you should provide details of why you believe the item has been disallowed in error, and your contact email address. If a disallowed item is successfully challenged, NHSBSA will reimburse the item and any payment adjustments will be reflected in the next Schedule of Payments. If a pharmacy contractor remains unsatisfied with outcome of a disallowed item challenge, they can email their query to info@cpe.org.uk for further advice on the matter.
For more information including two examples of products identified by Community Pharmacy England that may have been incorrectly disallowed by the NHSBSA see Check and challenge your disallowed items using MYS.
How are re-submitted items processed by the NHSBSA?
Referred back items that have been submitted for payment (and any disallowed items successfully challenged) will be priced using the Drug Tariff for the dispensing month that is currently being processed by the NHSBSA. 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.
For more information on referred back items please refer to our webpage on Prescription returns and Briefing 020/22: Understanding prescription returns and disallowed items.
Background
Where the NHSBSA cannot process a prescription item for payment due to insufficient endorsed information, it is returned to the pharmacy for the missing information to be added so that it can be correctly reimbursed.
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 returned item is assigned a referred back code to indicate the referred back reason.
NHSBSA sends out a notification email to the pharmacy NHSmail account if any new referred back or disallowed items have been generated for the contractor to complete on their MYS account. Pharmacy owners can view any referred back items for completion by checking the ‘Unpaid items’ tab on MYS landing page. Using MYS for receiving digital referred back and disallowed items allows contractor to:
- receive these items sooner and removes the risk of paper returns getting lost in transit;
- provide information required to processes referred back items faster;
- submit a challenge for any disallowed items electronically;
- 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.
When the required additional information has been added to the relevant sections within MYS, pharmacy owners can submit referred back items electronically to the NHSBSA for processing.
Related Resources
Community Pharmacy England Briefing 020/22: Understanding prescription returns and disallowed items
Using Your Schedule of Payment to Monitor Performance
