Oral liquid methadone fee arrangements agreed
Endorsing guidance (click for downloadable document)
Following its review of contractor data on methadone fees and supply, PSNC has today announced that the Department of Health (DH) has agreed new fee arrangements for oral liquid methadone to be introduced from April 2013.
The revised system now includes a requirement for contractor endorsement and has been agreed following extensive modelling to ensure that it reflects the costs of dispensing in all scenarios.
On each occasion the pharmacist provides methadone to the patient i.e. for each interaction or “pick-up,” contractors will continue to receive a professional fee, CD fee, consumables allowance and any relevant volume related fees.
The “item level fee” for oral liquid methadone prescriptions (introduced in July 2012) will continue to be paid but will change to £2.50 per prescription.
As well as this fee, from April 2013 contractors will be able to claim a fee of 55p per additional dose packaged separately.
“Additional” doses are doses given to patients in addition to the dose they have come to collect from the pharmacy for that day i.e. either to take at home later on that day or to cover non-collection days.
For example, for a patient collecting three doses on a Friday to cover the weekend:
- If the contractor dispenses all three doses together (i.e. the three daily doses are in one container), with a suitable measuring device, the contractor would not be eligible to claim for any additional 55p fees.
- If the contractor dispenses the Friday dose as a single dose (e.g. for supervised consumption) with the Saturday and Sunday doses packaged together in one container with a suitable measuring device, the contractor would be eligible for one 55p fee as one separate package was supplied for the Saturday and Sunday doses.
- If the contractor dispenses all three doses in separate containers, the contractor would be eligible for two 55p fees as two separate packages were supplied for the Saturday and the Sunday doses.
- If because of the volume, and the size of available containers, one dose is dispensed between two or more containers, the contractor is not eligible for another fee – i.e. splitting one daily dose into multiple containers does not create eligibility for separate fees.
These fees will apply whether or not the prescriber has requested the additional containers on the prescription and will apply to both FP10 and FP10MDA prescriptions for oral liquid methadone.
Alongside these new fee arrangements, there has been a change to the terms of service included in the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, which will come into effect as of 1st April 2013. This will require pharmacists to make an assessment and decide the most appropriate method of packaging for oral liquid methadone for each patient whether that be:
(a) Each dose in a separate container;
(b) An original pack (or original packs); or
(c) The oral liquid methadone in some other way.
The revised fee structure was agreed after lengthy negotiations between PSNC and the DH. PSNC’s objective throughout these negotiations has been to ensure that the new fees cover contractors’ costs in every variation of supply ordered, using data submitted by pharmacies as the basis for modelling work.
The new fee arrangement has several key advantages:
- Contractors will be paid proportionally for the workload involved in packaging each dose separately;
- Contractors who dispense additional doses in separate packages, even if this has not been requested by the prescriber, will now be paid for doing so. The cost of supply will always be covered and this was not possible when applying one set fee to cover all situations or having bands of fees;
- FP10s for oral liquid methadone are also paid according to the workload involved in their dispensing;
- Where part supervised/part take-home doses are prescribed, these will now be eligible for the additional payment of 55p for each take-home dose packaged separately.
“PSNC is very grateful to those contractors who provided data last summer for our time and motion study and analysis of methadone supply and costs of dispensing. The additional data enabled us to identify key issues such as the geographical variation of daily dose prescribing and the changing trends in FP10 prescribing patterns which have fed into our work to develop the new fee arrangements.
The PSNC committee are confident that these new arrangements will reflect the cost of supply in all scenarios.
While PSNC recognises that there is an additional endorsing requirement, this was the simplest way to ensure that fees are paid accurately and according to the number of additional separately packaged doses
Mark Burdon, independent contractor and a member of the PSNC methadone working group, said:
“As an independent contractor, I know the impact that any changes to reimbursement can have on a business. However, PSNC’s job is to try to distribute funding as fairly as possible between contractors, and this often requires difficult decisions.
As a representative on PSNC, my role is to represent all contractors equally, so while these new fee arrangements will not see fees as high as they were before July 2012 and so will have an impact on my own and other businesses, I do believe that they accurately reflect contractors’ costs and so represent a fair deal for the contractor base as a whole.”
What happened to the two-tiered £4.05 item level fee proposed by PSNC last year?
Last year, following its review of the methadone fee arrangements, PSNC proposed the introduction of a £4.05 item level fee for FP10s and any FP10MDA up to 7-days’ duration, with two sets of fees to be paid for any FP10MDA up to 14-days. This was based on extensive modelling of pharmacy costs in dispensing methadone, but assumed daily dose dispensing on every occasion. The new arrangement, because it is based on contractor endorsement, means that fees will only be paid where the work to package doses separately has actually been completed. It has also taken into account prescription data that has been made available since the earlier proposal.
Why are additional endorsement requirements needed?
The new system is designed to ensure that contractors have been paid for the work they have completed. Contractor endorsement is the simplest way to ascertain whether supply of individual doses has been made in separate packages.
How will pharmacies need to endorse oral liquid methadone prescriptions for payment?
Contractors will be required to endorse both FP10 and FP10MDA prescriptions for any additional separately packaged doses of oral liquid methadone supplied. The endorsement will be the same for both prescription types. The detail of the endorsements is currently being finalised with the DH and will be published with full guidance, including worked examples and FAQs, on the PSNC website as soon as possible.
When will the new payments begin?
The new fees will apply to all oral liquid methadone prescriptions dispensed from 1 April 2013, so contractors should ensure that they comply with the new endorsement requirements from that date. All Methadone prescriptions submitted to the NHSBSA with the March bundle i.e. by the 5th April 2013 will be priced in accordance with the March Drug Tariff. All prescriptions submitted in April’s prescription bundle (i.e. by the 5th May 2013); will be paid in accordance with the April Drug Tariff rules.
Do these changes apply to all controlled drugs which can be supplied on an FP10MDA form (e.g. buprenorphine)?
No, there have been no changes made to the payment arrangements for other controlled drugs prescribable on an FP10MDA form (e.g. diazepam or buprenorphine). Payment for these drugs remains based on the number of patient interactions or “pick-ups” from the pharmacy only. No item level fee is applied; nor can the fee for additional packaged doses be claimed.
Why are these changes only for methadone and not for all other drugs which can be supplied on an FP10MDA such as buprenorphine?
The arrangements recognise the difference in workload involved in the dispensing of oral liquid methadone compared to other drugs on an FP10MDA form; thus the £2.50 item level fee and, where endorsed, 55p for each additional packaged dose, are only paid against prescriptions for oral liquid methadone.
Posted 5 March 2013