Home DNG FAQ Archive
Frequently Asked Questions
Can I endorse ‘DNG' to claim exemption from discount deduction for unlicensed medicines?
As of 1st November 2011, the endorsement 'DNG' is no longer in use as the exemption from discount deduction for unlicensed specials and imports is now an automatic process.
Are appliances eligible to be added to the list?
Made to Measure Elastic Hosiery and Trusses could formerly be found in Zero Discount List A but these products were removed from the Scheme in September 2006. The Department of Health have refused to add appliances to the list for some time and have confirmed that appliances will not be eligible for entry into the list of ‘drugs for which discount is not deducted.'
The Department of Health are currently reviewing the arrangements for the supply of appliances to primary care. A copy of the PSNC response to this consultation can be downloaded by clicking on the link below.
2005 Consultation: DH Proposals on the Reimbursement of Appliances (PDF Format)
2005 Consultation: PSNC Response (PDF Format)
In the response, PSNC highlighted the fact that an NHS pharmacy contractor is not contractually obliged to supply appliances that would not normally be supplied in the course of their business. Therefore if a contractor was faced with a loss through dispensing the item, they may choose not to dispense it.
PSNC strongly believes that where discount is not available when purchasing an appliance, to ensure patient access and care, the product should be exempt from discount deduction.
Are borderline substances eligible to be added to the list?
Under the old arrangements, all borderline substances (foods, toiletries and cosmetics that have the characteristics of drugs) approved by the Advisory Committee on Borderline Substances were considered exempt from discount deduction.
Under the new arrangements, products will be assessed individually and may be added to the list if they meet one or more of the new criteria. Therefore whilst some borderline substances are included in the list, many are not. Click on the link below to download a list of borderline substances removed the List in September 2006:
Borderline Substance Products Being Removed from the ZD Arrangements in September 2006
If a product is in the list by brand name but the product has been prescribed generically, will the prescription item be exempt from discount deduction?
This depends on whether the product is listed generically in Part VIII of the Drug Tariff or not. If the product is not listed generically in Part VIII of the Drug Tariff, then the prescription will be priced based on the endorsed brand/manufacturer, therefore if that branded product is listed in the list of 'Drugs for which Discount is not Deducted,' the item will be exempt from discount deduction. For example, Revatio 20mg tablets are included in the list as this product meets the '3 criteria'. The generic description for this product (Sildenafil 20mg tablets) is not included in Part VIII of the Drug Tariff, therefore prescriptions for this product will be priced based on the branded product endorsed. As Revatio is included in the list, a prescription for Sildenafil 20mg tablets would therefore also be exempt from discount deduction.
If the prescribed generic product is listed in Part VIII of the Drug Tariff generically, the product will be priced based on the Part VIII listing regardless of what brand has been dispensed. In this scenario, the generic name must also be listed in Part VIII of the Drug Tariff for a generic prescription for the item to be exempt from discount deduction. For example Seroquel 100mg tablets meets the ‘3 criteria' so is included in the list. As this product's generic description (Quetiapine 100mg tablets) can be found in Part VIII of the Drug Tariff, the generic description is also included in the list to ensure prescriptions for this product, whether prescribed generically or by brand name will be exempt from discount deduction.
Please note that there may be occasions where a particular branded product meets the criteria but the generic equivalent of the product does not. In this case, the generic description would not be included in the list.
How was the criteria for products to be included in the list developed?
The Department of Health published the proposed criteria in their consultation on this issue. The criteria is intended to reflect those classes of product that require special handling by wholesalers and therefore which have additional supply chain costs. Click on the links below to view the Department of Health consultation on this issue and the PSNC Response:
Proposals to simplify the reimbursement arrangements for NHS dispensing contractors: A consultation (PDF Format)
PSNC Response to Drug Tariff Simplification Consultation (PDF Format)
DH Summary of Responses to the DT Consultation (PDF Format)
Can I refuse to dispense a medicine that I do not receive discount in obtaining and which is not on the DNG List?
Pharmacy contractors, through their Terms of Service, are obliged to dispensed all medicines ordered with reasonable promptness, regardless of whether discount is received when obtaining a product (The National Health Service (Pharmaceutical Services) Regulations 2005. Schedule 1; Part 2;5.(2)(b)).
Pharmacy contractors may decide to only order certain items from their wholesaler when a prescription is presented. In the case of commonly prescribed medicines, contractors will need to balance any decision not to hold stock against any inconvenience to the patient which may lead to that patient considering complaining or using another pharmacy for all of their pharmaceutical needs.
What endorsements do pharmacists need to make for items exempt from discount deduction?
There is no longer a requirement for any endorsements to be made as the process is now automatic for those products listed in Part II of the Drug Tariff as well as for unlicensed specials and imports.
Why is the Becodisks 400mcg Refill pack on the list when the Becodisks 200mcg Refill Pack was removed from the list?
Products are assessed individually. Becodisks 400mcg meets the 'three criteria' (Fewer than 500,000 items per year are dispensed, the average NIC per item is more than £50 and no discount is available). Becodisks 200mcg does not meet the new criteria as although no discount is available in obtaining the product the average Net Ingedient Cost per prescription item is less than £50.
Methotrexate Tablets 10mg are considered cytotoxic but i can't see them listed in the new list. Are they exempt from discount deduction?
Yes, all cytotoxic and cytostatic items listed in Section 8.1 of the BNF are exempt from discount deduction, regardless of whether the prescription has been written by brand or generic name. These products aren't listed individually in the list but can be found under the broad heading 'cytotoxic or cytostatic items'.
There are similar broad headings for Controlled Drugs in Schedule 1, 2 and 3 of the Misuse of Drugs Regulations 2001, immunoglobulins, cold chain items, insulins for injection, vaccines and antisera.
Do these changes also affect Dispensing Doctors?
No, Dispensing Doctors have a separate discount deduction scale from pharmacy contractors which can be found in Annex G of the GMS Statement of Financial Entitlements. Dispensing doctors do not benefit from the Zero Discount Concession, that is where discount is deducted from a practice, it is deducted for all products regardless of whether discount was received in purchasing the product or not.
Do these changes apply to Wales?
Yes.
Do these changes extend to the Isle of Man, Jersey and Guernsey?
PSNC has no remit over these jurisdictions but the NHSBSA Prescription Pricing Division has confirmed that the changes taking place in England will apply to the Isle of Man, Jersey and Guernsey. Queries on this should be directed to the pharmacy contractor committee in the relevant jurisdiction.
Do these changes extend to Scotland?
Scotland has separate arrangements on Zero Discount including a separate deduction scale and zero discount list. These changes do not apply to Scotland. For more information on the Scottish Zero Discount arrangements, please contact the Scottish Pharmaceutical General Council.