1. No category

Community Pharmacy Services Agreement
(CPSA)
1 July 2012
PHARMACY PROCEDURES MANUAL
Version Number: INTERIM v6.0
Effective Date: 14 November 2012
PREAMBLE
This procedures manual has been created with the purpose of providing guidance to claiming for
community pharmacy service provision under the requirements of the Community Pharmacy
Services Agreement 2012 (CPSA). As such it has been prepared by the Community Pharmacy
Services Operational Group (CPSOG) to inform all CPSA parties. It may also be used for pharmacies in
their claiming processes not attached to the CPSA.
Version control is held by District Health Board’s Shared Services (DHBSS) within Central Region’s
Technical Advisory Services Ltd (TAS) and the latest version, as well as archived documents, may be
found at the following web site:
http://www.centraltas.co.nz/DHBSharedServices/Pharmacy/CommunityPharmacyServices/tabid/2
53/Default.aspx
CONSULTATION
Version INTERIM v6.0, dated and effective from 14 November 2012, has been posted on-line as both
a document for use and to engage with the Sector for feedback. Feedback is therefore invited on both
content and usability, and may be directed in the first instance to the Pharmacy Services e-mail:
[email protected]
Pharmacy Procedures Manual v 6.0 INTERIM
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Contents
1.
INTRODUCTION ........................................................................................................................................... 1
2.
PHARMACY CLOSURE OR CHANGE OF OWNERSHIP .................................................................................... 1
3.
SUBMISSION OF BATCHES ........................................................................................................................... 2
3.1.
3.2.
3.3.
4.
VERIFICATION OF CLAIMS ................................................................................................................................. 2
BATCH DELIVERY INSTRUCTIONS ........................................................................................................................ 2
SUBMISSION OF BATCHES FOR AUDIT PURPOSES ................................................................................................... 3
LEGAL REQUIREMENTS ................................................................................................................................ 4
4.1.
4.2.
5.
LEGAL REQUIREMENTS OF PRESCRIPTIONS ........................................................................................................... 4
PROFESSIONAL GROUP PRESCRIBING .................................................................................................................. 4
PRESCRIPTION SUBSIDY REQUIREMENTS .................................................................................................... 7
5.1.
5.2.
5.3.
5.4.
5.5.
5.6.
5.7.
5.8.
5.9.
5.10.
5.11.
5.12.
5.13.
5.14.
5.15.
5.16.
5.17.
5.18.
5.19.
5.20.
5.21.
5.22.
5.23.
6.
ADDRESS ....................................................................................................................................................... 7
NHI ............................................................................................................................................................. 7
ARRC AND LTC PATIENTS ................................................................................................................................ 7
PRESCRIBER ................................................................................................................................................... 7
PRESCRIBER INFORMATION ............................................................................................................................... 8
PATIENT INFORMATION.................................................................................................................................... 8
CO-PAYMENTS FOR ANTIANDROGEN ORAL CONTRACEPTIVES ................................................................................ 11
DATE OF DISPENSING .................................................................................................................................... 11
PRESCRIPTION NUMBER (UNIQUE IDENTIFYING NUMBER) .................................................................................... 12
CONTROLLED DRUG PRESCRIPTIONS ............................................................................................................. 12
SUPPLY ORDERS ....................................................................................................................................... 16
SPECIFIC PRESCRIPTION TYPES ..................................................................................................................... 16
REPEAT SUPPLIES ...................................................................................................................................... 18
PRESCRIPTION ITEM OWING ....................................................................................................................... 19
NEGATIVE R............................................................................................................................................. 19
ANNOTATIONS ......................................................................................................................................... 19
ENDORSEMENTS ....................................................................................................................................... 21
SPECIALIST RECOMMENDATION ................................................................................................................... 21
ALTERATION TO QUANTITY DISPENSED.......................................................................................................... 21
COST, BRAND, SOURCE (CBS)..................................................................................................................... 22
ORIGINAL PACK DISPENSING ....................................................................................................................... 22
BROKEN PACKS ........................................................................................................................................ 22
ORAL ANTIBIOTIC LIQUIDS .......................................................................................................................... 22
INTERPRETATION OF REIMBURSEMENT RESTRICTIONS ............................................................................. 24
6.1.
6.2.
6.3.
6.4.
6.5.
6.6.
6.7.
6.8.
6.9.
EYE DROPS .................................................................................................................................................. 24
INSULIN VIALS AND CARTRIDGES ...................................................................................................................... 24
MUCILAGINOUS LAXATIVES ............................................................................................................................. 24
BRONCHODILATOR ASTHMA INHALERS .............................................................................................................. 24
STEROID ASTHMA INHALERS ........................................................................................................................... 25
EXTEMPORANEOUSLY COMPOUNDED PREPARATIONS (ECP) ................................................................................. 25
NAMED PATIENT PHARMACEUTICAL ASSESSMENT (NPPA) ................................................................................... 26
DISPENSING FREQUENCY ................................................................................................................................ 26
BRAND-SWITCH FEES ..................................................................................................................................... 29
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7.
HEALTH ENTITLEMENT CARDS ................................................................................................................... 31
7.1.
7.2.
7.3.
8.
COMMUNITY SERVICES CARDS......................................................................................................................... 31
HIGH USE HEALTH CARDS .............................................................................................................................. 31
PHARMACEUTICAL SUBSIDY CARDS................................................................................................................... 31
SPECIAL AUTHORITY .................................................................................................................................. 34
8.1.
8.2.
8.3.
8.4.
8.5.
9.
WHAT IS SPECIAL AUTHORITY? ........................................................................................................................ 34
OBTAINING SPECIAL AUTHORITY INFORMATION .................................................................................................. 34
TO DETERMINE HOW AN ERROR HAS OCCURRED .................................................................................................. 35
RISK NUMBER PROCEDURE ............................................................................................................................. 36
SPECIAL AUTHORITY QUICK REFERENCE TABLE ................................................................................................... 37
RECEIPTS ................................................................................................................................................... 38
10.
USEFUL CONTACTS ................................................................................................................................ 39
11.
APPENDICES .......................................................................................................................................... 40
11.1.
11.2.
APPENDIX A – SAFETY MEDICINES LIST ......................................................................................................... 40
APPENDIX B – GLOSSARY ........................................................................................................................... 42
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Pharmacy Procedures Manual
1.
INTRODUCTION
The Procedures Manual has been compiled for Pharmacies when claiming reimbursement for
services, and should be read in conjunction with the documents listed below. These documents will
form part of any audit process.
For the purpose of reimbursement, the order of priority is as follows:

All relevant legislation and regulations applicable to the practise of pharmacy in New Zealand;

The Pharmaceutical Schedule;

The Pharmaceutical Transactions Data Specification (in relation to matters concerning file
formats and data to be provided for processing purposes);

Protocols for other Community Pharmacy Services Agreement (CPSA) services, such as Long
Term Conditions Service (LTC).

Your Agreement for the provision of pharmacy services; and

This Procedures Manual.
2.
PHARMACY CLOSURE OR CHANGE OF OWNERSHIP
For circumstances where there is a Pharmacy closure or change of ownership, guidance on
appropriate procedures should be sought from your District Health Board (DHB) as soon as you
become aware of such a situation.
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3.
SUBMISSION OF BATCHES
3.1. Verification of Claims
All claimable items submitted by a Pharmacy must have the following:
a. The electronic claim is to be accompanied by the approved certification, as to the truth and
accuracy of the claim and compliance with the CPSA. Such certification occurring by use of the
electronic signature and key assigned to a Pharmacist.
b. The electronic claim is then to be supported by an original prescription form (original
prescription forms must be retained by the pharmacy and not returned to the patient), which
shall be filed in date of dispensing (the batch). Any form received by the pharmacy at a later
date must be inserted in the original batch containing the corresponding date of dispensing.
c. Meets all legal and contractual requirements.
Variances between the original prescription and the computer record or supply must be clearly
annotated on the prescription form for clarification.
Each batch must be accompanied by a coversheet (in the form approved by the Ministry of Health
from time to time) which is to be completed in full and signed on behalf of the pharmacy.
3.2. Batch Delivery Instructions
The Ministry of Health (MoH) stores each pharmacy’s prescription batches pursuant to the Medicines
Regulations requirements. Prescription batches must be collated correctly.
Procedures
Note
Each claim period must be batched separately, with a unique batch record form, and
must replicate the electronic claim file and claiming cycle.
For example, if claims are submitted once a week, the prescription batch must be
bundled weekly.
Where claims are made fortnightly, the prescription batch must be bundled
fortnightly.
Table 1.
Weekly Claim periods
1 - 7 day of the calendar month
8 – 15 day of the calendar month
16 – 23 day of calendar month
24 – last day of the calendar month
Fortnightly Claim Periods
1 – 15 day of calendar month
16 – last day of calendar month
Step 1
Collate prescriptions in order of date of dispensing; each dispensing date must be
secured tightly into separate bundles.
Step 2
Collate the date of dispensing bundles into one claim period batch (refer Note
above) this will depend upon your electronic claiming cycle.
Step 3
Complete a MoH Batch Record Form. Batch record forms can be downloaded from
MoH website or through your PMS system (provided that the PMS version complies
with the current MoH batch record form). Batch record forms must be completed
with all the below information:
Pharmacy Procedures Manual v 6.0 INTERIM
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a
b
c
d
e
f
g
Step 4
Service Provider’s Number (claimant number).
Service Provider’s Name (pharmacy name).
Period from (start date of the claim period) refer to table 1 above.
Period to (end date of the claim period) refer to table 1 above.
Service Provider Stamp (this information is generated when you use your own
software system).
Signature of a Pharmacist or person authorised by a pharmacy as its
representative for this purpose.
Date.
Attach the batch record form to the front (the first dispensing date) of the claim
period batch and tightly secure the entire prescription batch together, ready for
distribution to the Ministry of Health.
The delivery address for batches to be archived (unless otherwise advised by MoH)
is:
Archive Pharmacy Claims
137 London Street
WHANGANUI 4500
Step 5
More than one prescription batch may be sent to the MoH at once but each claim
period must be able to be identified separately at the MoH archives.
Important
Notes
Pharmacies may retain batches for 5 months unless in circumstances outlined in
Clause 3.3 below.
After the 5 month period, batches must be submitted to MoH.
If batches received by MoH do not meet the guidelines above, the batch may be sent
back.
If batches are not received by the due date MoH may send a warning letter requiring
the batch to be forwarded within 30 days.
If the batch has not been received within 30 days funding may be withheld for an
amount equating to the value of that batch.
Certified repeat copies are not required to be printed and sent with batches if they
do not differ from the original prescription.
3.3. Submission of Batches for Audit Purposes
On occasion, batches may be required early for audit purposes. Pharmacies will be notified when
this is necessary and the notified pharmacy shall comply with the time frames and delivery
requirements specified by the auditors.
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4.
LEGAL REQUIREMENTS
4.1. Legal Requirements of Prescriptions
For prescriptions other than Controlled Drugs the following is a checklist of the legal requirements
that must be on the prescription when it is presented for dispensing. Prescriptions submitted for
payment must meet legal requirements. (For Controlled Drugs – refer to Section 5.10.)
Procedures Checklist
a.
b.
c.
d.
e.
Be legibly and indelibly printed (written in pencil is not acceptable).
Prescriber’s indelible signature (not being a facsimile or other stamp).
Prescribing date.
Prescriber’s full name.
Prescriber’s full physical work address, or postal address for those who do not have a place
of work.
f. Prescriber’s telephone number.
g. Surname and each given name of the patient.
h. Physical address of the patient.
i. Patient date of birth (if the prescription is for a child under 13 years).
j. Name of the medicine.
k. Strength of the medicine (where appropriate).
l. Total amount of medicine or the total period of supply to be dispensed.
m. Dose and frequency of the dose (internal medicine).
n. Method and frequency of use (external medicine).
The following are the legal requirements which must be added by the pharmacy:
a. Name and address of the proprietor of the business at which the prescription is dispensed.
b. Dispensing date.
c. Quantity of medicine dispensed – per item.
d. Prescription number (unique identifying number) – per item.
4.2. Professional Group Prescribing
The following is a summary table of the prescribing requirements of professional groups as they
relate to community pharmacy.
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Summary Table: Professional Group Prescribing
Professional
Group
Medical
practitioners
Dentists
Midwives
Legislation: Refer to http://www.legislation.govt.nz
Medicines Act and
Misuse of Drugs Act
Misuse of Drugs Act –
Regulations
and Regulations
Subsidy Information
Shall not exceed 6
For the medical
months supply of an
treatment of a patient
oral contraceptive or 3
under their care. Class B
months supply in any
maximum period of
other case.
supply is 1 month; Class
C maximum period of
supply is 3 months.
h
Controlled Drug
prescriptions must be
first dispensed within 7
days of the date of
prescribing.
Shall not exceed 3
For dental treatment of
Dental controlled drug
months supply.
patient under their care
prescriptions are only
for a maximum period
subsidised for five days
of 7 days.
treatment with a Class B
Every prescription must
controlled drug. Seven
state ‘for Dental
days of a Class C
Treatment only’.
controlled drug will be
Controlled Drug
subsidised on a dental
prescriptions must be
prescription.
first dispensed within 7
days of the date of
prescribing.
Shall not exceed 6
Midwives may only
months supply of an
prescribe pethidine.
oral contraceptive or 3
Midwives may not
months supply in any
prescribe any other
other case.
controlled drugs, such
as codeine and
benzodiazepine,
Every prescription must
state ‘for midwifery use
only’.
Controlled Drug
prescriptions must be
first dispensed not more
than 4 days after the
date of prescribing.
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Professional
Group
Legislation: Refer to http://www.legislation.govt.nz
Misuse of Drugs Act –
Medicines Act and
Misuse of Drugs Act
Subsidy Information
Regulations
and Regulations
Nurse
practitioners
Shall not exceed 6
months supply of an
oral contraceptive or 3
months supply in any
other case, and is
limited to the list of
medicines detailed in
legislation (Medicines
Designated
Prescribers; Nurse
Practitioners)
Regulations 2005.
Optometrists
Shall not exceed 3
months supply, and is
limited to the list of
medicines detailed in
legislation (Medicines
Designated
Prescribers:
Optometrists)
Regulations 2005.
Refer to the
Pharmaceutical
Schedule for guidance.
Other
Prescribers,
e.g. Dieticians
Pharmacy Procedures Manual v 6.0 INTERIM
For the treatment of a
patient under the
nurse's care; in an
emergency only; for a
maximum period of 3
days. Limited to drugs
listed in the Misuse of
Drugs Regulations,
Schedule 1A Controlled drugs that
designated Prescriber
nurses may prescribe in
certain circumstances.
Controlled Drug
prescriptions must be
first dispensed within 7
days of the date of
prescribing.
No prescribing rights for
controlled drugs.
No prescribing rights for
controlled drugs.
6
5.
PRESCRIPTION SUBSIDY REQUIREMENTS
In addition to the legal requirements of a prescription (as per Section 4) some additional information
is required for subsidy purposes. The following clauses in this section provide details of that further
information.
5.1. Address
5.1.1.
Prescriber
The Prescriber’s full physical work address must be included. Refer to glossary.
5.1.2.
Patient
The patient’s full address must be included. Refer to glossary.
5.2. NHI
From 1 February 2013 you must include the service user’s NHI number for each claim item. You will
use the NHI provided on a prescription form unless you know that NHI number is incorrect (then use
the correct number).
5.3. ARRC and LTC Patients
Prescriptions for ARRC patients must include the name of the residential establishment, the patient’s
NHI number and from 1 February 2013 must include the patient’s date of birth.
Prescriptions for LTC patients must include the patient’s NHI and from 1 February 2013 must
include the patient’s date of birth.
5.4. Prescriber
a.
b.
c.
d.
e.
The Prescriber must be entitled to prescribe the pharmaceuticals included in any prescription
form (including any Controlled Drugs prescription).
You must include in every claim the Prescriber’s health professional code and registration
number (Prescriber identifier) if it is either listed on the prescription or otherwise known to
you.
i.
Medical Council of New Zealand (MCNZ) number; or
ii.
Nursing Council of New Zealand number; or
iii.
Midwifery Council of New Zealand number; or
iv.
Dental Council of New Zealand number; or
v.
other registration number, as applicable,
The Prescriber identifier must match the identity of the Prescriber signing the prescription
form.
Any claim with less than 90% of health professional codes included will be rejected until it
meets the necessary threshold.
If a prescription is received with no Prescriber identifier, and the pharmacy does not already
know the Prescriber identifier of that Prescriber, the pharmacy must obtain the Prescriber
identifier from either the Prescriber or their professional organisation to ensure that the
Prescriber is eligible to prescribe the pharmaceuticals. The pharmacy must then include the
Prescriber’s health professional code and registration number with the claim.
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5.5. Prescriber Information
In addition to the legal requirements of a prescription, the following Prescriber information is
required for subsidy purposes:
5.5.1.
Signature
A facsimile signature is not acceptable. Subject to the conditions below, if a prescription is faxed, the
original prescription must be obtained or the Prescriber must indelibly sign the faxed copy before a
claim can be made for the prescription item(s).
However, if the original prescription (or the faxed copy signed by the Prescriber as above) has not
been received by the pharmacy within four weeks of the date of the original dispensing,
reimbursement can be claimed. The signed prescription must be obtained and submitted in due
course (see clauses 3.1.b, 3.2 and 3.3 of the Procedures Manual) with the batch for audit purposes.
If no signed prescription is submitted with the batch then the pharmacy must refund any money
previously claimed in respect of this claimed item by crediting the amount against its next claim(s).
If the pharmacy considers that special circumstances apply to a specific claim item it may apply in
writing to the DHB. The DHB may, at its discretion, allow the pharmacy to retain payment. If no such
express written permission is provided then the refund must be made by the pharmacy.
If the pharmacy chooses to file both the fax copy and the original prescription form in the
prescription batch, the pharmacy must ensure that:
a.
b.
c.
d.
The fax copy and the original prescription form are correctly matched
The fax copy and the original prescription form are securely fastened to one another
All legal and subsidy requirements are met
These are filed in order of the date of dispensing within the batch.
If the pharmacy chooses to file only the original prescription form in the prescription batch, the
pharmacy must ensure that:
a.
b.
c.
d.
The original prescription form is correctly annotated with the name and address of the
proprietor of the business at which the prescription is dispensed, unique identifying number(s)
(third-part labels) and annotations
The fax copy is appropriately disposed of
All legal and subsidy requirements are met
The original prescription form is filed in order of the date of dispensing within the batch.
5.5.2.
Legibility
The prescription must be legibly and indelibly printed and cannot be written in pencil. A reprint of
the label for the item attached to a prescription form is not acceptable for claiming payment.
5.6. Patient Information
In addition to the legal requirements of a prescription, the following patient information is required
for subsidy purposes:
5.6.1.
Patient Eligibility
Patient eligibility must be clearly identified in accordance with the Health and Disability Services
Eligibility Direction 2011.
More detail can be found on the Ministry website
Pharmacy Procedures Manual v 6.0 INTERIM
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http://www.health.govt.nz/new-zealand-health-system/eligibility-publicly-funded-healthservices/guide-eligibility-publicly-funded-health-services-0.
The pharmacy may accept eligibility identification details included by the Prescriber on the
prescription as correct unless it is otherwise apparent from the prescription form, or otherwise
known to the pharmacy, that the patient is not eligible (and the Pharmacist should then annotate the
ineligible status on the prescription form, and no claim should be made pursuant to the CPSA).
If the prescription records the patient as ineligible (which may include NS), or no eligibility status is
identified the pharmacy may not make a claim pursuant to the CPSA unless the patient provides
documented evidence demonstrating his or her eligibility. In this case the Pharmacist should
annotate the change of eligibility status on the prescription and note the basis of eligibility (work
visa holder eligible to be in New Zealand for two years or more, refugee etc).
Persons who are not eligible for publicly-funded health services, but who are receiving
treatment/medicine as a result of personal accident injury covered by Accident Compensation
Corporation (ACC), are also eligible for ‘4’ co-payment. This includes, for example, tourists and
overseas students.
5.6.2.
Patient Categories
The patient category indicates the eligibility status of an individual and also determines the
pharmaceutical co-payments that are to be applied to that patient.
Key to interpret the following tables:
Y
J
A
Z
H
O
1
3
4
NS
Youth (0-5 years)
Junior (6-17 years)
Adult (over 18 years)
HUHC Holder
Hokianga resident on HHET form (see below)
Oral Contraceptive
CSC Card Holder
No CSC, and not Eligible Prescriber
Eligible Prescriber
Not subsidised
Note: Patient category codes may be updated from time to time. Any changes to the patient category
codes will be linked to an amendment of the Pharmaceutical Transactions Data Specification.
The Crown may also update the co-payments listed here from time to time. Pharmacies will be
notified of these changes via the Pharmaceutical Schedule and/or directly by the MoH or DHBs.
Pharmacy Procedures Manual v 6.0 INTERIM
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Youth (ages 0 to 5 years) – Y code
Status – must
be Eligible
Person
Eligible
Prescriber
CSC Holder
Neither of the
Above
HUHC
Holder /
Care Plus
Patient
Patient
Category
Yes
No
Yes
No
Yes
No
Y4Z
Y4
Y1Z
Y1
Y3Z
Y3
Maximum
Pharmaceutical
Co-payment from
1 Sept 2008 up to
31 December
2012
No PSC
With PSC
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
Maximum
Pharmaceutical
Co-payment from
1 January 2013
No PSC
$0
$0
$0
$0
$0
$0
With PSC
$0
$0
$0
$0
$0
$0
Junior (ages 6 to 17 years) – J Code
Status – must
be Eligible
Person
HUHC
Holder /
Care Plus
Patient
Patient
Category
Eligible
Prescriber
CSC Holder
Yes
No
Yes
No
Yes
No
Yes
No
J4Z
J4
J1Z
J1
J3Z
J3
O
O
Neither of the
Above
Oral
Contraceptives
Maximum
Pharmaceutical
Co-payment from
1 Sept 2008 up to
31 December
2012
No PSC
With PSC
$3
$0
$3
$0
$3
$0
$3
$0
$3
$2
$10
$2
$3
$0
$3
$0
Maximum
Pharmaceutical
Co-payment from
1 January 2013
No PSC
$5
$5
$5
$5
$5
$10
$5
$5
With PSC
$0
$0
$0
$0
$2
$2
$0
$0
Adult (ages 18 and above) – A Code
Status – must be
Eligible Person
Eligible
Prescriber
CSC Holder
Neither of the
Above
Oral
Contraceptives
HUHC
Holder /
Care Plus
Patient
Yes
No
Yes
No
Yes
No
Yes
No
Patient
Category
A4Z
A4
A1Z
A1
A3Z
A3
O
O
Pharmacy Procedures Manual v 6.0 INTERIM
Maximum
Pharmaceutical
Co-payment from
1 Sept 2008 up to
31 December
2012
No PSC
With PSC
$3
$0
$3
$0
$3
$0
$3
$0
$3
$2
$15
$2
$3
$0
$3
$0
Maximum
Pharmaceutical
Co-payment
from 1 January
2013
No PSC
$5
$5
$5
$5
$5
$15
$5
$5
With PSC
$0
$0
$0
$0
$2
$2
$0
$0
10
An “H” code is used for a patient who is usually resident in the Hokianga Ward of the Far North
District with a prescription issued by a registered medical practitioner employed by, and on a form
supplied by, the Hokianga Health Enterprise Trust.
Status – must be
Eligible Person
HUHC
Holder /
Care Plus
Patient
Patient
Category
Yes
No
Yes
No
Yes
No
H4Z
H4
H1Z
H1
H3Z
H3
Eligible
Prescriber
CSC Holder
Neither of the
Above
Maximum
Pharmaceutical
Co-payment from
1 Sept 2008 up to
31 December
2012
No PSC
With PSC
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
Maximum
Pharmaceutical
Co-payment
from 1 January
2013
No PSC
$0
$0
$0
$0
$0
$0
With PSC
$0
$0
$0
$0
$0
$0
5.7. Co-payments for Antiandrogen Oral Contraceptives
Prescribers may code prescriptions “contraceptive” (code ‘O’) when used as indicated for
contraception. The period of supply may be written for up to six months supply. From 1 January
2013 the co-payment on all prescriptions coded ‘O’ will change from $3.00 to $5.00.
Prescriptions coded in any other way are subject to the non-contraceptive prescription charges, and
the non-contraceptive period of supply. That is, prescriptions may be written for up to three months
supply.
Example
Private Specialist prescription for cyproterone acetate with ethinyloestradiol – patient is A3
Specialist has coded the prescription ‘O’
Period of supply is 6 months
Co-payment = $3 (From 1 January 2013 this will change to $5).
Specialist has coded the prescription A3, so not ‘O’
Period of supply is 3 months – as Prescriber has not indicated the prescription is being prescribed as
an oral contraceptive
Co-payment = $15
5.8. Date of Dispensing
The Date of Dispensing must be recorded on all prescriptions for which a subsidy is claimed. This
record must be stamped, hand-written or recorded on the third-part label. The Date of Dispensing
on the prescription including that on the third-part label must be the same as the date in the
computer record. If the third-part label is used as the only indication of Date of Dispensing the
pharmacy has a responsibility to ensure that the quality of the label means that it is fixed to the
prescription in a manner that will withstand multiple handling.
The Date of Dispensing must not precede the prescribing date. If the prescribing date returned on a
signed telephone/faxed prescription is after the Date of Dispensing, for the purposes of payment, the
signed prescription and the faxed forms must be stapled together or the date may be annotated by
the Pharmacist to explain the discrepancy between the prescribing date and the date of dispensing.
Pharmacy Procedures Manual v 6.0 INTERIM
11
No claim for payment may be made prior to completion of the dispensing process. This is the process
of a Pharmacist providing a patient or patient’s caregiver, or a Prescriber, with a Prescription Item
pursuant to a Prescription Form or order. It includes all the steps that occur from receipt of the
Prescription Form or order at the pharmacy to the Prescription Item being collected by, or delivered
to, the Service User or the Service User’s caregiver or Prescriber.
Uncollected medicines should be deferred and not included in any claim.
The Pharmacist must not re-dispense any medicine for which a claim has been submitted.
5.9. Prescription Number (Unique Identifying Number)
This numbering system applies to all prescriptions, Supply Orders, and other types.
The appropriate suffix is determined by the prescription. If the prescription is for a single supply
(including those items dispensed stat), the suffix used is ‘0’. For the initial dispensing of a
prescription where eligible repeats are prescribed, the suffix is ‘1’. Each subsequent dispensing of a
repeat on a prescription has the next consecutive number as its suffix.
Prescription numbers should follow the following format: 123456789/1.
The prescription number is required next to each Prescription Item and should be adjacent, where
possible, to the relevant item on the original prescription form. Sometimes third-part labels have a
reference to the item, but an effort should be made to place the label next to the item. If working
from a faxed or telephone copy, place the third part label on the copy then staple copy to the original
when received.
Hand written, legible numbers are for emergency or exceptional circumstances only.
Attaching a reprint of the medicine label to a prescription form for any item is not acceptable.
5.10.
Controlled Drug Prescriptions
The Misuse of Drugs Act limits the amount of and what medicines can be prescribed by different
prescribing groups.
All Prescribers must only prescribe within their scope of practice for patients under their care. Refer
to all current legislation and the summary table at Section 4.2, Professional Group Prescribing.
Pharmacy claims submitted to the MoH that do not comply with the legislative requirements, may
not be reimbursed.
5.10.1. Legal Requirements Checklist
The following is a checklist of the legal requirements that must be on the prescription when it is
presented for dispensing:
For CLASS B Controlled Drugs, the prescription must:
a
Be written on a form provided by the Director General of Health.
a
Be legibly and indelibly written in the Prescriber’s own handwriting.
b
Be indelibly signed by the Prescriber personally with his/her usual signature.
c
Include the date on which the Controlled Drug prescription is written.
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d
e
f
g
h
i
j
k
Include the Prescriber’s address as specified in the Glossary as the prescription address (this
can be stamped, however the stamped address must be on all three copies of the Controlled
Drug prescription).
Include the patient’s full home address as specified in the Glossary as the prescription address
surname, initials, and full street address of the patient.
Include the age in years and months (in words) if the patient is under 12 years.
Include the name and total amount of the Controlled Drug to be dispensed and the number of
occasions on which it may be dispensed.
Set out the name of the Controlled Drug in full or be abbreviated only by the use of BP, BPC or
other recognised titles.
Include the dose and frequency of the dose for an internal use medicine, and for external use
have the directions of use.
Where the prescription has an unusual dose, or what may be regarded as a dangerous dose, the
dose should be underlined and initialled by the Prescriber.
Any alterations must be signed by the Prescriber.
In addition to the above, if the Class B Controlled Drug is Methadone and if the Prescriber is
authorised by the MoH or its delegate, or works in a place for the time being specified by the Minister
of Health under the Misuse of Drugs Act, the prescription must be legibly and indelibly written, or in
a form approved from time to time by the Director General of Health.
If, for special reasons relating to the protection of the patient or for limiting the quantity of any
Controlled Drug in the possession of the patient, the Prescriber directs daily dispensing or other
dispensing intervals a Controlled Drug may be supplied on that number of occasions and not more
frequently than the intervals indicated. The total quantity covered by such a prescription cannot
exceed one month.
5.10.2. Annotation of Controlled Drug Prescriptions
All three copies of the prescription form must be annotated with:
a
The prescription number(s); and
b
Each D
c
ate of Dispensing; and
d
The quantity dispensed; and
e
The strength dispensed; and
f
The initials of the dispensing Pharmacist; and
g
Pharmacy stamp.
The first dispensing (for the supply of Class B Controlled Drugs only, excluding methylphenidate and
dexamphetamine) can be claimed as two dispensings if stock is unavailable to dispense the full
amount required. This includes situations where both dispensings are supplied on the same day.
Subsequent repeats where insufficient stock is available must be claimed as one repeat and an “owe”.
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Procedures
Out of Stock Dispensing
1. Claim for the first supply as an initial dispensing.
2. The second dispensing should be claimed as a repeat dispensing.
3. A note should be made on the Controlled Drug Prescription of the quantities and dates
of the dispensing of both supplies.
5.10.3. Methylphenidate and Dexamphetamine
Methylphenidate (Concerta, Ritalin, Rubifen) is scheduled as a Class B2 controlled drug. As such
Ministerial Approval is required before methylphenidate can be prescribed or supplied. Listed
below are the circumstances under which this approval is considered met for both prescribing by
medical practitioners and supply by Pharmacists. Further information can be found on the Medsafe
website at www.medsafe.govt.nz/profs/RIss/restrict.asp.
Prescribing
Prescriptions must be written by:
a
Medical practitioners with a vocational scope of practice of Paediatrics or Psychiatry, registered
with the Medical Council of New Zealand under the Health Practitioners Competence Assurance
(HPCA) Act 2003, for the treatment of Attention Deficit and Hyperactivity Disorder (ADHD), or
b
Medical practitioners with a vocational scope of practice of Internal Medicine, registered with
the Medical Council of New Zealand under the HPCA Act 2003, for the treatment of narcolepsy,
or
c
Medical practitioners with a vocational scope of Palliative Medicine, registered with the Medical
Council of New Zealand under the HPCA Act 2003, for the use of palliative care treatment, or
d
Any other medical practitioner registered with the Medical Council of New Zealand when acting
on the written recommendation of one of the vocationally registered medical practitioners
described above, for the conditions specified.
Supply
Any Pharmacist, registered with the Pharmacy Council of New Zealand, under the HPCA Act 2003, in
the course of his or her employment as a Pharmacist, may supply methylphenidate products
pursuant to a prescription meeting the following conditions:
The prescription must be written on a triplicate controlled drug form (H572) and be issued by:
a
A medical practitioner with a vocational scope of practice of Paediatrics, Psychiatry, Internal
Medicine or Palliative Medicine, when prescribing for the conditions stated above, or
b
Any other registered medical practitioner when acting on the written recommendation of one of
the vocationally registered medical practitioners specified above, with the name of the
appropriate recommending practitioner endorsed on the prescription.
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What this means for Pharmacists
If you receive a prescription for methylphenidate you must check that it meets the following criteria
before it is dispensed:
a
It is written on a triplicate controlled drug form (H572);
b
It is written by:
i.
An appropriate specialist in Paediatrics, Psychiatry, Internal Medicine or Palliative
Medicine, when prescribed for the conditions specified, or
ii.
A GP working under the written recommendation of an appropriate specialist listed above
for the conditions specified, and this is endorsed on the prescription.
A Pharmacist can endorse the prescription with the appropriate vocationally registered
practitioner’s name if they have verification of the correct information from the Prescriber.
Where prescriptions are written by a GP and the GP has not written vocationally registered
practitioner’s recommendation, the prescription cannot legally be dispensed.
Pharmacists are permitted to accept the endorsements contained on a prescription at ”face value”
unless they have reason to believe them to be incorrect.
Information of the vocational scope of practice for Prescribers can be found on the Medical Council of
New Zealand website: http://www.mcnz.org.nz.
Funding of methylphenidate is controlled through the Pharmaceutical Schedule published by
PHARMAC. Endorsement of a prescription with a Special Authority number does not negate the
requirement for the prescription to be endorsed with the specialist’s name. A non-subsidised
prescription still needs to be endorsed with the specialist’s name to be a legal prescription.
5.10.4. Dexamphetamine
The same requirements as for methylphenidate apply to prescribing and supplying dexamphetamine
with the exception that Ministerial approval has not been granted for prescribing by medical
practitioners with a vocational scope of Palliative Medicine, for use in palliative care treatment.
5.10.5. Repeat Dispensing
If the medical practitioner signing a prescription so directs on the prescription:
a. any controlled drug (not being a Class C controlled drug) may be supplied on not more than two
occasions, at an interval to be specified by the medical practitioner on the prescription, the first
such occasion being not more than seven days after the date of the prescription and the second
such occasion being not more than seven days after the termination of that interval, provided
that in no case shall the total quantity supplied, having regard to the dose and frequency of the
dose or the directions given by the Prescriber, be greater than a quantity sufficient for use for a
period of one month. Reg 31 (2)(a).
b. any Class C controlled drug may be supplied on not more than three occasions, at such intervals
as may be specified by the medical practitioner on the prescription or, if no intervals are so
specified, at monthly intervals provided that in no case shall the total quantity supplied, having
regard to the dose and frequency of the dose or the directions given by the Prescriber, be
greater than a quantity sufficient for use for a period of three months. Reg 31 (2)(b).
c. If the midwife signing the prescription so directs on the prescription, pethidine may be supplied
under section 8(2)(aa) of the Misuse of Drugs Act on not more than two occasions, at an interval
to be specified by the midwife on the prescription, the first such occasion being not more than
Pharmacy Procedures Manual v 6.0 INTERIM
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four days after the date of the prescription and the second such occasion being not more than 4
days after the termination of that interval: Reg 31 (2A).
If the Prescriber directs that the dispensing should be more frequent than monthly, the pharmacy
may dispense at that frequency. The dispensing on the prescription must commence within 7 days of
the date of the prescription.
The period during which the dispensing may then occur will run continuously from the date of the
initial dispensing for the next 30 days (or part thereof as specified on the script). If the patient does
not collect a repeat on the date when his or her part dispensing of the medication would have run out
then the pharmacy may not provide more medication to the patient than the amount that remains
from the date the patient presents for the repeat medication to the end of the 30 day period. This is
to ensure that the patient is seen by the Prescriber regularly.
Example: 30 day script with two repeats. Patient collects initial dispensing on 1 st of the month.
Patient is either then (for example) in hospital for a period or chooses not to take medication and
does not come for second dispensing until 20th of the month. The Pharmacist may only dispense one
repeat for 10 days, which is the balance remaining of the 30 day period. The patient must then
attend the Prescriber for a further 30 day script.
5.10.6. Submission of Controlled Drug Prescriptions
On the completion of all dispensings:
a
The top copy (white) is to be retained in the pharmacy;
b
The 2nd copy (yellow) and 3rd copy (red) are to be filed in the batch on the date of initial
dispensing.
5.11.
Supply Orders
Bulk Supply Orders (BSOs), and Practitioner Supply Orders (PSOs) must be supplied in accordance
with ”Miscellaneous Provisions” of the Pharmaceutical Schedule.
Except antipsychotic injections for mental health day clinics, PSOs will not be reimbursed where the
pharmaceuticals are supplied to hospitals or clinics.
At the end of every month an approved signatory for the facility is required to sign the BSO and
complete the “stock on hand” column.
BSOs, and PSOs will not be reimbursed where the pharmaceuticals are supplied to the Armed
Services or the Department of Corrections (including prisons). See exception in Section 5.12.1
regarding Ivermectin.
5.12.
Specific Prescription Types
5.12.1. Prescriptions for Multiple Patients
Prescriptions, such as antifungal or scabies treatments, for multiple patients on one form should be
treated as separate prescriptions. All names are required on the prescription, normal co-payment
rules will apply for each patient, that is, one co-payment per patient.
Ivermectin tablets are subsidised when prescribed on a Practitioners Supply Order (PSO) for
institutional use (age related residential care facilities, disability care facilities or penal institutions
only). Up to 100 tablets of ivermectin will be subsidised on a PSO which must be endorsed with the
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name of the institution and a valid Special Authority for a patient of that institution. Ivermectin is
also fully subsidised on a BSO where there is a valid Special Authority for a patient of that institution.
5.12.2. Pharmacy Generated Prescription Forms / Telephone Prescriptions
No claim for payment shall be made in respect of a pharmacy generated/telephone prescription form
until the pharmacy receives the signed form from the Prescriber and meets all legal and contractual
requirements and the dispensing process is complete.
The circumstances under which an orally communicated prescription may be made are set out in the
Medicines Regulations 1984.
5.12.3. Bulk/Merged Prescription Forms
Where a prescription is generated for multiple Rest Home patients, the pharmacy must ensure that:
a
The Prescriber has initialled beside each patient on the page; and
b
Each patient’s NHI number is listed; and
c
The name of the Rest Home facility is annotated; and
d
There is this statement acknowledging that each patient is under the Prescriber’s care, “I have
read and authorised these prescription orders for the above named patients”; and
e
Each page has a full Prescriber’s signature and date at the bottom of the page.
5.12.4. Certified Repeat Copies
A Certified Repeat Copy is a computer generated copy of the record of a repeat Prescription Item. It
can be used for dispensing repeat supplies as an alternative to dispensing from the original
prescription.
If not dispensing from the original prescription, a Certified Repeat Copy (CRC) must be generated
when repeats are different to those at the first dispensing (variable quantities, for example, supply of
the prescription item for two months for access exemption purposes).
The Certified Repeat Copy must be filed in the batch at the date of the repeat dispensing.
For further information regarding repeat supplies refer to Section 5.13.
5.12.5. Certified True Copies
A Certified True Copy must be used only when the original prescription form has to be made
available to the NZ Police, Medsafe, Medical Officer of Health, or the Coroner.
Procedures
A Certified True Copy of the complete prescription form should be made by the pharmacy, and
be retained and submitted in the normal manner as part of the batch.
A Certified True Copy must be annotated with the words: “Certified True Copy” and be signed
and dated by the dispensing Pharmacist.
A photocopy is the preferred option for a Certified True Copy. In special circumstances the
Certified True Copy can be handwritten or computer generated and the reason annotated.
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5.12.6. Certified True Photocopies
A Certified True Photocopy must be made when all items on a multi item prescription are not
processed on the same day;
A Certified True Photocopy is different from a Certified Repeat Copy and is used for a different
purpose.
The copy of the form must be a photocopy.
Procedures
On the original prescription after the dispensing annotate the items not being claimed on this
day.
Take a photocopy of the original prescription. The original prescription form should be inserted
into the batch as at the date of dispensing.
The photocopy is referred to as a Certified True Photocopy and should be retained on file for
dispensing of the remaining original items.
A Certified True Photocopy must be annotated with the words: “Certified True Photocopy” and
be signed and dated by a Pharmacist.
The Certified True Photocopy MUST include all the items on the original prescription with the
items previously dispensed crossed through. Prescription numbers for the items previously
dispensed must be included on the photocopy.
Once a Certified True Photocopy has been created, there must be no changes to the original
prescription The Certified True Photocopy must be an exact copy of the original when the
original is submitted to MoH for claiming.
If another certified true photocopy is required for a subsequent dispensed date, repeat the
process but use the 1st Certified True Photocopy as your starting point. The last Certified True
Photocopy created must be a complete picture and show details of all items dispensed from that
prescription form.
5.13.
Repeat Supplies
Authorised repeats can be dispensed:
a
When the Pharmacist has previously dispensed an initial dispensing from a prescription form,
repeat items were permitted pursuant to the Pharmaceutical Schedule and some items have not
yet been dispensed; and
b
When a specific and express request for that repeat is made by the Patient or his/her caregiver,
and
c
The Pharmacist can reasonably assume that the last preceding supply has been exhausted or
substantially exhausted including any previous prescriptions and repeats dispensed by that
pharmacy, or for a reason otherwise known to the Pharmacist (for example, the patient is
travelling and the patient signs the Access Exemption Declaration).
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As a general rule, for a pharmaceutical benefit to apply ”substantially exhausted” means that either
2/3rds of the supply period has elapsed since the previous dispensing or 2/3rds of the supply has
been used. In special circumstances where the Patient has lost or damaged the previous supply, or
has an increased need for the medication due to a change in dose or frequency, the Pharmacist can
supply the medication earlier. If an earlier supply is made in these circumstances, the reason for the
early supply must be annotated on the prescription or CRC for the patient to be eligible for a subsidy.
The pharmacy responsible for any initial dispensing on a prescription form must remain available to
dispense any authorised repeats requested by the patient and/or his or her caregiver and the
pharmacy may not return the original prescription to the patient.
5.14.
Prescription Item Owing
Procedures
a
b
c
d
The Pharmacist must consult with the patient to achieve a mutually acceptable
arrangement when it is not possible to dispense a medicine as prescribed.
It is preferable to provide the full dispensing. The Pharmacist should issue a part supply of
a prescription item in cases where the patient is required to begin the treatment
immediately.
If the full quantity of prescription item is not available, there must be a reference in the
computer record, or in an “owes” file and on the prescription form specifying the quantity
dispensed and the quantity owing.
The patient must be provided with written information on the quantity owed and the
timeframe for collection for the owed prescription item where known (for example, could
be out of stock). The Owed prescription items must be collected or delivered within the
period of supply on the prescription.
Payment will only be made for any owed prescription items when supplied to the patient or
his/her caregiver. No Service or Handling fees will be paid for these balances.
5.15.
Negative R
Under the new CPSA, the Dispensing Fee no longer exists, and the Handling Fee, which is now used in
the calculation, is set at $1. This means that the value of the transaction may not always be greater
than the value of the co-payment.
Deducting the co-payment from the transaction fees may result in a negative value (in the CPSA this
is called -R). Until an Information Technology solution is found DHBs will deduct the negative
amounts manually during the transition payment reconciliation process.
Refer to sections M and AB in the Transition Payment Advice Notice.
5.16.
Annotations
An annotation is text written by a Pharmacist. Any annotation should clearly differentiate the
information added by the Pharmacist from that written by the Prescriber. If possible all annotations
should be adjacent to the prescription item. Green ink is preferred unless the Prescriber has written
in green.
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Prescriptions should be annotated:
a
Where it is required by regulations, or
b
Where it is necessary for clarification or is specified in the Agreement or Manual, or
c
Where it is required for subsidy, including those outlined in the Pharmaceutical Schedule, for
example Cost Brand Source, Multiple-Patients.
d
Where there is no Patient category code on the prescription, refer table in Section 4.2, or when
it is known to be erroneous.
Changes made to the category codes by the Pharmacist must be initialled and reflected in the
electronic claim file.
Pharmacists may annotate prescriptions with clarifications to:
a
Dosage;
b
Strength;
c
Quantity;
d
Brand (the Pharmacist may only annotate a change of brand subject to the substitution rules
contained in the Medicines Regulations)
Points to note:
a. The reason for any variance between the original prescription and the electronic record must be
annotated on the prescription. Note: “C.B.” can be used as an abbreviation for Change Brand.
b. Where there is a financial implication for the DHB, the Pharmacist cannot increase the quantity
of a prescription, without the Prescriber signing the alteration. Non-subsidised items should be
identified.
c. A Pharmacist may annotate an Endorsement required for subsidy within the Pharmaceutical
Schedule only where the Pharmaceutical Schedule specifically permits the Pharmacist to
annotate the Endorsement. All other annotations must be hand-written or computer generated
by the Prescriber, or, where it has been altered or added by the Pharmacist, initialled by the
Prescriber.
d. Where a Specialist recommendation is required for subsidy on a prescription or PSO, the
dispensing Pharmacist may annotate the prescription or PSO, following verbal confirmation
from the Prescriber, with the name of the Specialist and date of recommendation. The
Pharmacist must also annotate the prescription with the words “confirmed by [practitioner]”.
Where the Pharmacist has an electronic record of such a valid Specialist recommendation from
a previous prescription for the same Community Pharmaceutical written by a Prescriber for the
same patient, the Pharmacist may annotate the prescription accordingly.
e. Pharmacists, when dispensing a subsidised Community Pharmaceutical, may alter the
presentation of a Pharmaceutical dispensed to another subsidised presentation, without
requiring a signature from the Prescriber, but may not alter the dose, frequency and/or total
daily dose. This may only occur when it is not practicable for the Pharmacist to dispense the
requested presentation. If the change will result in additional cost to the DHBs, then annotation
of the prescription by the dispensing Pharmacist must occur stating the reason for the change,
and the Pharmacist must initial the change for the purpose of Audit.
For clarity: The Pharmacist may not alter the dose, frequency and/or total daily dose without
sending the altered prescription to the Prescriber to be endorsed.
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5.17.
Endorsements
An endorsement is text written by a Prescriber on a prescription. The Pharmaceutical Schedule
defines the requirements, which may vary from time to time. Where an endorsement is required on a
prescription it must either be:
a. Hand-written, or computer generated on the prescription by the Prescriber; or
b. Where it is not hand-written, or computer generated by the Prescriber, and where it is specified
in the Pharmaceutical Schedule, be initialled by the Prescriber; and
c. Where it has been altered or added to by the pharmacy, be initialled by the Prescriber, unless the
Pharmaceutical Schedule permits the Pharmacist to annotate endorsements.
5.18.
Specialist Recommendation
Prescriptions originating from DHB hospitals on DHB stationery for “specialist” prescription items
(that is, Retail Pharmacy-Specialist and Hospital Pharmacy-Specialist) are deemed to have been
prescribed by an appropriate specialist, irrespective of the status of the medical practitioner writing
the prescription. For clarification only prescriptions written by a medical practitioner in these
circumstances are eligible for subsidy under this Pharmaceutical Schedule rule. Other Prescriber
types (for example midwife, nurse Prescriber, dentist) must include the name of the recommending
specialist for the patient to receive the corresponding subsidy.
This however does not apply to prescriptions which are subject to the restrictions ”Retail
Pharmacy–Specialist Prescription” and ”Hospital Pharmacy-Specialist Prescription”, where the
Specialist must sign the prescription.
To clarify, a Specialist can only be a Medical Practitioner, or a Dentist with a vocational NZMC
registration.
5.19.
Alteration to Quantity Dispensed
An alteration made by a Pharmacist to the unit quantity dispensed is one that does not affect the end
amount of medicine prescribed to the patient. The patient will get the same dosage of medicine in the
following example: the prescription reads ”500 mg, one tablet per day, 30” and the Pharmacist
dispenses ”250 mg tablets, two tablets per day, 60”. In this case, the Pharmacist has altered the unit
quantity, and subsequent dosage instructions, without changing the total daily dose or frequency
ordered by the Prescriber.
Alternatively, a change from tablets to mixtures (change in presentation of medicine) is deemed
appropriate as long as both the individual dose and total daily dose is not altered. In the above
example, if there is no additional cost to the DHB the Pharmacist can annotate and sign the changes.
Procedures
For any alteration made by the Pharmacist to the quantity dispensed, if there is a financial
implication or increased cost to the DHB:
a. The Pharmacist must annotate and sign the reason for the change, and
b. The change must be authorised and signed by the Prescriber.
In cases where PHARMAC has approved and notified in writing such a change in dispensing of a
named pharmaceutical, due to an out of stock event or short supply, the Pharmacist must
annotate and initial the alteration, and the prescription does not need to be returned to the
Prescriber for endorsement.
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5.20.
Cost, Brand, Source (CBS)
Where CBS is indicated against a medicine in the Pharmaceutical Schedule or if the item is a Named
Patient Pharmaceutical Assessment medicine not in the Pharmaceutical Schedule (as described in
the Pharmacy Agreement), the medicine is eligible for subsidy on the basis of the Pharmacists
annotation of purchase price, brand and source of supply. The purchase price should be GST
exclusive. The Pharmaceutical Schedule requires that the purchase price, brand and source of supply
be annotated. Alternatively a copy of the invoice for the purchase of the pharmaceutical may be
attached to the prescription, in order to be eligible for subsidy.
The details of the purchase may be subject to audit, and all receipts of purchase must be kept and
available for audit.
5.21.
Original Pack Dispensing
Procedures
If an item has the letters “OP” in the pack size column of the Pharmaceutical Schedule, then
payment is made to the nearest original unit size.
The pack size dispensed should be the closest size to meet the dosage instructions, and will be
reimbursed for the total subsidy per OP dispensed.
Example: Collapsible Tube (if defined as ‘OP’ in the Pharmaceutical Schedule): Locoid Lipo
cream Apply bd 15g. Even though the prescription only calls for 15g, the Pharmacist can claim
1OP or 30g. If the Locoid prescription had called for 50g, the Pharmacist can claim 2OP or 60g.
5.22.
Broken Packs
Where a Pharmacist dispenses a part pack of a proprietary product, subsidy is based on the
appropriate portion of the pack size listed in the Pharmaceutical Schedule, unless the item lists “OP”
in the pack size column of the Schedule.
For a prescription written for a three-month supply of a pharmaceutical that is supplied in a
collapsible tube, only the total quantity required to complete the three-month course will be
subsidised. Funding is not provided for one tube per month. However, if the Medicine Data Sheet
specifically states the product should be discarded after a period of time, say 30 days, then funding
will be provided accordingly. This must be annotated on the prescription.
For clarification Ovestin vaginal cream has no requirement to be discarded one month after opening.
If the prescribed quantity equates to one tube per month then this will be subsidised. In all other
circumstances only the quantity which equates to the dosing instructions will be subsidised.
5.23.
Oral Antibiotic Liquids
Where a Prescriber has written a prescription for a reconstitutable oral liquid antibiotic indicated in
the Pharmaceutical Schedule and the dispensing of which would require the Pharmacist to
reconstitute another pack the Pharmacist should reduce the amount dispensed to the quantity
contained in a whole pack provided that the reduction in the amount dispensed is less than 10% of
Pharmacy Procedures Manual v 6.0 INTERIM
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the pack and in the reasonable opinion of the Pharmacist will not affect the efficacy of the course of
treatment.
Example:
5ml tds for 7 days = 105ml
Dispense 100ml
Example:
10ml stat, 5ml tds for 7 days = 110ml
Dispense 110ml.
Remainder can be claimed if unused
Remainder can be claimed as wastage if unused. At the time of dispensing the Pharmacist must keep
a record of the quantity discarded
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6.
INTERPRETATION OF REIMBURSEMENT RESTRICTIONS
There are several specific rulings that provide an interpretation for Pharmacists on the quantity of
pharmaceuticals that can be reimbursed under the Pharmaceutical Schedule General Rules and the
CPSA for the provision of pharmacy services. These rulings are provided to MoH, having been
considered by the DHBs.
Where necessary for clarification, the Pharmacist should annotate the prescription.
6.1. Eye Drops
If a prescription is written for a three-month supply of eye drops, at least one original pack will be
subsidised per month even if the directions are such that one pack would suffice for the complete
three-month course. This follows the requirement to discard eye drops 30 days after opening. The
Pharmacist must annotate the prescription when they are claiming for quantities in excess of dose
and frequency prescribed.
The following guidelines should be used for calculating quantities of eye drops:
12 drops = 1ml
60 drops = 5ml
6.2. Insulin Vials and Cartridges
If a prescription is written for a three-month supply of insulin, at least one vial or one cartridge will
be subsidised per month even if the directions are such that one pack would suffice for the complete
three-month course. This follows the need to discard vials 30 days after opening. The Pharmacist
must annotate the prescription when claiming for quantities in excess of dose and frequency
prescribed.
6.3. Mucilaginous Laxatives
These products are reimbursed as an original pack. The following guidelines should be used to
calculate quantities.
One teaspoon = 7 grams
One dessertspoon = 14 grams
One tablespoon = 28 grams
6.4. Bronchodilator Asthma Inhalers
Where a prescription for a bronchodilator inhaler has a ”when required” component in the dosing
schedule, up to 1200 doses will be reimbursed per 3 months.
Example:
Salbutamol inhaler:
2 puffs q2h prn for 3/12
2,160 doses (or 11 x 200 dose inhalers)
Only 6 inhalers will be subsidised.
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6.4.1.
PRN
In these circumstances, because of the ”as required” component up to 1,200 doses (or 6 x 200 dose
inhalers) will be reimbursed. These inhalers should be dispensed in quantities depending upon the
patient’s needs.
Six inhalers can be dispensed as 2+2+2 or 3+2+1 or 4+1+1.
In instances where a quantity larger than 1,200 doses is required and the reason for the extra
quantity is annotated on the prescription by the Prescriber, the quantity prescribed will be
reimbursed.
6.4.2.
No PRN
If the dosing frequency does not have a “when required” component, then the quantity supplied must
relate to the total number of doses ordered.
Example:
2 puffs q2h for 3/12.
2,160 doses (or 11 x 200 dose inhalers).
6.5. Steroid Asthma Inhalers
1. For steroid inhalers without a definitive dosing and frequency instruction, only one inhaler can be
claimed in each monthly dispensing.
Example:
Beclomethasone inhaler 100mcg/dose 2-4 puffs prn
Maximum of 3 inhalers.
2. Prescriptions, which specify both a dose and frequency of dose, will be reimbursed up to the
maximum number of inhalers as provided for by the Prescriber’s instructions.
Example:
Beclomethasone inhaler 100mcg/dose 2-4 puffs bd increasing to 4 puffs bd prn for 3/12.
Maximum dosage is 720 puffs (or 4 inhalers).
Up to four 200-dose inhalers would be reimbursed on these instructions
Example:
Beclomethasone inhaler 100mcg/dose 4 puffs bd increasing to 8 puffs bd prn
Maximum dosage is 1,440 puffs (or 8 inhalers).A maximum of eight 200-dose inhalers would be
reimbursed on this prescription
6.6. Extemporaneously Compounded Preparations (ECP)
Extemporaneously Compounded Preparation means an extemporaneously compounded preparation
that is not available as a proprietary product and is therefore required to be compounded by a
pharmacy. For an Extemporaneously Compounded Preparation to be subsidised under the CPSA, it
must contain two or more subsidised component pharmaceuticals listed in the Pharmaceutical
Schedule. It does not include reconstitution of antibiotic liquids. (Schedule H, Payment Terms, CPSA
2012).
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Refer to the Pharmaceutical Schedule, Section C Extemporaneously Compounded Products and
Galenicals for further information on which products are eligible for subsidy.
6.7. Named Patient Pharmaceutical Assessment (NPPA)
Named Patient Pharmaceutical Assessment (NPPA) provides a mechanism for individual patients to
apply for funding for medicines not listed in the Pharmaceutical Schedule (either at all or for their
clinical circumstances). The NPPA Policy, which includes the prerequisite requirements and criteria
for funding is available on the PHARMAC website.
There are three pathways to NPPA funding – Unusual Clinical Circumstances, Urgent Assessment and
Hospital Pharmaceuticals in the Community – each with different prerequisite requirements.
Applications that meet the relevant prerequisites as described in the NPPA Policy are considered
against PHARMAC's decision criteria for funding.
Patients approved for Exceptional Circumstances funding prior to 1 March 2012 will continue to
receive medicines funding and be considered for renewal funding (where applicable) according to
the Exceptional Circumstances criteria under which funding was initially granted.
6.7.1.
Reimbursement for NPPA or EC Approvals
Where the NPPA funded medicine is listed on the Pharmaceutical Schedule the pharmacy will be
reimbursed as they usually would for that medicine with a multiplier of 5.30 on the handling fee.
Where the NPPA funded medicine is NOT listed on the Pharmaceutical Schedule the pharmacy will
be reimbursed at the GST exclusive invoice price to pharmacy, with a multiplier of 7.95 on the
Handling fee.
Refer to CPSA, Schedule H1, Payment Terms, CPSA 2012 for the full payment calculation.
Further information can be obtained from the PHARMAC website and the CPSA.
6.8. Dispensing Frequency
6.8.1.
Dispensing Frequency Rule
The Dispensing Frequency rule replaced the Close Control rule from 1 July 2012. The Dispensing
Frequency rule defines patient groups or medicines eligible for more frequent dispensing periods;
and the conditions that must be met to enable any claim for payment of handling fees for the
additional dispensings made. Pharmacy can only claim handling fees on repeats.
Refer to the Pharmaceutical Schedule, Section A, General Rules, Part IV for the detailed wording of
the Dispensing Frequency rule.
The rule does not override alternative dispensing frequencies as expressly stated in the Medicines
Act, Medicines Regulations, CPSA, or elsewhere in the Pharmaceutical Schedule.
PHARMAC has committed to reviewing the Dispensing Frequency rule to ensure it meets the needs
of patients, Pharmacists, prescribing Practitioners, and the intent of the CPSA. The Dispensing
Frequency rule may be updated from time to time. PHARMAC will notify Prescribers and
Pharmacists of any changes via the Pharmaceutical Schedule, its updates and other methods of
notification.
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Patients who were on Close Control prior to 1 July 2012 should be maintained on the same
dispensing frequency until they are assessed for LTC and if eligible have an LTC management plan
implemented. Those not eligible for LTC should be safely transitioned to standard dispensing
frequencies (either monthly or stat in accordance with Schedule rules).
Aside from the specific scenarios detailed below or Close Control patients (detailed above), general
Pharmaceutical Schedule rules (monthly or stat dispensing) should be followed. If LTC or Core
patients require more frequent dispensing, and it is not one of the scenarios outlined below then the
following should occur:
a. For LTC patients, the Pharmacist determines the dispensing frequency and it can occur as often
as required to meet the patient’s compliance and adherence needs.
b. For Core patients the dispensing frequency should be no more often than monthly. The
Pharmacist can determine the dispensing frequency either stat or monthly. Anything more
frequently needs to be determined by the prescribing Practitioner. Verbal approval is
acceptable and the Pharmacist must annotate the prescription, sign and date it.
The Dispensing Frequency rule covers:
a. Frequent dispensings for persons in residential care
b. Frequent dispensings for trial period or Safety Medicines
c. Frequency dispensing for Pharmaceutical Supply Management
6.8.2.
Frequent dispensings for persons in residential care
Pharmaceuticals can be dispensed in quantities not less than 28 for patients in either Age-related
Residential Care (ARRC) or Residential Care Institutions funded by the Ministry of Health or DHBs.
Either the prescribing Practitioner or the dispensing Pharmacist needs to specify the
a. Patient’s name,
b. NHI number,
c. Name/address of the ARRC or community residential care facility, and
d. Maximum quantity or period of supply to be dispensed at any one time on the prescription.
Class B Controlled Drugs other than methylphenidate and dexamphetamine should continue to be
dispensed in 10-day lots.
Patients in ARRC or Community Residential Care facilities are eligible for trial periods. Prescribers
are able to order a one-off trial period on the prescription for a dose change or new medication.
Pharmacists are not able to initiate this type of Dispensing Frequency.
6.8.3.
Frequent dispensings for trial period or Safety Medicines
Prescribing Practitioners can request additional dispensings under the following scenario:
a. Trial periods
 This is a one-off shortened dispensing period that can be used for patients who are having a
change of dose or are being started on a new medicine.
 The prescribing Practitioner must endorse each item “trial” or “trial period’ and specify the
maximum quantity or period of supply. The prescribing Practitioner does not need to initial
the item.
 Pharmacists cannot initiate trial periods.
6.8.4.
Safety and co-prescribed medicines
The following medicines can be prescribed with more frequent dispensing for safety reasons.
a. Tri-cyclic antidepressants.
Pharmacy Procedures Manual v 6.0 INTERIM
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b.
c.
d.
e.
f.
Antipsychotics.
Benzodiazepines.
Class B controlled drugs.
Codeine (including combination products).
Buprenorphine with naloxone.
A full list of Safety Medicines is included in Appendix A of this Procedures Manual.
Prescribing Practitioners do not have to endorse Safety Medicines. They must specify the maximum
quantity or period of supply.
Patients in Community Residential Care facilities, ARRC or Penal Institutions are not eligible to have
Safety Medicines dispensed more frequently, unless they are being dispensed in accordance with the
Medicines Act, Medicines Regulations, CPSA, or rules elsewhere in the Pharmaceutical Schedule.
Medicines that are co-prescribed with one, or more, of the medicines on the Safety List as defined in
the Pharmaceutical Schedule may be dispensed at that same frequency. For example, if the Safety List
medicine has a dispensing frequency of weekly, then if appropriate any other medicines coprescribed on that same prescription may be dispensed weekly. It is not mandatory to dispense at
the same frequency. The Pharmacist should use their clinical judgement to determine the
appropriate dispensing frequency. The Pharmacist must annotate the prescription with the amended
dispensing quantity and frequency.
Refer to the Pharmaceutical Schedule for the full details.
In the above scenarios, the Pharmacist must dispense as prescribed. If the prescribing Practitioner
requests more frequent dispensing and the Pharmacist does not consider the patient requires it, the
Pharmacist must contact the prescribing Practitioner to discuss the situation. If the prescribing
Practitioner agrees that the frequency is not required, then the Pharmacist may alter the dispensing
frequency. The Pharmacist must annotate the prescription noting the discussion with the prescribing
Practitioner and date it. This is not required for subsequent prescriptions where the same situation
has been agreed, if a note has been made in the patient’s medication profile.
6.8.5.
Frequent Dispensing for Pharmaceutical Supply Management
From time to time PHARMAC may request Pharmacy to dispense a particular medicine more
frequently than otherwise allowed in the Schedule. This is to manage stock supply issues or
emergency situations. In these circumstances:
a. PHARMAC has approved and will notify Pharmacists to annotate prescriptions for a specified
Community Pharmaceutical(s) “out of stock” without Prescriber endorsement for a specified
time.
b. The dispensing Pharmacist must annotate each of the approved Community Pharmaceutical(s)
with the words “out of stock” or “OOS”, initial this annotation in their own handwriting and
comply with maximum quantity or period of supply to be dispensed at any one time, as
specified by PHARMAC at the time of notification.
c. Frequent Dispensing for Pharmaceutical Supply Management is a request only.
d. Pharmacy can only claim a handling fee for additional dispensings required under this rule. No
claim shall be made to any DHB for subsidised dispensing where dispensing occurs more
frequently than specified by PHARMAC to manage the supply management issue.
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6.8.6.
Flexible dispensing for Pharmacists
A Dispensing Frequency rule in the Pharmaceutical Schedule gives Pharmacists more flexibility when
dispensing some medicines. Refer to Pharmaceutical Schedule, Section F: Part III (Flexible and
Variable Dispensing Periods for Pharmacy). This allows Pharmacists to use variable dispensing
periods for non-Stat medicines (those not identified with a ) in the following situations:
(a) Stock management where the original pack(s) result in dispensing greater than 30 day’s supply;
Example
Erythropoietin beta prefilled syringes 2,000 iu, once each week, 3 months’ supply.
These are supplied in packs of six syringes and generally are prescribed for weekly administration.
Erythropoietin beta is a monthly dispensed medicine, so is not a Stat Medicine.
This may be dispensed as 4+4+4 or 6+6.
(b)To Synchronise a patients medication where multiple medicines result in uneven supply periods.
Example
Pharmacists may choose to dispense only a portion of the total prescribed period of treatment to
synchronise prescriptions. If a patient presented with a prescription from a private cardiologist at a
different time to their usual GP prescription, then the Pharmacist may only dispense enough
medicine on the first dispensing to bring it in line with the repeats on the GP script.
Pharmacists must annotate the prescription with the reason for flexible dispensing. Pharmacists
cannot dispense greater than the total period of supply.
These changes are not mandatory. If a Pharmacist has concerns about the clinical appropriateness of
altering the dispensing frequency, they should check with the Prescriber.
Refer to the Pharmaceutical Schedule for the full details.
6.8.7.
Certified Exemption by Pharmacists
Pharmacists, as well as Prescribers, are able to initiate ”certified exemption” (Pharmaceutical
Schedule, Section F: Part II) dispensing where clinically appropriate to enable some prescription
items to be dispensed all-at-once. This applies to items listed in the Pharmaceutical Schedule, Section
F, Part II and identified within the Pharmaceutical Schedule with a . The patient must be stabilised
on the medicine and the Pharmacist or Prescriber has reason to believe the patient will continue on
the medicine and is compliant. The Pharmacist will need to annotate the prescription with the words
”Certified Exemption”.
Refer to the Pharmaceutical Schedule for the full details.
6.9. Brand-switch Fees
Brand-switch Fees (BSF) are payments to pharmacy by DHBs to recognise the additional counselling
required for switching patients between brands of certain medicines.
6.9.1.
BSF Amount
You will be reimbursed $4.33 ”drug cost” plus the 4% mark up, plus one handling fee. This equates
to $5.50.
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6.9.2.
How to claim a BSF
Payment can be claimed via a Pharmacode® specific to each eligible brand of medicine. This can be
claimed for each patient with the first dispensing of the identified brand.
Claiming is dependent on the dispensary software you choose to utilise. For further details on how
to do this contact your software vendor.
6.9.3.
Eligible BSF Medicines
Medicines used generally for chronic conditions that are subject to Sole Supply change and are not
available over-the-counter. Additional criteria for expenditure, timing of any prior change and
patient numbers are also considered. The criteria were agreed by the Pharmacy Services Advisory
Group. BSF does not apply to all brand changes.
6.9.4.
When to Claim a BSF
Generally this is when the medicine has been granted Sole Supply status. The BSF is claimed on the
first dispensing that occurs after Sole Supply has commenced. This means the patient may have
already been dispensed the new brand.
BSF can only be claimed for during the time period indicated in the Pharmaceutical Schedule. This
period is generally the first three months of the Sole Supply period for most medicines and six
months for oral contraceptives.
6.9.5.
BSF Claim Prescriber Codes and Patient Categories
These are the same as used for the pharmaceutical eligible for BSF.
6.9.6.
BSF Co-Payments
No co-payment is payable. The BSF does not count towards Pharmaceutical Subsidy Card.
6.9.7.
Number of BSFs Claimable
You can claim one BSF per patient per medicine that has been changed. When a patient is on two
strengths of the same medicine, only one BSF may be claimed.
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7.
HEALTH ENTITLEMENT CARDS
7.1. Community Services Cards
Community Services Cards are available to provide targeted subsidies to selected patients to access
Health and Disability Services, in particular pharmaceuticals and general practice services.
If a patient qualifies for a Community Services Card, he/she will receive an individual card. If the
Patient is married (that is, legally married or living with someone in a relationship which is similar to
marriage – reference Health Card Regulations 1993 Reg. 3) both patients will have their own card.
Either card can be used to cover dependent children.
Patients who qualify for NZ Super or a Veteran's Card will have CSC entitlement noted on their
Supergold Card. For further information contact Work and Income.
7.2. High Use Health Cards
High Use Health Cards are for those people who visit their doctor on 12 occasions within a year for
an ongoing medical condition/s. There are specific requirements necessary for eligibility.
A High Use Health Card is issued to an individual and not a family.
7.3. Pharmaceutical Subsidy Cards
Each time an initial dispensing of a prescription with repeats or a ”stat” dispensing (single supply) is
made and all or the initial part of a co-payment is paid by a family unit, this should be recorded on
either the Patient’s Prescription Record Card or against the individual’s medication history. Please
note that where the Patient does not pay a patient co-payment the item does not count towards the
family’s PSC count.
Patient Co-payments are not required for the following items/prescriptions and therefore do not
count towards the family’s PSC count:
a
Subsidised Class B Controlled Drugs and buprenorphine with naloxone sublingual tablets, other
than methylphenidate hydrochloride or dexamphetamine sulphate.
b
Children aged under six years.
c
Patients enrolled with the Hokianga Health Enterprise Trust.
d
Antituberculotic (TB) prescription items.
e
Antileprotic prescription items.
f
Repeat supplies if the full co-payment has been made on previous dispensings.
g
Prescription items that are not subsidised.
h
Medicines for approved Templeton patients.
i
If the patient specifically requests a change to a brand not listed in the Pharmaceutical Schedule
where there is an alternative subsidised brand available.
j
Any other pharmaceuticals listed from time to time in the Pharmaceutical Schedule with no copayment payable.
Where a patient pays less than the full co-payment cost, these are included on the Pharmaceutical
Subsidy Card.
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Procedure for Issuing a Pharmaceutical Subsidy Card (PSC):
Procedures
Part 3 – Pharmaceutical Subsidy Cards, Section 22(2)
For the purpose of this Part, the Director General may regard as married any man and woman
who, although not legally married or in a civil union, have entered into a relationship in the
nature of marriage, and may determine a date on which that relationship is to be taken as
having commenced.
Section 2(1)
A dependent child has the meaning given to it by section 3(1) of the Social Security Act 1964;
but does not include a child for whom an orphan’s benefit or an unsupported child’s benefit is
paid under that Act:
From the Social Security Act 1964
Part 1 – Monetary benefits (Section 3(1)
Dependent child, in relation to any person, means a child –
a. Whose care is primarily the responsibility of that person; and
b. Who is being maintained as a member of that person’s family; and
c. Who is financially dependent on that person; and
d. Who is not a child in respect of whom payments are being made under section 363 of the
Children, Young Persons, and Their Families Act 1989
e. A member of a family unit may, at any time, request to see a copy of the family prescription
record.
The Pharmacy computer system must maintain accurate links to the prescriptions of the family
unit members where known. These links will be audited.
Once a family unit has received 20 initial dispensings of single supplies of subsidised
pharmaceuticals in the year commencing 1 February to 31 January, the family must be issued
with a Pharmaceutical Subsidy Card by the pharmacy.
The 20 prescriptions recorded may have been dispensed by any number of pharmacies.
However, prescriptions from another pharmacy must be able to be verified by a printout or
receipt from the dispensing pharmacy.
If the pharmacy uses computerised records to register the dispensed items to the family unit, a
print out or record of the items from all involved pharmacies should be attached and retained
when issuing a Pharmaceutical Subsidy Card.
The PSC must contain the names of the family members eligible to use the card, as indicated on
the card, and be signed by the issuing Pharmacist, including the name of the pharmacy..
The Pharmacist certifying exemption and issuing the Pharmaceutical Subsidy Card must sign the
printout of the 20 items or the Prescription Record Card. The claimant number must be
included.
On the issue of a Prescription Subsidy Card, the Pharmacist must record the number of the
Pharmaceutical Subsidy Card on the Prescription Record Card, or printout, and retain the
completed Prescription Record Card, or printout, for 10 years following the date of issue.
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A duplicate card should not be issued under ordinary circumstances. A photocopy of the
Pharmaceutical Subsidy Card can be used to inform another pharmacy of the family member’s
entitlement such as in the case of a child at a boarding school.
The Pharmaceutical Subsidy Card period is from February 1st in any year until January 31st of
the next. All patients noted on the Pharmaceutical Subsidy Card are entitled to reduced copayment charges until that card expires.
The Pharmacist will be provided with a supply of blank PSCs for each period by Wickliffe Ltd on
behalf of MoH. Additional supplies are available from Wickliffe Ltd (Reorder Number 74077).
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8.
SPECIAL AUTHORITY
8.1. What is Special Authority?
The Pharmaceutical Schedule specifies “Special Authority” pharmaceuticals and their access criteria.
“Special Authority” means the Community Pharmaceutical is not eligible for subsidy unless it has
been prescribed and dispensed to a patient in accordance with all the restrictions and instructions
specified for that Pharmaceutical in Sections B, C or D of the Pharmaceutical Schedule. Prescribers
submit applications for Special Authorities on behalf of their patients to MoH. A Special Authority
number entitles patients who comply with the relevant criteria to one of the following:

Subsidy on pharmaceuticals or special foods;

Manufacturer’s price in cases where a premium would otherwise be payable. The entitlement to
full subsidy continues following an increase in price;

A higher subsidy than would be available without a Special Authority, but possibly still less than
the manufacturer’s price. This is known as an alternate subsidy and is sometimes linked to the
price of cheaper alternate products. Although the entitlement may at times be equal to the
manufacturer’s price, this would not continue following an increase in price;

Waive a restriction that would otherwise apply, such as a maximum quantity per prescription.
An example of the approval number is CHEM1234567890/Jan14. The month and year refer to the
expiry date of the Special Authority (the approval will expire on the last day of the stated month).
8.2. Obtaining Special Authority Information
Special Authority information can be obtained from:
1. Special Authority Online look up - Online access available 24 hours per day, seven days per
week (Unless an outage is notified by email to you from Sector Services).
2.
Sector Services Contact Centre 0800 243 666 - Available 8am – 5pm Monday to Friday with the
exception of Wednesday when the hours are 9:30am – 5pm.
To access Special Authority Approval information over the phone, you will need the pharmacy
claimant number, if the pharmacy cannot be identified the caller will be asked to fax their enquiry to
0800 100 131 and Sector Services will contact the pharmacy to discuss the enquiry.
To clarify, the expiry date of a Special Authority Approval you will be required to have available the
Patient’s name, the NHI number, and Special Authority pharmaceutical details (if known) to obtain
any Patient information.
Special Authority approvals are not retrospective. Subsidy is applicable from the date of receipt of a
valid application at MoH. If prescriptions are presented prior to authorisation of the Special
Authority approval number, and medication is required urgently, payment arrangements should be
made with the patient.
If a three-month prescription is first dispensed before the Special Authority expiry date, the repeats
will be reimbursed if they are collected after the Special Authority expiry date unless the medicine
has been delisted from the Pharmaceutical Schedule.
The Special Authority number will validate prior to payment. If the number found is still current and
is being used for the designated pharmaceutical, the item will be reimbursed.
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If the claim item is unable to be validated, it will reject and not be reimbursed. In these circumstances
refer to your Error Code Booklet.
8.3. To determine how an error has occurred
1.
2.
Review the original prescription.
Verify the Special Authority information through the Special Authority Online Lookup, (or if you
do not have access contact Sector Services on 0800 505 125).
Contact the Prescriber.
3.
If the patient has a valid Special Authority and the information supplied on the prescription is
incorrect, the claim item can be edited to include the correct information and resubmitted in the next
claim for payment.
Procedures
The Special Authority number has been annotated on the prescription by the Prescriber




Check the expiry date given is current and for the applicable patient and pharmaceutical
prescribed.
Check the number follows the appropriate format (up to 10 numeric characters).
Dispense the medication either with a valid Special Authority number, or at a charge to the
patient, or as an ethical supply.
Submit a claim.
Procedures
The prescription is presented without a Special Authority number and the item requires one
It is permitted to split the script to make an initial small unsubsidised dispensing at patient cost
pending issue of a Special Authority approval. If the Special Authority approval is successful the
balance of the script can be processed as a subsidised prescription (not to exceed in total the
original prescribed amount).
1. Review Special Authority lookup Information (or if you do not have the access contact Sector
Services on 0800 505 125).
2. If a Special Authority application is approved, and the appropriate information is available this
can be added to the claim for payment.
3. If there is to be a delay in obtaining the information, (e.g. an application has not yet been made
and Special Authority approval not in place, or there is no ability to contact anyone to
ascertain the correct information) the following options can be considered:
i. Delay supply of the medication until the appropriate documentation can be sourced if the
Pharmacist is comfortable the patient will be medically fine to wait; or
ii. Supply the medicine at the patient’s cost: or
iii. Supply the medication as an “ethical supply” because in the professional judgement of the
Pharmacist the patient will be at serious risk without the pharmaceutical. Note: if
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dispensing as “ethical supply”, where possible, ensure the process outlined above for
obtaining a correct Special Authority number has been completed before sending the
claim.
If points i - iii cannot be done, contact Sector Services (0800 243 666) to apply for a risk number.
If a risk number is approved you can then submit the item for payment.
Sector Services may provide a risk number after a review of the circumstances. The risk number
can be added to the claim item and resubmitted in the next claim for payment, if approved by
Sector Services
Risk numbers issued to cover Prescriber error, or the ethical supply situations are valid for the life
of the prescription. The correct Special Authority information should then be used. It is important
with the administration of Special Authority numbers that any additions or changes made by the
Pharmacist are initialled on the prescription and dated to ensure in an audit situation it is obvious
what information the Pharmacist is responsible for versus the Prescriber.
8.4. Risk Number Procedure
Procedures
A risk Special Authority number to cover ethical supply will be issued only in the following
circumstances.
 The Prescriber could not be contacted.
 The Prescription was presented:
o When access to the online Special Authority lookup tool was technically unavailable due to
notification by Sector Services.
o Outside Sector Services contact centre hours of operation and could not wait to be
dispensed during business hours.
 The patient was at serious risk without the medication, such as a life threatening condition or
imminent hospitalisation. Examples of where this would apply are a hyperglycaemic event
when appropriate insulin is not available, or a risk of kidney graft rejection without immediate
availability of immunosuppressants.
“Ethical supply” does not cover medicines where it is unlikely there would be a serious
deterioration in the patient’s condition due to a delay in receiving the medicine, such as a
prescription for a statin. It is expected “ethical supply” under Special Authority will not be a
frequent occurrence. It is designed as a last resort to protect patients at risk. These should only be
for enough supply to get the Patient through while the clinician is contacted for an application.
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8.5. Special Authority Quick Reference Table
The following table may be of assistance as a ‘quick reference’ table for Pharmacists.
Prefix
CHEM
SA Type
Special Authority
Description
Special Authority allow patients to
receive Special Authority medicines
through a Community Pharmacy.
EXCP
Named
Patient
Assessment
RISK
Risk Number
Available where a Pharmacy has made a
dispensing in good faith or if the patient
has a life threatening condition.
TEMP
Templeton
Enables subsidy for patients who were
residents at the Templeton Centre at
the time of closure.
The approval numbers cover all
medicines required by the patient.
Pharmaceutical
Pharmacy Procedures Manual v 6.0 INTERIM
Allows a patient to access a subsidy
sufficient
to
fully
fund
the
pharmaceutical.
Criteria
and
application details are described in the
Pharmaceutical Schedule.
37
9.
RECEIPTS
The following information is required on each receipt issued:
a. Name of the patient.
The following information is required for each prescription item on the receipt:
a. Name of the prescription item.
b. Total cost.
c. DHB subsidy.
d. Patient contribution.
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10. USEFUL CONTACTS
Medicines Control (Auckland)
(Wellington)
0800-248-671
0800-163-060
Ministry of Health
General
0800 855 066
Pharmacy Payments
0800 353 2425
Pharmacy Online System Support 0800 505 125
Special Authority
0800 243 666
PHARMAC
0800-660-050
Wickliffe Press
0800-259-138
Work and Income
Community Service Cards
CSC-Supergold
0508-555-999
0800-999-999
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11. APPENDICES
11.1.
Appendix A – Safety Medicines List
Safety Medicines
Medicines
a) a tri-cyclic antidepressant
Amitriptyline
Controlled
Drug Class
Clomipramine hydrochloride
Dotheipin hydrochloride
Doxepin hydrochloride
Imipramine hydrochloride
Maprotiline
hydrochloride
(note: tetracyclic)
Nortriptyline hydrochloride
b) an antipsychotic
Amilsulpride
Aripiprazole
Chlorpromazine hydrochloride
Clozapine
Haloperidol
Levomepromazine
Lithium carbonate
Olanzapine
Pericyazine
Quetiapine
Risperidone
Trifluoperazine hydrochloride
Ziprasidone
Zuclopenthixol hydrochloride
Flupenthixol decanoate
Fluphenazine decanoate
Haloperidol decanoate
Olanzapine
pamoate
monohydrate
Pipothiazine palmitate
Risperidone
Zuclopenthixol decanoate
c) a benzodiazepine
Alprazolam
C5
Diazepam
C5
Lorazepam
C5
Oxazepam
C5
Lormetazepam
C5
Midazolam
C5
Nitrazepam
C5
Temazepam
C5
Triazolam
C5
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Clonazepam
C5
Clobazam
C5
Fentanyl
B3
Fentanyl citrate
B3
Methadone hydrochloride
B3
Morphine hydrochloride
B1
Morphine sulphate
B1
Morphine tartrate
B1
Oxycodone hydrochloride
B3
Pethidine hydrochloride
B3
Dexamphetamine sulphate
B1
Methylphenidate hydrochloride
Methylphenidate hydrochloride
extended-release
B2
e) codeine
codeine phosphate
C2
(includes combination products)
paracetamol with codeine
C6
f) buprenorphine with naloxone
buprenorphine with naloxone
C4
d) a Class B Controlled Drug
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11.2.
Appendix B – Glossary
The following terms will assist understanding in this document.
Claimable Item(s)
Means an individual transaction relating to the provision of services
and/or pharmaceuticals in accordance with the CPSA, but excludes a
Long Term Condition (LTC) Claim. Refer CPSA Part E, E1.3
Definitions.
CSC
Community Services Card. A card which is available to low or middle
income earners to enable them and their family to access subsidised
health services, as provided by Work and Income on behalf of the
Ministry of Health.
Eligible Person
A person eligible for publicly funded health services under the
Eligibility Direction (refer to http://www.health.govt.nz/newzealand-health-system/eligibility-publicly-funded-healthservices/guide-eligibility-publicly-funded-health-services-0).
Eligible Prescriber
A Prescriber who issues a prescription in the following circumstances:
a. When the Prescriber is employed by a DHB (e.g. Public Hospital
or community-based service);
b. When the Prescriber is subcontracted to a Primary Health
Organisation (PHO);
c. When the Prescriber is employed by an After Hours provider
with a service agreement with a DHB or a PHO;
d. When the Prescriber is providing a fully publicly-funded service
under a Section 88 notice alone (i.e. a midwife under the
Maternity Notice).
Exclusions to the eligible provider or Prescriber policy are:
a. Providers providing completely privately-funded services;
b. Providers providing services under a Section 88 notice alone
that are not solely publicly-funded (i.e. a specialist under a
Maternity Notice, a practitioner or specialist under the General
Practitioners Notice or a Specialist Notice).
Family Unit
From The Health Entitlement Cards Regulations:
Part 3 – Pharmaceutical Subsidy Cards, Section 22(1)
Family Unit means –
a. A married or partnered couple with one or more dependent
children:
b. A married or partnered couple with no dependent children:
c. One person with one or more dependent children:
d. One person who is not a member of a family unit described in
paragraphs (a) to (c) of this definition:
Where married or partnered means—
a. Being married to a spouse (subject to regulations 3(b) and
22(2)); or
b. Being in a civil union with a civil union partner
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And married meaning: any man and woman who, not being legally
married or in a civil union, who have entered into a relationship in
the nature of marriage.
HUHC
High Use Health Card, as defined in the Health Entitlement Card
Regulations 1993.
Patient(s)
For the purposes of this document, the term Patient(s) refers to the
term Service User as defined in the Pharmacy Services Agreement.
PRC
Prescription Record Card.
Prescription Address
Prescriber: the Prescribers full physical work address, which shall
include:
a. For an urban based Prescriber: the full street address (including
unit number (if applicable), street number / alpha, street name,
suburb (if in common use) and town or city).
b. For a rural Prescriber street number and street name (if
applicable) and RD number with the correct mail town.
c. The address may not be a PO Box or Rural Delivery number except
where the Prescriber does not have a place of work. A rural grid
number is acceptable.
Patient: the patient’s full home address, which shall include:
a. For an urban patient: the patient’s full street address (including
unit number (if applicable), street number / alpha, street name,
suburb (if in common use) and town or city)
b. For a rural patient: street number and street name (if applicable)
and RD number with the correct mail town. A rural grid number is
acceptable.
c. The address may not be a PO Box or Rural Delivery number.
d. For a patient with no fixed abode: the practice’s full street address
(including unit number (if applicable), street number / alpha,
street name, suburb (if in common use) and town or city).
Procedures Manual
The publication entitled “Pharmacy Procedures Manual”, as varied by
us or our agent, together with all of the other DHBs, from time to time
following consultation with Providers.
PSC
Pharmaceutical Subsidy Card. A pharmaceutical subsidy card, as
defined in the Health Entitlement Card Regulations 1993.
Safety List
A Safety List Medicine as defined in the Dispensing Frequency rule of
the Pharmaceutical Schedule
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