Expiry rules for EPS prescriptions  

 

It is likely that dispense notifications and subsequent reimbursement claims are carried out in a timely fashion to ensure remuneration issues do not arise. However, you should be aware of the expiry rules that exist and set your operating procedures to avoid encountering complications they could introduce.

 

The expiry rules for prescribed items primarily depend on the legal classification of the prescribed item. The expiry of an item can also depend upon whether an item was prescribed as an acute item or through the repeat prescribing or repeat dispensing mode.

 

Schedule 1, 2 and 3 controlled drugs are not currently in scope of EPSR2 until legislative changes take place. However, as the expiry rules for schedule 2 and 3 controlled drugs are the same as schedule 4 controlled drugs, they will be considered here.

Prescribed item vs. Prescription expiry  

Legally, expiry is based on the prescribed item not the overall prescription. The NHS Spine, however, calculates expiry at the prescription level.

For example: if an acute prescription contains a schedule 4 controlled drug (referred to as CD4 below) and a non-controlled drug, these items will individually expire after 28 days and 6 months respectively.

However, when both present items are present on a single prescription, after 28 days has elapsed, the CD4 will have be marked as expired whilst it will still be possible to dispense the unscheduled item (so long as it is still withing the six month expiry period).

Start date (appropriate date)

The expiry of a prescription item runs from the start date (also known as the appropriate date or prescribed date) of the prescription. Typically, it is the date prescriber produces the prescription.

It is possible that a prescriber may wish to post date a prescription – that is set a prescription to start at some later date in the future, next week for example. In these instances the prescribing system will retain post dated prescription until the start date, at which point they will be placed on the NHS Spine.

Date of expiry calculation for 6 month / 12 month prescriptions

Some prescription items will expire after 6 or 12 calendar months. There will be situations where, for example, the prescribing month has more days than the month of expiry.

If the day of prescribing is greater than the number of days in the month of expiry, then the expiry day will be set as the last day of the expiry month.

For example, a prescription starting on 31st March would have an expiry of 30th September.

Normally, 12 month prescriptions would expire on the same day in the year following the start year. For example a prescription with a start date of 15th May 2013 would expire on 15th May 2014. Prescriptions written on 29th February in a leap year will expire on 28th February the following year.

Time of expiry

All prescriptions expire at 23:59:59 on the date of expiry regardless of the time at which they were written.

For example a standard prescription item on a prescription written at 15:39 on 23rd May 2010 will expire on 23rd November 2011 at 23:59:59.

Prescriptions not retrieved from the NHS Spine

If a prescription is not retrieved from the NHS Spine (or has been returned to the NHS Spine and not pulled down again) the NHS Spine will expire the prescriptions.

The NHS Spine will expire an acute or repeat prescribing prescription after six months. The NHS Spine expires at the prescription level not the prescription item level. The NHS Spine will expire returned prescriptions using the same rule if they are not retrieved from the NHS Spine after being returned.

As the NHS Spine does not differentiate between schedule 2, 3 or 4 controlled drugs and normal prescription items the NHS Spine will not expire schedule 2-4 controlled drugs correctly (i.e. it will release expired prescriptions in these instances). In these circumstances the PMR will be required to calculate the correct expiry dates and expire the items as appropriate.

The NHS Spine will automatically expire a repeat dispensing prescription after six months if the first issue has not been retrieved from the NHS Spine or it has been returned to the NHS Spine then not subsequently retrieved for dispensing.

If the first issue of a repeat dispensing prescription has been dispensed then the NHS Spine will expire subsequent issues twelve months after the start date.

Prescriptions retrieved from the NHS Spine but not dispensed  

If a prescription is retrieved from the NHS Spine but not dispensed, the prescription will expire as if the prescription had not been retrieved, for example, six months after the appropriate date.

 

Prescriptions retrieved but no notification sent  

If a prescription is retrieved and dispensed but no dispense notification is sent to indicate dispensing activity has taken place, then the NHS Spine will expire the prescription as if the prescription had not been retrieved, for example, six months after the appropriate date.

The expiry date of a dispense notification for schedule 2, 3 or 4 controlled drugs is 28 days.

On start-up, the system will inform you if a dispense notification expiry is imminent for any prescriptions, for example, within 14 days of their expiry.

 

 

The system will prevent you from submitting dispense notifications after they have expired as they will be rejected by the NHS Spine.

 

If it suits your internal processes, the system can submit dispense notifications automatically after the prescription has been collected. This can reduce the risk of encountering expired dispense notifications.

 

See Notify options

Prescriptions notified but no claim sent  

All electronic reimbursement endorsement messages (claims) must be sent within 180 days of the dispensed date within the last sent dispense notification message. This is known as the "claim reconciliation period". After this period, any reimbursement submission will be prevented by Pharmacy Manager as it will not be accepted by the NHS Spine.

On system start-up, Pharmacy Manager will inform you if a reimbursement claim expiry is imminent for any prescriptions, for example, within 14 days of their expiry.

 

 

If the claims are not submitted, the system will subsequently inform you that they have expired as the due date has passed.

 

Recalculated dispense notification expiry dates

In some instances the opportunity to claim is lost if a timely dispense notification and claim is not made.

Once an EPSR2 acute prescription is prescribed, there is a six months period in which dispensing must take place and the dispense notification must be made. Furthermore, the claim must be submitted within 180 days of dispensing.

If you do not make submissions in a timely manner, the discrepancy between the two expiry windows may mean you can still make a dispense notification but have lost the opportunity to make a claim.

 

In order to prevent this situation arising, the system will, where necessary, recalculate the dispense notification expiry date to fit in with the claim expiry, alerting you accordingly.

Example scenario

An acute prescription or the first iteration of a repeat prescription can have a dispense notification expiry date, at 6 months, which will occasionally exceed the claim window (which is only 180 days) albeit only by a day or two. If you overlook making a dispense notification you could be in a situation where you may eventually submit a valid notification only to find out you are unable to make the subsequent claim.

  • An acute prescription is prescribed on 1st May 2014.

  • At this point, the dispense notification expiry is 1st November 2014, but if the prescription is dispensed on any day between 1st May and 5th May the claim expiry will expire between 27th October and 31st October, for example, 180 days later and could possible be exceeded by a late dispense notification.

  • Consequently, the system will recalculate the dispense notification expiry in alignment with the claim expiry and alert you accordingly.

  • For example, when dispensed on 1st May, the dispense notification expiry date will be 27th May, aligned to the claim expiry and sharing the same imminent expiry alert message.

Example scenario

Iterations of a repeating prescription (i.e. after the initial iteration) can have a dispense notification expiry date, at 12months, which will exceed the claim window (which is only 180 days). If you overlook making a dispense notification you could be in a situation where you may eventually submit a valid notification only to find out you are unable to make the subsequent claim.

  • A repeat prescription for 12 x 28 day iterations is prescribed on 3rd January 2014 when the first iteration is also dispensed.

  • The second iteration is dispensed 28 days later on 31st January 2014

  • At this point, the dispense notification expiry is 3rd January 2015, but the claim expiry for the second iteration is 30th July 2014 (180 days on from 31st January 2014).

  • Consequently, the system will recalculate the dispense notification expiry in alignment with the claim expiry and alert you accordingly.

  • This recalculation will take place for every iteration up to and including the seventh iteration.

  • The eighth iteration is then dispensed on 18th July 2014.

  • At this point, the dispense notification expiry remains 3rd January 2015, whilst the claim expiry is now 14th January 2015 (180 days on from 18th July).

In such an instance, there is now no need to recalculate the dispense expiry date as all the remaining claims will occur after the respective dispense notifications need to be made.

 

In the event that the repeat prescription is for a shorter period, e.g. 6 x 28 day iterations, all iterations will be subject to a recalculated dispense notification expiry/ alert as all claim expiry periods will occur before the prescription dispense notification expiry in each instance.

Expiry rules summary  

The following table outlines the rules regarding expiry of dispense notifications and claims as summarised above. Many represent rare occurrences that you are unlikely to encounter if dispense notifications and claims are made in a timely fashion.
 

Pharmacy Manager provides ample and frequent reminders about any imminent prescription expiry, however, should you leave a prescription to expire, the system will prevent it being submitted when the only outcome is for the dispense notification (or claim) to be rejected by the NHS Spine.

 

Scenario

How Pharmacy Manager Works

Downloaded prescription for a non-controlled drug item with no activity

The prescription will expire in 6 months from the prescribed date

Downloaded prescription for a non-controlled drug item which has been dispensed but no Dispense Notification has been submitted

The prescription will expire in 6 months from the prescribed date

After a prescription for a non-controlled drug item has had a successful final Dispense Notification

The claim will expire 180 days after the dispensing date within the last Dispense Notification

A prescription for a CD4 item (or a prescription containing one or more non-CD4 items and one or more CD4 items) with no activity

From a Pharmacy Manager perspective, the prescription will expire the CD4s 28 days after the prescribed date, whilst the non-CD4 items will expire 6 months after the prescribed date

A prescription for a CD4 item (or a prescription containing one or more non-controlled drug items and one or more CD4 items) which has been dispensed but no Dispense Notification has been submitted

The prescription will expire in 6 months from the prescribed date

After a prescription for a CD4 item (or a prescription containing one or more non-controlled drug items and one or more CD4 items) has had a successful Dispense Notification

The claim will expire 180 days after the dispensing date within the last Dispense Notification

Iteration 1 of a repeat dispensing prescription with no activity

The prescription will expire in 6 months from the prescribed date

Iteration 1 of a repeat dispensing prescription which has been dispensed but no Dispense Notification has been submitted

The prescription will expire in 6 months from the prescribed date

Iteration 2 and above of a repeat dispensing prescription with no activity

The prescription will expire 12 months after the original prescribing date

Iteration 2 and above of a repeat dispensing prescription  which has been dispensed but no Dispense Notification has been submitted

The prescription will expire 12 months after the original prescribing date. However, the system will, where necessary, recalculate the dispense notification expiry to be in alignment with the respective claim expiry.

A repeat dispensing prescription which has had a successful Dispense Notification

The claim will expire 180 days after the dispensing date within the last Dispense Notification

A prescription which has been partially dispensed or has an owing and is held as such on the NHS Spine

Owings in Pharmacy Manager expire at the same time as the prescription, regardless of whether or not the Dispense Notification has been sent. If a prescription has not been fully dispense notified in Pharmacy Manager, then the system will not allow a claim message to be sent.

After 180 days without any further dispensing activity, items marked as partially dispensed will be marked on the NHS Spine as Dispensed, and items marked as owed will be marked as Not Dispensed. The NHS Spine will then accept a claim for any dispensed items within a further 180 day period.

Downloaded prescription for a non-controlled drug item which has been partially dispensed and has had a successful Dispense Notification

The prescription will expire 180 days from the dispensing date within the last Dispense Notification.

Downloaded prescription a CD4 item which has been partially dispensed and has had a successful Dispense Notification

The prescription will expire 180 days from the dispensing date within the last Dispense Notification.

Iteration 1 of a repeat dispensing prescription which has been partially dispensed and has had a successful Dispense Notification

The prescription will expire 180 days from the dispensing date within the last Dispense Notification.

Iteration 2 of a repeat dispensing prescription which has been partially dispensed and has had a successful Dispense Notification

The prescription will expire 180 days from the dispensing date within the last Dispense Notification.

 

Response not received

On rare occasions you may, for example, submit a claim which is not acknowledged by the NHS Spine. The status of such a message will be set as Last message timed out - please resend.

 

 

Any such message with this status will need resubmitting or there is a risk, similar to a reimbursement claim expiry, which could mean you lose reimbursement.

 

Updated 19th February 2018