Endorsement guidance for oral liquid Methadone  

New fee arrangements for oral liquid methadone were introduced from April 2013 in England and Wales. Support for these is reflected in Pharmacy Manager.

On each occasion the pharmacist provides methadone to the patient, for example, for each interaction or “pick-up,” contractors will receive a professional fee, a CD fee, a consumables allowance and any relevant volume related fees, though the latter are out of scope of Pharmacy Manager.

The item level fee for oral liquid methadone prescriptions is £2.50 per prescription.

As well as this fee, from April 2013 contractors will be able to claim a fee of 55p per additional dose packaged separately. Additional doses are doses given to patients in addition to the dose they have come to collect from the pharmacy for that day, for example, either to take at home later on that day or to cover non-collection days.

These new fees are included in the NHS FP34 report summary estimate.

Whilst FP10 (MDA) form types will typically be endorsed by hand,  Pharmacy Manager indicates the number of package doses which is endorsement information that you need to complete, along the number of prescriptions on the form.

Professional Fees

Each interaction/pick-up must be endorsed (with the total volume supplied for each patient interaction/pick-up. The prescription would trigger the same number of  professional fees, CD fees and consumables fees

Package Doses - FP10(MDA) Prescriptions

In the following scenario where an FP10 (MDA) form is used for prescribing Methadone 1mg/ml oral solution sugar free , 40ml daily/560ml in total, with daily instalment intervals except Sunday which is collected in a separate container on Saturday.

Pharmacy Manager provides endorsement guidance which would typically be appended to the left hand side of the prescription whilst the right hand side contains the detail relating to each patient interaction/pick-up.

The number of package does is only accurately represented when all the instalments have been dispensed:

The left hand side bar displays the packaged dose endorsement.

PD fees = total number of separately packaged dosages supplied minus total number of pick-ups/interactions, for example, 14 – 12 = 2 PD fees.

The counter at the bottom left corner displays, for pharmacy audit purposes, the number of prescriptions dispensed on the form. This reflects the number of collected instalments. If a patient forfeits some daily doses due for example, to non-attendance, these would be manually reclaimed. The counted number of items on the completed form would be reduced accordingly.

Examples

For a patient collecting three 20ml doses on a Friday to cover the weekend:

Friday doses	Tues	Wed	Thur	Fri	Sat	Sun	Mon	PD Fees
One container	20	20	20	60	0	0	20	0
Two containers	20	20	20	20,40	0	0	20	1 x PD
Three containers	20	20	20	20,20,20	0	0	20	2 x PD

• If the contractor dispenses all three doses together, for example, the three daily doses are in one container, with a suitable measuring device, the contractor would not be eligible to claim for any additional PD fees.

• If the contractor dispenses the Friday dose as a single dose, for example, for supervised consumption, with the Saturday and Sunday doses packaged together in one container with a suitable measuring device, the contractor would be eligible for one PD fee as one separate package was supplied for the Saturday and Sunday doses. The endorsement would show as PD1 on the left hand side of the Dispensary Supply screen.

• If the contractor dispenses all three doses in separate containers, the contractor would be eligible for two PD fees as two separate packages were supplied for the Saturday and the Sunday doses in addition to the Friday dose. The endorsement would show as PD2 on the left hand side of the Dispensary Supply screen.

There are many other examples/permutations.

Package Doses - FP10 Prescriptions

Although instalment dispensing is not permitted on FP10 prescriptions, where you dispense each individual dose in a separate container, you can claim the additional package dose fees. However, the number of interactions/pick-ups will always be one.

The quantity should be divided down into daily doses, for example, 30,30,30,30,30,30,30.

In the illustration below, this equates to seven doses of 30ml each. The quantity can be entered as shown, resulting in seven labels being printed, one for each dose. If you have only entered the quantity as 210, no package doses would be calculated and only one label would be generated:

When the endorsement is shown, it indicates six package doses (PD6) can be claimed. This informations applies to both electronic claims or simple printed endorsements on paper prescriptions.

Spilt pack fee

The 10p split pack fee payment will only be made where the total quantity prescribed (sum of all the doses) is outside of a pack size listed in the Drug Tariff (or a multiple of one or more listed pack sizes).

In the Drug Tariff, Methadone 1mg/ml oral solution is available in 100ml and 500ml packs sizes whilst Methadone 1mg/ml oral solution sugar free is available in 30ml, 50ml, 100ml & 500ml pack sizes.

This translates into the following examples:

	Methadone 1mg/ml oral solution 100ml and 500ml pack sizes	Methadone 1mg/ml oral solution SF 30ml, 50ml, 100ml & 500ml pack sizes
14 days x 29ml dosages (406ml)	Special fee payable	Special fee payable
14 days x 40ml dosages (540ml)	Special fee payable	Special fee not payable (500 + 30 + 30)
14 days x 50ml dosages (700ml)	Special fee not payable (500 + 100 + 100)	Special fee not payable (500 + 100 + 100)