|
NHS
|
|
HDL(2001)33
|
|
|
Health
Department |
St Andrew's
House |
|
|
|
NATIONAL HEALTH SERVICE, CHARGES FOR DRUGS AND APPLIANCES FROM 1 APRIL 2001 Summary 1. This letter advises Health Boards and NHS Trusts of:
Full details are contained in the attached Annex. Action 2. Health Boards and NHS Trusts are asked to bring the Memorandum to this letter, which contains advice on exemption and remission of charges, as quickly as possible, to the attention of all staff involved in dealing with matters relating to prescription charges and refunds, pre-payment certificates, elastic stockings, tights, fabric supports and wigs. Bulk supplies of the Memorandum are being sent under separate cover. Yours sincerely
|
11th April 2001
Addresses For information
Enquiries to: |
|
ANNEX BACKGROUND 1. Regulations have been made and laid before Parliament providing for the following revisions:-
2. The new rates will apply to all applications for pre-payment certificates which are received by Practitioner Services Division on or after 1 April 2001. (The new rates will apply even where the start date of the certificate is backdated to before 1 April to allow for recovery of prescription charges already paid.) The new rates should not be applied to certificates where application is received prior to 1 April 2001, regardless of the starting date of the certificate. Pre-payment certificates should not be issued with starting dates more than 7 days earlier, or one month later, than the date on which the application is received. NB Prepayment certificates
cover hospital out-patient charges for drugs and appliances (other than
fabric supports and wigs) supplied through the hospital service. DIFFERENT CHARGE AND EXEMPTION ARRANGEMENTS IN WALES 3. From 1 April 2001 there are some differences between Wales and the rest of the UK in respect of prescription charges and exemption from charges. In Wales the level of charge remains £6.00 and every person under the age of 25 now receives free prescriptions. However, prescriptions written in Wales (or in respect of patients who live in Wales) which are presented for dispensing in Scotland must not be treated differently from any other prescriptions i.e. the rules and charges which apply in Scotland must be applied to all prescriptions presented for dispensing in Scotland. CHARGES FOR FABRIC SUPPORTS AND WIGS 4. As from 1 April 2001 the charges for these items, which are supplied only through the hospital service, are as follows:-
COLLECTION OF CHARGES IN HOSPITALS 5. Health Boards and NHS Trusts are asked to ensure that hospital authorities make arrangements for collecting and bringing to account charges made in hospitals. PUBLICITY ABOUT PRESCRIPTION CHARGES AND PREPAYMENT CERTIFICATES 6. Leaflet HC12 "Charges and Optical Voucher Values" is being updated to include revised figures from 1 April 2001 and will be issued in due course. Any remaining stocks of the HC12 effective from 1 April 2000 should be destroyed when the April 2001 version is received. 7. Leaflets HC11/HC11(LP) - patients' leaflets - are being updated and will be issued in due course. Remaining stock of earlier versions should be destroyed when you receive the 1 April 2001 version. 8. A bulk supply of the revised publicity material will be sent to Primary Care Trusts/Island Health Boards for distribution to GPs, pharmacy contractors, appliance suppliers, general dental practitioners, opticians and ophthalmic medical practitioners. Bulk supplies of the revised publicity material will also be sent to Trusts/Boards for use by the public. 9. Pre-payment Certificates: A revised application form for the purchase of prepayment certificates (form EC95 (Rev April 2001)) is being printed. Any remaining stocks of the forms showing April 2000 fees should be destroyed on receipt of the April 2001 revised version. REGULATIONS 10. Copies of the NHS (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2001 which give effect to these changes will be sent to Health Boards and Trusts in due course. Memorandum to HDL (2001) General Medical Practitioners NATIONAL HEALTH SERVICE CHARGES FOR DRUGS, APPLIANCES, WIGS AND FABRIC SUPPORTS AND THE COST OF PRE-PAYMENT CERTIFICATES FROM 1 APRIL 2001: 1. This Memorandum advises doctors, pharmacy contractors and appliance suppliers of:-
PRESCRIPTION CHARGES 2. Regulations have been laid before Parliament to increase prescription charges from 1 April 2001 as follows:-
Item charges a. and b. above will also be payable for items supplied by hospitals to out-patients. Item charges at c. to h. above apply where the consultation at which the supply of the item is authorised takes place on or after 1 April 2001. EXEMPTION AND REMISSION CATEGORIES 3. This paragraph sets out the arrangements for exemption from prescription charges and remission of charges. (Claims for remission of charges under the NHS Low Income Scheme must be submitted on claim form HC1 or refund form HC5.)
In-patients 4. No charge may be made for any NHS appliance supplied to a hospital in-patient. Out-patients 5. Out-patients may be charged only for those appliances specified in the appropriate Regulations ie wigs, abdominal and spinal supports, dentures and bridges, elastic hosiery and contact lenses, and for prescribed appliances etc which are listed in the Drug Tariff (and for contact lens fluid supplied as part of contact lens therapy). The revised NHS charges set out in this Memorandum will be payable, except in those cases where the patient is exempt or eligible for remission of charges. Day Surgery Patients 6. Drugs administered to day surgery patients in hospitals are free of charge as are those drugs supplied until such time as the patient can attend their General Practitioner. Day surgery patients who get a prescription from a hospital doctor which is dispensed in the hospital pharmacy are liable for prescription charges (unless they are exempt or eligible for remission of charges). COST OF PRE-PAYMENT CERTIFICATES 7. In respect of all applications received by Practitioner Services Division (PSD) on or after 1 April 2001 the cost of pre-payment certificates will be as follows:-
8. Pre-payment certificates offer a saving to people who need more than 5 prescribed items in a period of 4 months, or more than 14 items in a year and who are not exempt from prescription charges. A prepayment certificate is also valid for hospital out-patient charges for drugs and appliances (other than for fabric supports and wigs supplied through the hospital service). PPC REFUND ARRANGEMENTS 9. For 4 month and 12 month PPCs a full refund should be made if, during the first month of the PPC start date, the holder becomes entitled to free prescriptions on grounds of:
REFUND ARRANGEMENTS FOLLOWING THE DEATH OF A PPC HOLDER 10. For 4 and 12 month PPCs a full refund should be made if, during the first month of the PPC start date the holder dies, or goes into hospital and dies while the PPC remains valid. 10.2 For 4 month and 12 month PPCs if the holder dies, or goes into hospital and dies there at any time after the first month, a proportional refund is payable, i.e. one-quarter or one-twelfth of the full fee in respect of each complete, unexpired month of the PPC's validity. 11. Examples of calculating the refund on death of a PPC holder:
12. In all the examples above, if the PPC starts on 1st of a month and the patient dies (or goes into hospital and then dies) on 1st of a month, the months in the unexpired portion start from the month following death (or admission). For example, 12 month PPC starts on 1 August, patient dies on 1 December, unexpired portion 7/12, ie January to July. If patient had died on 30 November, unexpired portion would be 8/12, ie December to July. Part Refunds (available for 12 month PPCs only) 13. For 12 month PPCs only, where the holder becomes entitled to free prescriptions in months 2 to 4 from the PPC start date, the refund payable will be the difference between the 12 month fee and 4 month fee. This applies where patients have become exempt on grounds of:
14. Examples of calculating the refund when PPC holder becomes entitled to free prescriptions during months 2-4 of a 12 month PPC: PPC starts 21 June and:-
Medical certificates all start on 1st of the month. If income support or tax credit were substituted in the above example, an award starting before 21 July would mean a full refund and an award staring on or after 21 July and before 21 October, would mean the refund would be 12 month fee minus 4 month fee. TIME LIMITS FOR MAKING PPC REFUND CLAIMS 15. The time limits for making a claim for a refund under the revised arrangements are as follows:
16. In cases involving the death of the PPC holder (see above) the Practitioners Services Division of the CSA may decide if there was a good cause for making the claim outside the time limit. In all other cases, if a claim is received late it should be refused. However, in exceptional cases, the time limit may be extended if there is a good reason for making the claim outside the specified period. If, following the initial refusal, the claimant says that there was a good reason for the delay, he should be advised to set this down in a letter to the PSD, who will refer the case to the Scottish Executive Health Department with their recommendations. PHARMACIST CONTRACTORS AND APPLIANCE SUPPLIERS: SORTING OF PRESCRIPTION FORMS 17. In general, prescriptions written on or after 1 April 2001 will be assumed to attract the increased charge. Where this is not the case (eg a referred-back prescription from a previous month) contractors are requested, in their own interest, to sort into bundles (and label accordingly) prescriptions on which the old charge had been collected. DISPENSING DOCTORS 18. Dispensing doctors should collect prescription charges at the new rate from 1 April 2001 and remit them to Primary Care Trusts/Islands' Health Boards in the normal way. PUBLICITY ABOUT PRESCRIPTION CHARGES AND PREPAYMENT CERTIFICATES 19. A revised leaflet HC12 "Charges and Optical Voucher Values" is being updated to include revised figures from 1 April 2001 and will be issued in due course. Any remaining stocks of the HC12 effective from 1 April 2000 should be destroyed when the April 2001 version is received. 20. Pre-payment Certificates: A revised application form for the purchase of prepayment certificates (form EC95 (Rev April 2001)) is being printed. Any remaining stocks of the forms showing April 2000 fees should be destroyed on receipt of the April 2001 revised version. 21. Leaflet HC11/HC11(LP): Patients' leaflets are being updated and will be issued in due course. Remaining stocks of earlier versions should be destroyed when you receive the April 2001 version. 22. Any questions arising from this Memorandum should be addressed to the relevant Primary Care Trust/Island Health Board.
SCOTTISH EXECUTIVE
HEALTH DEPARTMENT April 2001 File ref: NIP/6/21 |