Exemption Checking Standard Operating Procedure

Description

1. Receiving Hardcopy FP10 NHS prescriptions NHS prescription may arrive at the pharmacy in either an electronic form (via ETP) or in hardcopy form via an FP10 (green prescription). In regards to hardcopy, the patient or their representative must complete the relevant sections of the reverse of the FP10DT EPS dispensing token to claim exemption from NHS prescription charge payment & the Pharmacist should check this is completed with the patient / their representative. 2. Electronic checking. In accordance with regulation 3(1) or (1A) of the Charges Regulations(1), before providing any drugs or fulfilling a prescription form or a repeatable prescription, our Responsible Pharmacist will determine whether any person who makes a declaration that the person named on the prescription form or the repeatable prescription does not have to pay the charges specified. If the patient declares a specific exemption (listed below), they will eligible to receive free NHS prescriptions from our pharmacy. Alongside the RTEC functionality to check whether the claim may be fraudulent, our system intelligently applies a second check, using a logic gate of NHS stipulations against specific patient criteria, any instances which are contrary to this logic are flagged to the Responsible Pharmacist calls the patient either by telephone or video chat. Other logic includes: under 16, over 60 – our system checks the patients date of birth (D.O.B.) in accordance with their ID verification. aged 16 to 18 and in full-time education – our system verifies D.O.B. alongside a patient declaration of full-time education attendance. in possession of a Prescription prepayment certificate (PPC) – patients are asked to upload a photo of their pre-payment certificate our system checks and confirm it. income support, income-based Jobseeker’s Allowance, income-related Employment and Support Allowance, Pension Credit Guarantee Credit, Universal Credit, NHS certificate for partial help with health costs (HC3) valid NHS tax credit exemption certificate – our system checks the patients D.O.B. in accordance with their ID verification. are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx) – our system checks D.O.B for gender and child bearing age hold a valid war pension exemption certificate and the prescription is for your accepted disability – our system checks D.O.B. have a specified medical condition and have a valid medical exemption certificate (MedEx), or have a continuing physical disability that prevents you going out without help from another person and have a valid medical exemption certificate (MedEx) – our system checks the medicine on the prescription against the exempted condition. cancer, including the effects of cancer or the effects of current or previous cancer treatment a permanent fistula (for example, a laryngostomy, colostomy, ileostomy or some renal dialysis fistulas) requiring contious surgical dressing or an appliance a form of hypoadrenalism (for example, Addison’s disease) for which specific substitution therapy is essential diabetes insipidus or other forms of hypopituitarism diabetes mellitus, except where treatment is by diet alone hypoparathyroidism myasthenia gravis myxoedema (hypothyroidism requiring thyroid hormone replacement) epilepsy requiring continuous anticonvulsive therapy a continuing physical disability that means you cannot go out without the help of another person (temporary disabilities do not count, even if they last for several months) 3. Invalid Exemptions In the event, that the patient declares an exemption and the RTEC shows this to be invalid. Patients may submit hardcopy proof of exemption to the pharmacy for validation. Document(s) can be sent to the pharmacy for verification via the delivery driver and then later returned to the patient. The PMR system would then be updated to reflect that necessary check has been carried out and a note of when the next check is required should be entered onto the system. The Regulations require a patient to produce ‘satisfactory evidence’ to confirm exemption. Where appropriate (ie for deliveries made other than by the pharmacy’s delivery driver), the patient may scan or fax copies of the evidence to the pharmacy (or use the postal / courier service) and the pharmacy can note that the evidence provided was a facsimile.