Endorsing is the process by which dispensers tell the Prescription Pricing Division (PPD) what they have used to fulfil a prescription. It details exactly what was dispensed against what was prescribed. This process enables the PPD to provide the practice with accurate reimbursement and remuneration.
To the uninitiated, endorsement can be a minefield of 'do's and don'ts' but the principles are simple if you approach them logically and once learned, they soon become second nature.
What to endorse
Although many clinical systems endorse the prescription at the time of printing, it is vital that all dispensers know how to endorse, as you cannot rely on the computerised prescription. Handwritten prescriptions (and power cuts) are still common and need to be endorsed in the same way as other prescriptions.
The first category of endorsing need is easy to understand: if any dispensed item, whether generic or branded, has more than one pack size listed in the Drug Tariff, an endorsement of the pack size used is needed.
The important thing here is that although more than one size may exist, if the Drug Tariff only lists one there is no need to endorse.
It only takes a few minutes to go through Parts VII and Part VIII of the Drug Tariff to produce a list of those practice-prescribed drugs which have more than one pack size. There are some surprises, for example, amoxicillin 250mg does not need endorsing but amoxicillin 500mg does. This list can be laminated and placed on the wall in the dispensary as an aide-memoire.
The second category is for those modified-release drugs which are prescribed generically but dispensed as a brand, for example diclofenac 75mg SR. Because there are large numbers of brands available, at a huge range of prices, the PPD will not guess which brand you have used.
If the prescription is not endorsed with this information, it will be returned to the practice for clarification. This means that payment for that prescription will be delayed by at least one month and possibly longer.
Some modified-release products are beginning to appear in the Drug Tariff, for example, isosorbide mononitrate 60mg modified release tablets. This means that if your prescription is not endorsed, the PPD will pay the stated price without returning the prescription. You may be using a brand that costs more than the price stated and will lose on the transaction.
The recomendation is always that any drug used for treating cardiac conditions should be prescribed by brand to ensure continuity of dosage, and many practices brand all their modified release preparations.
In April 2006, the PPD announced a major change: in accordance with this, if a drug is listed generically in Part VIII of the Drug Tariff (for example, lisinopril) but a brand is being dispensed (in this case Zestril), the prescription must read: Zestril. An endorsement to this effect is not sufficient and only the cost of the generic drug will be reimbursed. Prescriptions have to be checked carefully to ensure that changes are made where necessary, to avoid loss of income.
Drugs not listed in the Drug Tariff
If a drug is not listed in the Drug Tariff, for example, testosterone implants, the prescription must be endorsed with the brand and the cost price. This also applies when a special order has been obtained. By definition, the price will be specific to that one prescription - the PPD no longer require copies of the invoice for that item, but will now also pay the postage for obtaining the item, if it is endorsed.
To avoid confusion, all dressings should be prescribed by brand and only endorsed if there are two pack sizes. Check how surgical lines appear in Part IX of the Drug Tariff and ensure that the item is prescribed this way.
Many inexperienced dispensers ask why they cannot endorse everything. The answer is that, once electronic scanning of prescriptions is introduced at the PPD, any forms that have endorsements on them will need to be looked at manually and could slow the reimbursement process down. It is important to hone the skill of enough endorsing, but not too much.
It is equally important to endorse prescriptions at the time of dispensing. Spot-checking an inexperienced dispenser's endorsing at the end of the month is one thing, doing it for them is another. Efficient endorsing will help protect dispensing income and must be viewed as an integral part of the dispensing process.
- Annette Arthur is a consultant for dispensing practices