MODULE 4 – IRELAND

Table of Contents

Module 4 – Introduction ................................................................................ 2

Objectives ........................................................................................................... 2

Suggested Time Allocation for Each Section......................................................... 3

Section 1 – The General Medical Services ............................................................ 4

Section 2 – GMS Prescriptions ............................................................................. 6

Section 3 – Repeat GMS Prescriptions................................................................ 17

Section 4 - Hospital Emergency Scheme ............................................................. 20

Section 5 – Stock Orders .................................................................................... 22

Section 6 – Dental Prescriptions ........................................................................ 25

Section 7 – Hardship Scheme ............................................................................. 27

Section 8 – Private Prescriptions ........................................................................ 29

Section 9 – The Drugs Payment Scheme (DPS) ................................................... 31

Section 12 – European Prescriptions .................................................................. 45

Section 13 – High Tech Medicines Scheme ......................................................... 47

Section 14 – Opioid Substitution Treatment Scheme ......................................... 51

Section 15 – Psychiatric Services Scheme ........................................................... 58

Section 16 – Stoma Appliances .......................................................................... 59

Section 17 – Incontinence Appliances ................................................................ 67

Section 18 – Reagent Strips ............................................................................... 69

Section 19 – Month’s End Procedures ................................................................ 73

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Module 4– Introduction

Welcome to Module 4. This module of the Pharmacy Technician Course NVQ Level 3 is an
account of the Medicine Schemes operating in Ireland. Before studying for this module on
the Medicine Schemes in Ireland please check that you have access to the following:
 List of items allowed on the GMS – This is usually accessible on the dispensary computer
database.
 PCRS List of Flat Rated Non-Drug Items Reimbursable under the GMS Scheme.
 A full list of all the medicines and aids that are allowed on the GMS can also be accessed
on the PCRS website under the “List of Reimbursable Items” tab.

Assessment of Module 4 will be through:

 Intertext questions which must be completed as you work through the module.
Remember, if in doubt, discuss the query with your pharmacist.

Multiple Choice Questions (MCQs) are completed at the end of the module under examination
conditions and the score reported back to your assessor on the marking form. After completing
the MCQs, the enclosed Short Answer Questions and Case Studies need to be undertaken
and the work submitted to your designed marker for assessing.

Objectives
When you have studied this Module you will be able to:
 Identify the roles and functions of the Primary Care Reimbursement Service (PCRS).
 Identify drug and non-drug items that are allowed for payment under the various
State Medicine Schemes by use of the GMS Codes and the IPU Product File on your
dispensary computer.
 Calculate payment entitlements under the various State Medicine Schemes.
 Identify patient eligibility to access a particular State Medicine Scheme.
 Ensure that you can carry out procedures to claim the relevant fees for exceptional
items.
 Be aware of the different types of stoma and incontinence appliances.
 Be able to carry out the end of month procedures to process GMS claims electronically
and manually.

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Suggested Time Allocation for Each Section
Section 1: The General Medical Services ¾ hour
Section 2: GMS Prescriptions 3½ hours
Section 3: Repeat GMS Prescriptions ¾ hour
Section 4: Hospital Emergency Scheme ½ hour
Section 5: Stock Orders ½ hour
Section 6: Dental Prescriptions ¾ hour
Section 7: Hardship Scheme ½ hour
Section 8: Private Prescriptions ½ hour
Section 9: The Drugs Payment Scheme 2 hours
Section 10: The Long Term Illness Scheme 1 hour
Section 11: Health Amendment Act ¾ hour
Section 12: European Prescriptions ½ hour
Section 13: High Tech Medicines Scheme 1¼ hour
Section 14: Opioid Substitution Treatment Scheme 1½ hours
Section 15: Psychiatric Services Scheme ¼ hour
Section 16: Stoma Appliances 1½ hours
Section 17: Incontinence Appliances ¼ hour
Section 18: Reagent Testing Strips 1 hour
Section 19: Month’s End Procedures 1 hour

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Section 1 – The General Medical Services
This section should take you approximately THREE
QUARTERS of an HOUR to complete.

Objectives

By the end of this section you should understand:

 What the GMS means;
 Who is eligible for GMS services;
 What the roles and functions of the PCRS are;
 What is meant by a GMS contract; and
 What information is contained in the GMS codes.

Introduction

If you have been working in a pharmacy for a while you will be familiar with the General
Medical Services, or GMS. The purpose of the GMS is to provide full pharmaceutical, medical
and surgical services free-of-charge to:
 Anyone who qualifies under the current entitlement rules. There is no fixed
income limit applied to this, but there are means test guidelines.
 Anyone over 70 years of age, who is eligible after a means test.

In order to qualify for services under the GMS a person has to apply to the PCRS, stating their
income from all sources.

The PCRS then decides on the application and those who are successful are issued with a medical
card. Medical card holders then choose a doctor from a list of GPs practising in their area. While
they must attend this GP, they are free to have their medicines dispensed in any pharmacy
which participates in the GMS scheme.

The Primary Care Reimbursement Service

The GMS is administered by a body called the Primary Care Reimbursement Service (PCRS),
which is based at Exit 5, M50, North Road, Finglas, Dublin 11. Its main function is to make
payments to pharmacists, doctors and dentists for services provided under the GMS scheme.
The PCRS is responsible for:
 Calculation of payments for these services;
 Making payments;
 Verification of the accuracy and reasonableness of claims; and
 Compilation of statistics and other information in relation to these services.

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The GMS contract

Any pharmacy which wishes to provide services to GMS patients must hold a GMS contract
(also known as a community pharmacy contract). These contracts are issued by the HSE. We will
not deal with the GMS contract in detail here. Instead we will examine how the GMS works,
and how the administrative and other procedures affect your work in the pharmacy.

GMS Codes

UNLESS AN ITEM HAS A GMS CODE IT WILL NOT BE PAID FOR BY THE PCRS

This means that when you get a GMS prescription you need to check whether all the items on it
are allowed. Any that aren’t can still be dispensed, but the pharmacy won’t be paid for them by
the PCRS.

If your pharmacy has a dispensary computer system, then all the GMS allowable items will be
indicated on the system as such, and their five digit GMS code will also be on the system.
Each month you must update your IPU Product File on your dispensary system. This is very
important, because as well as updating the prices on your computer, it also contains all of the
amendments to GMS coding.

Write down how you update the IPU Product File on your pharmacy’s computer?

Look at the list of products on your dispensary computer and write down the GMS code for:

Exocin Ophthalmic Solution 0.3% 5 ml

Diovan 80 mg Tablets 28 pack

Depo-Medrone Injection 40 mg/ml 1 ml injection

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Section 2 – GMS Prescriptions
This section should take you approximately THREE and a
HALF HOURS to complete.

Objectives

By the end of this section you should understand:

 What a GMS prescription form is, and what it looks like;
 How to check a GMS prescription to see it is properly written;
 What important medical card details need to appear on the prescription;
 What is meant by allowable GMS items, and how to check a prescription for these;
 How to ensure all the required details on a GMS prescription are completed;
 How to code GMS prescriptions, and how to deal with special cases like generics and
items for which restricted quantities or special approvals are required; and
 How to dispense and code GMS prescriptions where dispensing is afterhours, in a
number of phases, or where items are not dispensed.

Introduction

When a doctor wants to prescribe a medicine for one of their GMS patients they have to write
the prescription on a special GMS prescription form. An example of one of these prescriptions
is shown overleaf.

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7
Checking your GMS prescriptions

Let’s look a bit more closely at what you need to check on receiving the prescription.

1. Is the prescription properly written?

You always need to check that the prescription complies with all the legal requirements that
we looked at in module 3.

Go back to the section in Module 3 on prescription writing requirements. Take

a few minutes to look over these requirements again.

2. Does the patient have a medical card, and is the number entered on the prescription?
Whenever a new patient presents with a medical card prescription you should make sure to
take down their medical card number. Enter these on the patient’s PMR on your computer, so
that you will have them for reference purposes later on. The patient’s medical card number
needs to be on the prescription. If it isn’t, then the PCRS will not pay you for the prescription.
If the number is wrong you can either leave it as it is (the PCRS will pay you even if the prescriber
has entered the number incorrectly due to an agreement between the IPU and the PCRS called
‘the incomplete claims protocol’) or you can correct it yourself. But be careful – if you enter a
different GMS number and you happen to get it wrong, the PCRS will not pay you for the
prescription. If the number on the prescription is for a doctor visit card, the PCRS will also not
pay you for the prescription.

A patient’s medical card number can be checked on the PCRS pharmacy application suite by
entering the eligibility confirmation option. This allows you to input the patient’s medical card
number to check if it is valid. It also provides you with other information about the patient (e.g.
if they are exempt from prescription charges or if they have any special drug approvals). We
will discuss these later on in this module.

Finally, you might come across prescriptions with the letters STC written in the section for
medical card number. This means ‘special type consultation’. It means that the patient has not
yet been issued with their medical card, but has been accepted onto the GMS.

Write down the details of two places where you can check a patient’s GMS number if it is not on
the prescription or PMR:

1.

2.

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3. Are all the items on the prescription allowable on the GMS?

Later on in this section we will be looking in detail at what is and is not allowed on the
GMS. For the moment, you just need to be aware that some things are allowed, and
some are not. If the prescription contains items not allowed on the GMS, the patient could
either bring it back to their doctor to have something else prescribed, or they could elect to
pay for the prescribed item.

4. Are all the details on the prescription complete?

Sometimes the doctor might not enter some essential details like the dosage, quantity or
strength of the medicine to be supplied. If this happens you should try to contact the prescriber
and clarify the missing details. The pharmacist must then write on the prescription the
amended details supplied by the doctor, together with a note stating that the prescriber
was contacted to verify these details. The abbreviation ‘PC’ may be used for ‘prescriber
contacted’.

If the prescriber cannot be contacted then the pharmacist will have to use their own
professional judgement to dispense the prescription according as they see fit. They will have
to write on the prescription what they have done, along with a note saying that they tried to
contact the prescriber but were unable to do so. The abbreviation ‘pnc’ may be used for
‘prescriber not contacted’.

Coding your GMS prescriptions

Once you’ve dispensed the prescription, if you send your claims electronically you will have
selected the relevant GMS code for the item(s) that were dispensed and your dispensary
computer will have created a record of this to send electronically to the PCRS at the end of the
month. It is, therefore, important that you select the correct item and GMS code from the list
of products on your dispensary computer so that the PCRS pays the pharmacy correctly for
what they have dispensed to the patient. If you do not send your claims electronically, you
need to write the GMS codes and the quantities of the items dispensed onto the prescription.
This is referred to as manual claiming.

In most cases this is straightforward enough. Most medicines and appliances have their
own individual GMS codes, so you enter this along with the quantities of the items dispensed.

Each specific pack of each product or standard preparation has a unique five-figure code.
This code identifies the product or item dispensed. When claiming manually, quantities of less
than 10,000 computer units dispensed on a prescription, claim form or stock order form
MUST be indicated by the use of four digits. When the quantity supplied is less than 1,000
leading zeroes MUST be used, e.g. 0001, 0005, 0050, 0100.

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 Write down the GMS numbers for the following items:

Teveten 600 mg tablets 28 pack

Duphalac Liquid 300 ml
Flixotide Evohaler 250 mcg 120 dose
Depo Medrone Injection 40 mg/ml 1 ml injection
Xarelto Film Coated Tablets 20 mg 28 pack
Ask your pharmacist to check your answers.

There are some special cases where coding prescriptions isn’t quite so simple:

1. Uncoded Medications

There are some items which are allowed on the GMS but do not have GMS numbers. These are
mainly ostomy and urinary appliances. (We will be looking at these in a later section).

2. Extemporaneous Preparations

An extemporaneous preparation is one made up in the pharmacy. Doctors will occasionally

prescribe these, but they are far less common than they used to be. If you do come across a
prescription for an extemporaneous item then there are some special GMS rules to follow.

For extemporaneous dispensing of oral medication the GMS code is 99159. For
extemporaneous compounding and dispensing of powders the GMS code is 99160

For extemporaneous dispensing of ointments or creams the code is 99161.

A description of the preparation dispensed, including the quantity of each ingredient is also
required.

3. Interchangeable Medicines and Reference Pricing

The Health (Pricing and Supply of Medicinal Goods) Act 2013 introduced the concepts of
interchangeable medicines and reference pricing to the supply of medicines. The HPRA publishes
lists of interchangeable medicines; each list contains a group of medicinal products that all
contain the same drug in the same strength. If you receive a prescription for a medicinal product
that is on one of these lists you can substitute it for another medicinal product that is on the
same list as the medicinal product that was prescribed. All of the interchangeable lists can be
viewed on the HPRA website. The interchangeable lists typically contain a particular strength of
a branded medicinal product and all the generic versions that can be substituted for that
branded medicinal product.

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Once the HPRA has deemed a medicinal product to be interchangeable then the PCRS can set a
reference price for the medicinal products that are on the interchangeable list. The reference
price is the reimbursement price that the PCRS will pay the community pharmacy for supplying
any of the medicinal products that are on the interchangeable list. So regardless of the medicinal
product that you supplied from the interchangeable list, and how much it cost the community
pharmacy to purchase it, there is one reimbursement price (the reference price) that the PCRS
will pay the community pharmacy for supplying this medicinal product to patients. It is important,
therefore, that you ensure that the medicinal product that you supplied to the patient does not
cost more that the reference price.

When you are dispensing a medicinal product that has had a reference price set by the PCRS, they
require you to record how the doctor has prescribed that medicinal product by choosing one of
four options:
 INN prescribed – this is where the doctor has simply written the drug name on the
prescription e.g. atorvastatin 10mg.
 Branded generic prescribed – this is where the doctor writes a particular generic version
on the prescription e.g. Atorvas 10mg.
 Proprietary prescribed – this is where the doctor writes the original branded version of
the medicinal product on the prescription e.g. Lipitor 10mg.
 “Do not substitute” invoked – this is where the doctor writes “do not substitute” on the
prescription as they would like the patient to receive the original branded version of the
medicinal product e.g. Lipitor 10mg. In this case the patient will not have to pay the
extra cost for receiving the original branded version.

If the doctor has not written “do not substitute” on the prescription and the patient would like
to receive the original branded version of the medicinal product, then the patient will have to
pay the additional cost for receiving this.

4. Phased Dispensing

Sometimes a doctor will ask on the prescription to have a medicine dispensed in phases or
instalments e.g. dispense weekly. The PCRS will allow you a special phased dispensing fee for
this, and the fee will be paid for each phased dispensing necessary after the first dispensing of
the item. Phased dispensing will usually take place for the following reasons:

a. At the request of the patient’s doctor.

b. If the stability or shelf life of the medicine requires it, an example being a prescription
for Augmentin Paediatric Suspension, 5mls to be taken each day for a month. Reconstituted
Augmentin Paediatric has to be discarded after one week.

c. A small initial supply is to be dispensed to establish the patient’s tolerance to the medication
before commencing a full course of treatment.

d. The patient is not considered to be capable of safely and effectively managing their
medication. You might come across this where a doctor is treating someone who may be
dependent on benzodiazepines or other habit forming drugs.

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If you submit your GMS claims electronically you will select one of the reasons above and input
the number of phased dispensings into the computer. If you claim manually you must make sure
to endorse the prescription to show you have dispensed this item in phases. This is done by
entering the FULL QUANTITY DISPENSED against the GMS Drug Code, and on the line underneath
entering the appropriate phased code indicating HOW MANY ADDITIONAL PHASED DISPENSINGS
are being claimed.
The phased dispensing codes are:

a. At the doctor’s request 889_ _

b. Stability or shelf life of the medicine requires 888_ _
c. A small initial supply 887_ _
d. Patient safety 886_ _

Take a look at the following GMS prescription. The doctor has asked for the medicine to be
dispensed in four lots and it is coded as shown.

From 1 May 2017 any newly initiated phased dispensing for patients for reasons (a) and (d) (as
outlined above) must receive authorisation from the PCRS prior to dispensing in order to ensure
payment for the phased dispensing. An application for approval can be made through the PCRS
pharmacy application suite.

Late Dispensing
If the doctor marks the prescription URGENT and it is received and dispensed by the pharmacist
after hours then a late dispensing fee may be claimed. After hours means any time outside
the opening times of the pharmacy as stated on the pharmacy’s GMS contract. Remember
that you should have your opening times clearly posted in the pharmacy. The prescription should
be marked with the time and date of dispensing.

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The non-dispensing fee
In certain circumstances the pharmacist might decide that it is not in the best interests of
the patient to dispense an item indicated on their GMS prescription. If claims are submitted
electronically the non-dispensing code 79999 should be selected and the reason why the item
was not dispensed should be entered. If claiming manually the non-dispensing code should be
entered on the prescription and the quantity column left blank. A handwritten note explaining
why the item was not dispensed should also be included on the prescription.

Restricted quantity items

There are a number of items for which only a certain quantity is reimbursable under the
GMS, regardless of the quantity prescribed. These quantities are the maximum you will be
paid for, even if you dispense more.

Sildenafil / Tadalafil
The maximum reimbursable quantity of Sildenafil or Tadalafil tablets is four per patient per
month.

As of 1 April 2017 the PCRS will only reimburse pharmacists the reference price that has been
set for Sildenafil, and the reimbursement price for Tadalafil. If a patient requires the original
branded version and the GP writes “Do not substitute” on the prescription, pharmacists will only
be reimbursed the reference price as set by the PCRS.

Nicotine-Replacement Therapy (NRT)

The initial quantity of NRT prescribed for a patient is limited to a two-week supply, in order to
evaluate the effectiveness of the therapy. A month’s supply can be dispensed thereafter.
NRT may only be prescribed on a single GMS form. NRT prescribed on the repeat GMS form
will not be paid for.

The unlicensed medicines (ULMs) list

Unlicensed medicines (also known as exempt medicinal products) are medicines that do not
have a marketing authorisation in Ireland. They should only be prescribed when a licensed
product is not available and the prescription should be initiated by a consultant.

Previously, a medical card patient had to apply to their local health office to seek approval for
all ULMs to be dispensed under the Hardship Scheme (see section 7), but, in April 2010 the
HSE issued a list of ULMs that no longer required individual authorisation by the local area
health office when dispensing to medical card patients. These ULMs have been given a GMS
code. A revised list of ULMs was issued by the PCRS in August 2016 which was effective from 1
September 2016.

The ULMs on this list should be prescribed on a GMS prescription and the listed drug codes
selected on the computer, or entered on the GMS prescription (if claiming manually) when
dispensed. The pharmacy should keep a record in the patient’s PMR of the name of the
consultant who initiated the ULM and the hospital within which they work. A copy of the relevant
invoice should be attached to these prescriptions which should then be submitted in the normal
manner with your other GMS prescriptions to the PCRS at the end of the month.

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ULMs not on this list will still require approval by the local health office to be dispensed
under the Hardship Scheme (see section 7).

Ask your pharmacist to show you the ULMs list and write down the drug code for the six ULMs
listed below:

ULM Drug code

Anoheal cream 2% 30 g
Medrone tablets 4 mg 30 pack
Dalacin C solution 75 mg/5 ml 80ml
Tranxene capsules 5 mg 30 pack
Voltarol suppositories 25 mg 10 pack
Scopoderm TTS patches 1.5 mg 2 pack

Direct-Acting oral anticoagulant medicines (DOACs) e.g. Eliquis, Lixiana, Pradaxa,

Xarelto
Direct-acting oral anticoagulants can be prescribed for a number of different indications. They can
be prescribed after a patient has a knee or hip replacement, in which case they are taken by the
patient for a short period of time. In these circumstances the patient is not required to obtain
approval from the PCRS for the DOAC to be covered for the patient on their medical card.

A growing number of patients are now taking DOACs on a long-term basis for the treatment of
blood clots or an irregular heartbeat. In these circumstances the patient must first be approved
by the PCRS before they receive the DOAC if they would like to have it covered on their medical
card. The doctor who prescribed the DOAC is able to apply for this approval on the PCRS website.
To check if a patient has been approved, enter the patient’s medical card number into the
eligibility confirmation section of the pharmacy application suite; if they have been approved it
will be indicated at the bottom of the screen in the “Special Drug Approval” list.

Other medicines requiring authorisation

A number of other medicines and appliances require prior authorisation by the PCRS in order for
them to be covered on a patient’s medical card. These items include:
 Entresto Film Coated Tablets
 Versatis Medicated Plasters
 Abbot FreeStyle Libre Sensor
 Nadolol Tablets and Oral Suspension

The prescriber can apply for approval for these items for a patient through the PCRS website. To
check if a patient has been approved, enter the patient’s medical card number into the eligibility
confirmation section of the pharmacy application suite; if they have been approved it will be
indicated at the bottom of the screen in the “Special Drug Approval” list.

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Prescription charge
The prescription charge is a levy that a community pharmacy must collect from a medical card
patient when they are dispensed any item on a prescription written by a doctor, dentist or nurse.
The charge was introduced in October 2010. The charge must be collected from medical card
patients accessing medicines or appliances on any of the following schemes:
 GMS scheme;
 Hospital Emergency scheme;
 Dental Treatment Services scheme;
 European Economic Area scheme;
 Hardship scheme; and
 Patients receiving medication for the treatment of TB.

The current prescription charge is €2.00 per item up to a maximum of €20 per person or his or
her dependents (i.e. family) in any month. From January 2019, the prescription charge for medical
card patients over the age of 70 will be €1.50 per item.

Certain groups of patients are exempt from the prescription charge:

 Medical card patients living in direct provision; and
 Women who hold a. Redress for Women Resident in Certain Institutions Act 2015
Services Card

The exemption for both of the above groups can be checked by entering the patient’s medical
card number into the eligibility confirmation section of the HSE pharmacy application suite. If the
patient qualifies for one of the above exemptions it will appear in the ‘prescription charge status’
section at the bottom of the screen.

Third party verification

When a patient is dispensed items on a GMS prescription, the person receiving the items is
required to acknowledge receipt of these by signing the relevant section of the GMS prescription.
Where a person other than the named patient on the prescription is collecting the items, this
person should sign the prescription and the relationship of that person to the patient should be
recorded on the prescription.

Emergency Hormonal Contraception service

Female medical card holders can obtain Emergency Hormonal Contraception (EHC) directly from
their pharmacist, without a GP prescription, following a pharmacist delivered consultation. Two
products can be supplied under the EHC service:
 Prevenelle 1500 mcg tablet; and
 ellaOne 30 mg tablet.

The pharmacist is paid a consultation fee for exercising their professional judgement in respect of
the EHC. There are two separate GMS codes applicable to this service:
1. 79996 – when EHC is supplied to the patient.
2. 79997 – when EHC is not supplied to the patient.

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A unified claim form is submitted to the PCRS to claim for payment of this service. The pharmacy
contract number must be used as the doctor code. The patient must sign the unified claim form
to confirm that they have received the service. The pharmacist must also sign the unified claim
form and include their PSI registration number. The completed claim forms should be submitted
with the GMS prescriptions at the end of the month.

The EHC service is exempt from the prescription charge.

Compression hosiery products

Medical card patients are entitled to two pairs of compression hosiery per calendar year under
the GMS scheme. Compression hosiery products were allocated GMS codes effective from 1
January 2018. As a result, claims for payment for these products can be submitted to PCRS in a
similar manner to all other items allowed on the GMS scheme.

Registered nurse pescribers

Practice nurses who are registered nurse prescribers (RNPs) should use the GMS prescriptions
that their employer holds (i.e. the GP that they work for) in order to prescribe within the GP
practice setting. On completion of an application process community nurse/midwife prescribers
will be issued with primary care prescription forms and allocated their own GMS number by the
PCRS. Each primary care prescription form contains the original copy of the prescription and three
additional copies:

 Original – for presentation by the patient to the pharmacist;

 Copy 1 – for the pharmacist records;
 Copy 2 – for the GP records; and
 Copy 3 – for inclusion in the patients clinical notes maintained by the RNP.

RNPs issuing GMS prescriptions are only permitted to prescribe medicinal products on the List of
GMS Reimbursable Items. They must also include the patient’s medical card or eligibility number
(e.g. Long Term Illness number) on the prescription. RNPs should not use the repeat GMS
prescription form.

For the purposes of the various medicine schemes (e.g. medical card scheme, drugs payment
scheme etc.), the existing PCRS systems and processes for pharmacists apply when claiming for
prescriptions issued by RNPs.

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Section 3 – Repeat GMS Prescriptions
This section should take you approximately THREE
QUARTERS of an HOUR to complete.

Objectives

By the end of this section you should understand:

 What a repeat GMS prescription is;
 What a repeat GMS prescription looks like, when it is used, and what items can be
included on it; and
 How to dispense a repeat GMS prescription.

Introduction

A doctor may prescribe a maximum of three months’ treatment for a medical card patient on a
special repeat GMS prescription form, an example of which is shown on the next page.

The prescriber must write ‘repeat x 2’ on the top copy. The repeat GMS prescription form should
NOT be used for either CD2 or CD3 controlled drugs, nicotine replacement therapy products,
oral nutritional supplements or items which are only to be prescribed once.

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18
 Write down six examples of medicines that should not be prescribed on the
repeat GMS prescription form:

1.

2.

3.

4.

5.

6.

Dispensing the repeat GMS prescription

The repeat GMS prescription form is a six-part form, two parts to each dispensing. Each of the
instalments can be dispensed at any pharmacy.

When you have dispensed the first month’s instalment you keep the bottom two copies, stamp
the top copy and write the date of dispensing on it and return the remaining copies to the
patient. If you submit your claims manually, you then code the bottom two copies as you
would for an ordinary GMS prescription. The pharmacist must sign it in the appropriate place.
The patient must sign the relevant section each time they collect the items, as for the single
GMS prescriptions.

The same procedure applies on the second dispensing, where you keep the remaining
bottom two copies, and return the top two copies to the patient. These top two copies will be
used for the final dispensing.

At the month’s end all repeat GMS prescriptions need to be collected together, numbered
and submitted to the PCRS along with the single GMS prescriptions.

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Section 4 - Hospital Emergency Scheme
This section should take you approximately HALF an HOUR
to complete.

Objectives

By the end of this section you should understand:

 What a hospital emergency prescription is;
 Who can prescribe a hospital emergency prescription and for whom;
 How to dispense a hospital emergency prescription; and
 Special rules to be aware of when dispensing hospital emergency prescriptions.

Introduction

Where a medical card patient has been discharged from an Acute General Hospital or a
residential palliative care setting (hospice), or has attended the Accident and Emergency
Department (Casualty) of a General Hospital, they may have been issued with a prescription.
Hospital doctors are not part of the GMS, so this prescription would not be valid for
dispensing under the GMS scheme.

The patient can bring the prescription to their GP, who will then transfer the prescription
details onto a GMS form, which can then be dispensed.

Alternatively, the patient may have the hospital prescription dispensed under the terms of the
hospital emergency scheme. The prescription charge is payable by patients for items dispensed
under the hospital emergency scheme. These are outlined below.

Rules for dispensing

A pharmacist may dispense a MAXIMUM OF SEVEN DAYS SUPPLY as an emergency hospital

prescription under the GMS. The procedure for this is as follows:

1. The patient must have a valid medical card which you are required to make sure is in date
at the time of dispensing.

2. The prescription may only be dispensed on the day of issue, or in special circumstances
within 24 hours of issue (i.e. on the following day).

20
3. The hospital or hospice must be a participant in the hospital emergency scheme (The
PCRS has issued a list of all the participating hospitals and hospices; make sure you have this
list available in your pharmacy)

4. The pharmacist must complete a unified claim form, indicating the patient’s details and
the quantity and codes of all items dispensed.

5. A photocopy of the prescription is attached to the unified claim form. The original
prescription is returned to the patient or retained in the pharmacy as appropriate.

6. The doctor code is entered as 61559

7. The completed unified claim form is signed by the patient and submitted at the month’s end
to the PCRS.

Prescriptions obtained during an outpatient visit to a hospital are not valid for dispensing under
the hospital emergency scheme.

21
Section 5 – Stock Orders
This section should take you approximately HALF an HOUR
to complete.

Objectives

By the end of this section you should understand:

 When a doctor might use a stock order form;
 What the different type of stock order forms are, what they look like, and the
different things they are used for; and
 How to supply a stock order.

Type 1 – Dispensing doctor’s stock order form

In certain cases a doctor may dispense medicines for his own medical card patients. The
doctor gets his medicines from a pharmacy within his area of practice by using a Stock
Order (SO) form.

A sample SO form is shown on the next page. This is called a Type 1 or ‘White’ SO form. The
SO form is a four-part copy form. When the doctor has filled in the form he keeps the bottom
(fourth) copy for himself and submits the remaining three copies to the local HSE office. The
HSE then retains the third copy and forwards the remaining two copies to the pharmacy
nominated by the doctor. The pharmacy then supplies the items required to the doctor, and
the doctor signs the SO to verify he has received the items.

The pharmacy keeps the second copy and submits the original top copy to the PCRS for
payment. Only items supplied on or after the date on which the SO is received by the pharmacy
will be reimbursed by the PCRS.

Your pharmacy will be paid for Type 1 SO forms as follows:

 Ingredient cost + 20% mark-up + VAT if applicable.

22
Type 2 – Syringe/needle/dressing stock order form

You may have noticed that there are a variety of syringes, needles and dressings that have been
allocated GMS codes. These are referred to as flat rated non-drug items. This means that the
PCRS will only reimburse you at the stated reimbursement price, even if you have dispensed a
higher cost item. The PCRS updates the list of flat rated non-drug items allowable on the GMS
scheme from time to time. The syringes, needles and dressings are covered on the Type 2 SO
form.

You have to be careful that you dispense and code prescriptions and stock orders for
these Type 2 items correctly. Most of them will be flat-rated items. Dressings are not covered on
GMS prescriptions and are only allowed on Type 2 SO forms.

As well as prescribing these items for patients, doctors also keep stocks of them for use in their
surgeries. They obtain these by way of a Type 2 Syringe/Needle/Dressing Stock Order Form, a
sample of which is shown on the next page. This is sometimes called a ‘Pink’ SO form. The Pink
SO form is used to supply:

23
1. 2ml, 2.5ml, 5ml, and 10ml non-insulin disposable syringes, with or without needles.

2. Dressings for use in doctor’s surgery which are included in the list of dressings paid for by
the PCRS.

Your pharmacy will be paid for Type 2 SOs as follows:

 Ingredient cost + 0% mark-up + VAT if applicable.

24
Section 6 – Dental Prescriptions
This section should take you approximately HALF an HOUR
to complete.

Objectives

By the end of this section you should understand:

 What a DTSS prescription is;
 What a DTSS prescription looks like, when it is used, and what items can be included
on it; and
 How to dispense, code and claim for a DTSS prescription.

Introduction

There is a special section of the GMS called the Dental Treatment Services Scheme (DTSS).
Under the DTSS, medical card patients over the age of 16 are also entitled to free dental
treatment (once their dentist is participating in the DTSS). The dentist can prescribe medicines,
but only if they are included on the Dental Formulary. A special prescription form is used, and
a sample of this is shown on the next page. The patient can attend any pharmacy with a
GMS contract to have the DTSS prescription dispensed.

You can see from this that the DTSS prescription is very similar to the GMS prescription. In terms
of coding and completing the form the procedure is the same as for GMS forms. Even if your
pharmacy submits its claims electronically, you must write the GMS codes and the quantities of
the items dispensed on the DTSS prescription as these must be submitted manually.

25
A list of medicines that are covered under the DTSS can be found on the PCRS website.

Indicate with a tick which of the following medicines are allowed on the DTSS:
Voltarol Retard 75 mg tablets
Clonamox 250 mg capsules
Anxicalm 2 mg tablets
Distaclor 125 mg/5 ml suspension
Motilium 10 mg tablets
Flagyl S suspension
Keral 25 mg tablets
Tegretol Retard 200 mg tablets
Melfen 400 mg tablets
Zovirax cream 2 g
Augmentin Duo 400 mg/57 mg suspension 35ml
Hydrocortisyl 1% cream
Pethidine 50 mg/1 ml injection

26
Section 7 – Hardship Scheme
This section should take you approximately HALF an HOUR
to complete.

Objectives

By the end of this section you should understand:

 Who is entitled to avail of the hardship scheme and when; and
 How to dispense and claim payment for a prescription dispensed under the hardship
scheme.

Introduction

As you will be well aware now, there are certain items prescribed on a GMS prescription which
are not allowed under the GMS scheme. In certain instances a patient’s medical status might
require that he or she be prescribed a medicine which does not have a GMS code (a non-
reimbursable item).

If this happens the patient can apply to the local HSE office under the terms of the hardship
scheme to have the prescribed items dispensed free of charge. The pharmacy will be asked by
the HSE to complete a hardship scheme application form (HD1) indicating the cost of the
prescribed drug. If the HSE approves this application then the pharmacy is notified that the HSE
will cover the cost of the required medicines. These hardship scheme prescriptions should be
sent directly to the local HSE office for payment, along with a copy of the relevant invoice, a
signed unified claim form and a completed hardship scheme claim form (HD2).

Your pharmacy will be paid for hardship scheme claims as follows:

 Ingredient Cost + Dispensing Fee + VAT (if applicable)

27
 List three medicines that have been dispensed in your pharmacy under the Hardship
Scheme

1.

2.

3.

28
Section 8 – Private Prescriptions

This section should take you approximately HALF an HOUR

to complete.

Objectives

By the end of this section you should understand:

 What the difference between GMS and private prescriptions is;
 What types of private prescriptions there are; and
 How unified claim form works.

Introduction

We have already looked at the GMS scheme and how it works. You will remember that certain
people are entitled to treatment under the GMS scheme, i.e. those who qualify for a medical
card. For those not entitled to services under the GMS scheme there are a variety of
other schemes under which they might receive their medicines and other prescription items. For
convenience we will refer to all these schemes collectively as ‘private’. These schemes are:

 Drugs Payment Scheme;

 Long Term Illness Scheme; and
 Health Amendment Act Scheme.


29
Unified claim form
All the different private prescription schemes use the unified claim form. A sample of this is
shown below:

Any time you dispense something on one of the private prescription schemes you need to enter
all the details on one of these forms. This is usually automatically generated by the dispensary
computer system. After dispensing the patient signs the form to verify that they have received
the medicines indicated on the form.

A patient may not be eligible for the Long Term Illness Scheme or the Health Amendment Act
Scheme, and their monthly expenditure on prescription medicines may not exceed the Drugs
Payment Scheme threshold. In such cases the patient will simply pay the pharmacy for any
prescriptions that they have dispensed in the pharmacy. They will also receive a unified claim
form detailing the items that they have received from the pharmacy. This can be used to claim
tax relief from Revenue.

30
Section 9 – The Drugs Payment Scheme (DPS)
This section should take you approximately TWO HOURS to
complete.

Objectives

By the end of this section you should understand:

 What the DPS is;
 Who can apply for the DPS;
 How to register with the DPS;
 Special conditions to be met when applying for the DPS;
 How to dispense DPS prescriptions, and how to complete the DPS claim form;
 What items are allowed on the DPS;
 Special instructions regarding quantities to be dispensed on the DPS;
 How DPS payments are calculated;
 How to submit DPS claims; and
 Important dates for submission of DPS claims.
.
Introduction

The Drugs Payment Scheme (DPS) is open to anyone ordinarily resident in the State who is
not covered by the GMS or Long Term Illness schemes. It works as follows:

The family, which is the individual, his or her spouse or partner, and any dependents pays the
pharmacy up to the designated threshold per month for all prescribed medicines and
appliances. The pharmacy then claims payment for any excess above the threshold directly from
the PCRS. From January 2019 the designated threshold will be €124.00 per month.

‘Dependents’ include children under 18 and anyone between 18 and 23 who is in full time
education. It also includes anyone, regardless of age, with a physical or mental disability or a
mental handicap or illness who cannot maintain themselves fully, is ordinarily resident at the
family home and does not have a medical card.

31
At the moment the DPS requires that all medicines and appliances in respect of any one calendar
month must be dispensed from one pharmacy. If a prescription is obtained from another
pharmacy for the same month payment up to the designated threshold must also be made to
this pharmacy. However, the patient may claim back any excess payment above the designated
threshold by submitting their unified claim forms and a completed DPS refund claim form to the
PCRS.

Registering for the DPS

Anyone who wishes to register for the DPS must complete a DPS application form, which is
available from the HSE and from pharmacies. You can give these to patients who wish to
apply for the scheme.

The applicant needs to enter their:

 Name and address (all applicants within a family must live at the same address);
 The name of each person they wish to have included on the DPS; and
 The PPS number of each person they wish to have included on the DPS;
 The date of birth of each person they wish to have included on the DPS.

Notes on the application

The applicant needs the PPS number of each person they wish to have included in the scheme.
These may be located on payslips or on correspondence that has been received from Revenue.
They may also be obtained by contacting the local social welfare office.

The application form is then returned to the local HSE office and, in due course, the patient will
be issued with a DPS card showing their:
 Name;
 Date of birth;
 DPS number; and
 Expiry date of card.

Dispensing DPS prescriptions

Once someone presents you with a prescription and tells you that they are in the DPS scheme
you should ask for their DPS card. All DPS claims need to have the patient’s DPS number on
them, so be sure to note the DPS number in the patient’s PMR file, along with the expiry date.

32
You then dispense the prescription and complete the required details on the unified claim
form. Two copies of the claim form need to be made – one is given to the patient, the other
you keep and use to claim from the PCRS at the end of the month. The patient must sign the
unified claim form that is submitted to the PCRS. If someone is not registered for the DPS, but
wants to have a prescription dispensed you can get them to fill in the emergency application
form in the pharmacy (they MUST have their PPS number). You then send the top copy of
the emergency application form to the local HSE office and attach the bottom copy to the unified
claim form to send to PCRS at the end of the month.

Items allowed on the DPS

The following items are allowed for reimbursement on the DPS (note that they have to have
been prescribed for the patient):
 Any medicine or appliance which has a GMS code;
 Incontinence wear;
 Certain Dressings; and
 Certain unlicensed medicines (those listed on the ULMs list as previously described
under the GMS scheme).

The DPS operates on a calendar month system, and the patient must pay up to the designated
threshold amount for their prescribed drugs or appliances per month. You should make sure
to dispense an appropriate quantity of medicines, especially in the case of someone who is
on long-term repeat prescriptions. It is a condition of the DPS that no individual or family
grouping will pay more than €124 in a calendar month (i.e. €124 x 12 in a full year). The payment
of a second €124 (in the same pharmacy) should only arise when a person is intentionally
getting the following month’s supply on the grounds that they will be away the following month
or for other such reason. To ensure that an individual or family makes no more than 12
payments in a year it is suggested that, where appropriate, once in a 12-month period or
periodically throughout the year, more than a 28-day supply is given .

Suppose you are given a prescription for Lyrica 50mg capsules, one twice daily for three
months. The patient gives you his DPS card and asks if he can have all three months
dispensed together. What would you do?

33
Remember that the DPS operates on a monthly basis. The prescription is for one tablet twice
daily, so you’ll only be reimbursed for a maximum of 62 tablets in any one claim period. You
could dispense the whole three months, and submit one claim for each relevant month, but
you will have to ask the patient to pay for each of the three months.

Look at the sample prescription below. Assuming you dispense this prescription,
complete the required details on the unified claim form on the next page. You can
take it that this is your first form of the month, so your form number is 1. You can also
take it that the patient has a valid DPS card, his number is 1234567B A, and you’re
dispensing the prescription on the day it was written.

Dr Fergus
e e Co Kerry
064 123456

Manus O’Brien Today’s date

Ballymain
Co Kerry

Rx

Teveten 400mg tabs, one daily

Lipitor 40mg tabs, one daily
Nu-seals Aspirin 75mg tabs, one daily

Repeat x 5

Fergus Fitzgibbon MB

34
35
Dispensing unlicensed medicines under the DPS

As previously mentioned in section 2 there is a list of ULMs which can be dispensed

under the GMS. ULMs should only be prescribed and dispensed when a licensed alternative
is not available. ULMs on the ULMs list have a GMS code and can be dispensed under the DPS
in the same way as for the GMS scheme. Some ULMs without a GMS code may also be allowed
on the DPS. Before dispensing an ULM without a GMS code check with the PCRS that the item
will be covered by the scheme and attach a copy of the invoice for the medicine to the unified
claim form.

DPS payments and claims

Your pharmacy will be paid for dispensed DPS prescriptions as follows:

 Reimbursement price + Dispensing fee + VAT (if applicable)
The dispensing fee is inclusive of broken bulk and container allowance.

Look back at the DPS unified claim form you completed on the last page. Now, using
the reimbursement price from the IPU price list, the DPS dispensing fee and VAT of
0% for oral medicines, calculate the amount you would claim for each of these items,
and insert it in the far right hand column of the unified claim form above. (Hint –
remember that the PCRS have set a reference price for Lipitor 40mg).

Check your answer by processing this prescription through your computer, and printing out the
DPS unified claim form.

The same rules apply to the dispensing of DOACs, and Sildenafil and Tadalafil under the DPS as
were discussed previously under the GMS scheme (section 2). Nicotine-replacement therapy is
not covered under the DPS. As for the GMS Scheme prior authorisation by PCRS is required by
PCRS before the following items will be covered for a patient on the DPS:

 Entresto Film Coated Tablets;

 Versatis Medicated Plasters;
 Abbot FreeStyle Libre sensor; and
 Nadolol Tablets and Oral Suspension.

36
Dispensing extemporaneous products under the DPS

The PCRS supplies each pharmacy with a list of extemporaneous dispensing fees, and codes
for claiming extemporaneous products under the various medicine schemes.

Ask your pharmacist to show you this list and write down the codes for the following
extemporaneous products dispensed under the DPS:

1. 30 g of Hydrocortisone 1% Cream in Silcocks Base 50:50.

2. 300 g of Coal Tar 2% in Emulsifying Ointment.

3. 100 ml of Captopril 5 mg in 5 ml suspension.

4. 200 ml of Eltroxin 10 mg in 5ml suspension.

At the end of the month you have to collect all your DPS unified claim forms together, and
number them sequentially (if you have generated the unified claim forms using your computer
they’ll be automatically numbered for you). Check that each form is correctly completed,
and then separate them into two bundles, one bundle comprising of forms for which the
patient has not exceeded the designated threshold and another for those forms for which
the patient has exceeded the designated threshold. Remember to take into account all
qualifying family members and dependents when you’re working out whether a patient has
exceeded the threshold.

ULMs which do not have a code should be bundled together. These are known as DPS
exceptions (see section 19).

ONLY those forms in respect of patients (or families) which have EXCEEDED the designated
threshold should be submitted to the PCRS. The PCRS will then subtract this amount from the
total amount – remember that the patient has already paid this to you – and you will be paid
the rest. You will also receive a statement indicating what you have been paid for in respect
of each form, and also details of any claims which were rejected due to incomplete,
missing or invalid information. You need to check your statement carefully to ensure that the
correct payments have been made, and make sure to reply to the PCRS regarding any rejected
claims as quickly as possible.

Electronic claims should be submitted to the PCRS by the 3 rd working day of the month
following dispensing and the pharmacy will receive payment on the 21st or 22nd day of that
month. Manual claims should be submitted by the 7th day of the month following dispensing.

37
Exercises – DPS

1. What items, in addition to those drugs and appliances with GMS numbers are
allowed on the DPS?
2.

2. If you want to submit your claim to the PCRS electronically, when must it be in by?

3. Mrs Browne, a regular customer, tells you she wants to apply for the DPS and asks you
if the following members of her family would be eligible for inclusion. Would they?

(i) Her husband.

(ii) Her daughter, Patricia aged 22, who is a full-time student.

(iii) Her son, Matthew aged 19, who works full time.

38
Section 10 – The Long Term Illness Scheme (LTI)
This section should take you approximately ONE HOUR to
complete.

Objectives

By the end of this section you should understand:

 What the LTI scheme is;
 Who is entitled to services under the LTI scheme, and how they register; and
 The payment rates, claims procedure and submission dates for the LTI scheme.

Introduction

The Long Term Illness (LTI) Scheme is open to anyone who suffers from certain long-term chronic
illnesses or disabilities. These are:
 Diabetes Insipidus;
 Diabetes Mellitus;
 Cerebral Palsy;
 Cystic Fibrosis;
 Epilepsy;
 Haemophilia;
 Hydrocephalus;
 Spina Bifida;
 Acute Leukaemia;
 Multiple Sclerosis;
 Muscular Dystrophies;
 Parkinsonism;
 Phenylketonuria;
 Mental Handicap;
 Mental Illness in a person under 16; and
 Conditions arising from the use of Thalidomide

Patients registered with the LTI scheme can have any medication and appliance prescribed for
their condition dispensed to them free of charge. Any item dispensed on the LTI scheme is
exempt from the prescription charge. The PCRS has published core lists of medicines and
appliances that are allowed on the LTI scheme for each of the chronic illnesses and disabilities
covered by the scheme. They can be accessed on the HSE website.
Ask your pharmacist to show you these lists.

39
In the core list for patients with Diabetes Mellitus, medications for hypertension and
hypercholesterolaemia are included and so can be dispensed free of charge to these patients.
The items allowed under this provision include antihypertensives, diuretics, beta-blockers,
calcium channel blockers, agents acting on the renin-angiotensin system and serum lipid
reducing agents.

If patients registered for the LTI scheme also have a medical card, all the medications and
appliances that are covered on the LTI scheme should be dispensed to that patient under that
scheme. Any medications that are not covered on the LTI scheme should be prescribed for the
patient on a medical card prescription and dispensed under the GMS scheme. If patients
registered for the LTI scheme do not have a medical card they will have to pay for any
medications or appliances that are not covered on the LTI scheme. They may also register for
the DPS.

If a woman is diagnosed with gestational diabetes during pregnancy, this will not be covered
under the LTI scheme.

Give an example of a medicine allowed on the LTI scheme for patients with
Diabetes Mellitus from each of the following drug classes:

1. Antihypertensive

2. Diuretics

3. Beta-blockers

4. Calcium channel blockers

5. ACE inhibitors

6. Statins

Check your answers with your pharmacist.

40
Registering for the LTI

In order to register with the LTI the patient’s doctor must complete a LTI scheme application
form. Remember that to qualify for the scheme patients MUST be diagnosed as suffering from
one of the indicated long-term illnesses or disabilities. The patient is then issued with an LTI book,
showing their registered number. Once they are registered with the scheme patients can have
their medicines dispensed at any pharmacy, at any time. Eligibility for the LTI Scheme does not
depend on income or other circumstances and is separate from the medical card scheme and the
GP visit card scheme. Patients may be eligible for both a Medical Card / GP visit card and the LTI
scheme at the same time.

ULMs dispensed under the LTI Scheme

The procedure for dispensing ULMs, that the HSE have agreed to cover for the patient, is the
same as for the DPS. Look back at section 9. Any ULMs not on the ULMs list will not have a
GMS code. If you are submitting your claims manually these unified claim forms are
bundled together and claimed for under ‘LTI exceptions’.

Extemporaneous prescriptions

The procedure for dispensing extemporaneous prescriptions under the LTI scheme is the same
as for the DPS. Look back at section 9.

LTI payments and claims

The payment rates, claiming procedure, claim submission dates, payment dates and procedures
for dealing with rejected claims for the LTI scheme are the same as for the DPS. Have a quick
look back to see how this all works for the DPS.

Now have a look at the sample prescription below. Assuming the patient is registered
for the LTI scheme, what illness do you think they might be suffering from? Would all
the items on the prescription be allowed on the LTI scheme for this patient?

41
 DR. PHILIP P. DONNELLY,
SUITE 104, THE BLACKROCK CLINIC, CO. DUBLIN. TEL: (01)
1234567

Today’s date

Helen Jones
Port Rd, Letterkenny, Co. Donegal

Rx
Sinemet CR, sig 1 bd Parlodel

2.5 mg tabs,sig 1 tid Repeat x 5

Philip Donnelly MB

If this patient was prescribed a course of Amoxicillin 500 mg tds for 5 days, what scheme would
this be dispensed under?

Check your answers with your pharmacist.

42
Section 11 – Health Amendment Act (HAA)
This section should take you approximately THREE
QUARTERS of an HOUR to complete.

Objectives

By the end of this section you should understand:

 What the Health Amendment Act is;
 To whom it applies, and what services they are entitled to; and
 How to dispense, code and claim for a Health Amendment Act prescription.

Introduction

You may be aware of the Hepatitis C controversy where a number of people contracted Hepatitis
C from blood transfusions, the use of blood products and the use of Human Immunoglobulin
Anti-D. One of the outcomes of this was the passing in 1996 of the HAA. Anyone who is eligible
under the terms of the Act is entitled to certain health services – including prescription
medicines and appliances – without charge. Patients are provided with a Health (Amendment)
Act 1996 Services Card from the HSE. The card is valid for the lifetime of the patient.

Health Amendment Act payments and claims

Claims for items dispensed under the HAA should be made monthly, in a similar manner to the
DPS and LTI schemes. Claims are made via the unified claim form. The patient does not pay any
contribution to the cost of their medicines.

If a person with a HAA card is being prescribed High Tech medicines then these are dispensed
in accordance with the terms of the High Tech Medicinal Products Scheme.

Your pharmacy will be paid for dispensed HAA prescriptions as follows:

 Reimbursement price + Dispensing fee + VAT (if applicable) Claims can be made
electronically or manually.

You will also receive a statement from the PCRS indicating what you have been paid for in respect
of each unified claim form, and also details of any claims which were rejected due to incomplete,
missing or invalid information. Check your statement carefully to ensure that the correct
payments have been made, and make sure to reply to the PCRS regarding any rejected claims as
quickly as possible.
43
Exercise – Health Amendment Act

1. How long is a Health Amendment Act 1996 Services Card valid for?

2. By what date do you need to submit your Health Amendment Act claims to the
PCRS?

3. Only medicines for the treatment of Hepatitis C are allowed under the Health
Amendment Act – True or False?

4. How much must a patient with a Health Amendment Act 1996 Services Card pay
towards the cost of their medicines each month?

Check your answers with your pharmacist.

44
Section 12 – European Prescriptions

This section should take you approximately HALF an HOUR

to complete.

Objectives

By the end of this section you should understand:

 What types of European prescriptions you might encounter

 How to dispense, code and claim for these

Introduction

Special provisions exist for the supply of medicines to citizens of other European Economic Area
States. Prescriptions for these patients are written on the EU prescription form. This form is
issued in triplicate format. The top copy should be submitted to the PCRS by the pharmacist
upon dispensing to claim payment, the second copy is to be retained by the pharmacist for their
records and the third copy is retained by the GP for record purposes.

EEA prescriptions

European Health Insurance Cards (EHIC) have been issued to EU residents since the EHIC was
introduced on 1 June 2004. The card entitles all holders to easy access to necessary
healthcare in the public system of any EU (European Union) or EEA (European Economic Area)
country, or Switzerland, if they become ill or injured while on holiday or temporary stay in
that country.

Temporary visitors to Ireland from other European Economic Area States may receive
medicines prescribed on an EU prescription form free of charge once the prescribed medicines
are allowed on the GMS. The prescription charge should be collected for items dispensed under
this scheme. The doctor should enter the patient’s name and full address in their country of
origin, and their EHIC number in the space provided. In the case of UK residents their social
security number may be entered instead of their EHIC number.

The GMS drug codes and quantities dispensed for each medicine should be entered on the EU
prescription form because claims for this scheme must be submitted manually.
45
If a patient with an EHIC presents a hospital prescription, this should be dispensed under the EU
scheme following the same rules for the dispensing of prescriptions under the hospital
emergency scheme (see section 4).

At the month’s end, all dispensed EU scheme prescriptions should be collected together,
numbered and submitted by the 7th of the month following the month of dispensing.

You will be paid for prescriptions dispensed under the EU scheme as follows:

 Reimbursement price + Dispensing fee + VAT (if applicable)

46
Section 13 – High Tech Medicines Scheme

This section should take you approximately ONE AND A

QUARTER HOURS to complete.

Objectives

By the end of this section you should understand:

 What the High Tech Medicines Scheme is;
 To whom it applies, and what services they are entitled to;
 How to dispense, code and claim for a High Tech prescription; and
 The role of the High Tech Hub.

Introduction

Under the terms of the High Tech Medicines Scheme certain medicines from a list agreed
between the IPU and the HSE are supplied to patients directly through community pharmacies.

These include expensive medicines such as immunosuppressive drugs, certain fertility drugs,
cancer drugs and interferons. Ordinarily a consultant working in an Irish Hospital must initiate
treatment with a High Tech Medicine. If an EU prescription is presented for a High Tech
Medicine, a copy of the EU prescription and supporting GP prescription or letter from a GP based
in the Republic of Ireland and a letter seeking approval should be submitted to the High Tech
Hub for review.

In order to receive medication under the High Tech Medicines Scheme a patient must either
have a medical card, a DPS card or an LTI book. If the patient has an LTI book they can use their
LTI entitlement to receive the High Tech medication if that medication is included in the list of
medications that are allowable for that particular LTI condition.

47
 Write out a list of some of the medicines currently allowed on the High Tech Medicines
Scheme that have been dispensed in your pharmacy during the last year:

Check your answers with your pharmacist.

Dispensing medicines under the High Tech Medicines Scheme

A patient who is being treated with a High Tech medicine has to register with the HSE and
nominate the pharmacy from which they want to obtain their supplies. The pharmacy will
only be paid for dispensing the High Tech medicine if they are the patient’s nominated
pharmacy. You can check if your pharmacy is the patient’s nominated pharmacy by entering
the patient’s medical card, DPS or LTI number into the eligibility confirmation section of the
pharmacy application suite; if the patient is registered for the High-Tech scheme in your
pharmacy then the pharmacy’s five digit GMS code will appear in the nominated pharmacy
section. If the patient has a different nominated pharmacy you will have to complete a change
of pharmacy form and send this to the HSE.

When the patient wishes to have their prescription dispensed the pharmacy will order the
medicine and will receive a special delivery note upon receipt. Some High Tech medicines are
ordered from the PCRS High Tech Hub, some are ordered from the pharmaceutical
wholesalers, and some have to be ordered directly from the manufacturer, or their Irish agent.

48
 Go back to your list of the medicines currently allowed on the High Tech scheme and
write in beside each one the name of the supplier from which you would order it.

Check your answers with your pharmacist.

The pharmacist then completes a unified claim form in respect of the medicines dispensed, and
this is signed by the patient. The patient’s GMS, DPS or LTI number must be added to the unified
claim form. The claim form, along with the delivery note which must be signed by the
pharmacist, is then sent in at the end of the month to the PCRS.

High Tech Medicines Scheme payments and claims

Payment and claiming procedures for the High Tech Medicines Scheme are different than those
for the other schemes we’ve looked at so far.
The pharmacist still sends in a unified claim form for each dispensing. However, instead of
getting paid for the medicines they dispense, they are paid a patient care fee of €62.03. DPS
patients must pay the appropriate DPS monthly charge for each month’s supply of a High Tech
medicine.
The PCRS pays the patient care fee to the pharmacist and also pays the wholesaler directly for
the medicines supplied to the pharmacy.

The community pharmacy can claim the patient care fee for up to three months following the
month in which the High Tech Medicine was dispensed to the patient, even if no High Tech
medicine was dispensed, as they may still be providing care to the patient. In these circumstances
a reduced patient care fee of €31.02 is paid to the community pharmacy.

All High Tech claim forms, together with their delivery notes, should be bundled together and
sent to the PCRS to arrive not later than 5th of the month following the month in which the
medicines were dispensed.

49
PCRS High Tech Hub

All orders for High Tech medicines that are included in the PCRS High Tech Hub list must be placed
with the High Tech Hub. As of August 2018, all High Tech medicines for IVF and Pulmonary Arterial
Hypertension are now listed on the High Tech Hub. If a pharmacy wishes to order one of these
medicines to supply to a patient on foot of a High Tech prescription, they must place the order
for this medicine with the High Tech Hub.

Any High Tech medicine that is available for ordering through the High Tech Hub but ordered via
a separate mechanism is treated by PCRS as a private transaction and the pharmacy will be liable
for payment for the cost of the High Tech medicine. Further High Tech medicines will be added to
the High Tech Hub; pharmacies will be notified of updates to the list of High Tech medicines that
are available from the Hub as this occurs.

In order to place an order for a High Tech medicine through the High Tech Hub, the patient must
be registered for the High Tech Medicine Scheme, they must have a valid High Tech prescription
(the details of which have been entered into the High Tech Hub) and you must be the nominated
pharmacy for that patient.

Ask your pharmacist to show you the Pharmacy User Guide and the Pharmacy Frequently Asked
Questions for the High Tech Hub.

50
Section 14 – Opioid Substitution Treatment Scheme
This section should take you approximately ONE and a
HALF HOURS to complete.

Objectives

By the end of this section you should understand:

 What the Opioid Substitution Treatment Scheme is, how it works, who is eligible for
services and how they are admitted to the scheme;
 How the central treatment list and the opioid substitution treatment card operate;
 What an opioid substitution treatment prescription looks like and what it is used for;
 How to dispense from an opioid substitution treatment prescription and how to
endorse it after dispensing; and
 How to submit claims for opioid substitution treatment prescriptions.

Introduction

In Module 3 we looked at the opioid substitution treatment prescription form. We saw how it
was introduced as part of legislation to expand the range of products available for the
community based treatment (that is, from GPs and pharmacies) for opiate dependent patients.
We also looked in detail at how the law on prescribing, dispensing and recording controlled drugs
applies to the opioid substitution treatment prescription form. Now we will look at how to deal
with the administration and processing of these forms.

Take a look back at Module 3, Section 12 to familiarise yourself with the background information
on the community based opioid substitution treatment services scheme and opioid substitution
treatment prescription forms.

51
Prescribing and dispensing on the Opioid Substitution Treatment prescription
form

Before you dispense this form you need to check a couple of things.

1. Do you have the patient’s valid Opioid Substitution Treatment Card in your pharmacy?
Check to make sure it is in date.

You could make a note on the patient’s PMR of the expiry date, so that you would be
forewarned of its expiry and you’d have plenty of time to contact the patient’s doctor and
the Central Treatment List.

For any queries on Opioid Substitution Treatment cards, patient eligibility etc., it’s a
good idea to have useful contact names and telephone numbers to hand. Find out the
name and phone numbers of:

(a) The Drug Treatment Services liaison pharmacist for your area

(b) Your contact person in the Central Treatment List

2. Is the prescription properly written in accordance with the legal requirements for
controlled drug prescriptions?

Is the sample prescription on the next page properly written? If not, what is missing?

52
53
I’m sure you would agree that the prescription is written correctly in accordance with legal
requirements. We can now proceed with dispensing the prescription.

Firstly, look at it carefully to be sure you understand what the doctor has prescribed. It is a
prescription for Methadone 1 mg/1 ml solution, and the doctor has prescribed 45mls of this daily
for the patient. In this case the doctor has requested two supervised doses, on Monday and
Thursday, with the remainder of the doses given as take-aways. So you would be dispensing the
following:

Monday 6 March
One supervised dose of 45 ml and one take-away dose of 90 ml.

Thursday 9 March
One supervised dose of 45 ml and one take-away dose of 135 ml.

Endorsing the prescription

After dispensing Monday’s supervised and take-away doses, you need to enter the
appropriate details onto the prescription. You need to enter the date of dispensing; the
quantities dispensed and get the pharmacist to initial each entry. Look at the excerpt from the
sample prescription form below.

In the example we are looking at here we fill in two dispensings for the same day: the 45 ml
supervised dose that the patient would consume in the pharmacy and the 135 ml take-away
dispensing.

If this was a patient who came every day for a supervised dose, we would only be filling in
one dose per day. You continue on like this, filling in the dispensing details for each day,
until the last day of dispensing.
For our sample prescription the last day of dispensing happens to be the next day the patient
is due i.e. 9 March.

54
 Fill in the dispensing details for the last day’s dispensing on the excerpt of the
sample prescription form above.

Since this is the last dispensing there are other details which also need to be entered.

These are:
 Signature of patient, verifying that they have received the stated items;
 Signature of pharmacist, verifying that they have dispensed the stated items;
 Patient’s Opioid Substitution Treatment Card number;
 Drug code;
 Total quantity dispensed (in figures);
 Number of instalments;
 Number of supervised doses; and
 Pharmacy stamp in the appropriate section.

Fill in all the remaining details for the last day’s dispensing on the excerpt of the
sample prescription form above.

55
Let’s have a look at how the prescription form looks when it’s fully dispensed.

Don’t forget to enter the required details in the CD Register after the final dispensing.

Prescription forms for buprenorphine and buprenorphine/naloxone are completed in the exact
same way. If a patient is prescribed both strengths of Suboxone (2 mg/0.5 mg and 8 mg/2 mg),
a separate prescription form

56
Month end procedures

At the month’s end you need to collect all your dispensed Opioid Substitution Treatment
Prescription forms and go through the following procedures:

1. Check that each of them is correctly completed;

2. Number them in sequence;
3. Separate them into two bundles, one consisting of the original top copies, the other
consisting of the bottom copies;
4. Attach the top copies in numerical order with a treasury tag;
5. Complete a summary claim form, attach it to the top copies and send this bundle to the
HSE, PCRS, P.O. Box 6422, Exit 5 M50, North Rd, Finglas, Dublin 11, to arrive no later than
14 days after the last day of the month in which supply was completed;
6. File away the bottom copies and keep them for two years; and
7. You will receive an Opioid Substitution summary listing, together with the relevant
payment within two months of having submitted your forms. Check t h e details against
the copies you have on file, and report any discrepancies to the PCRS.

The payment for Opioid Substitution Treatment prescriptions is calculated as follows:

Ingredient cost As appropriate

+
Patient care fee Lower patient care fee (for up to 12 dispensings per month). Higher
patient care fee (for more than 12 dispensings per month).
+
MDA fee For dispensing a controlled drug.
+
Dispensing fee PCRS pays a dispensing fee for each individual dispensing.

57
Section 15 – Psychiatric Services Scheme
This section should take you approximately QUARTER
OF AN HOUR to complete.

Objectives

Patients attending public psychiatric clinics in the former Eastern Regional Health Authority used
to receive prescriptions from these clinics for their medication which they could then get
dispensed free of in any community pharmacy. The pharmacy claimed reimbursement directly
from the local HSE office. However, this scheme has ceased to operate and psychiatric patients
attending clinics in the former Eastern Regional Health Authority area must now bring their
prescriptions to their GP to be transferred to GMS prescriptions if they have a medical card.
Otherwise, they must pay for their medicines, and be included on the DPS if they are registered
for this.

58
Section 16 – Stoma Appliances
This section should take you approximately ONE and a
HALF HOURS to complete.

Objectives

By the end of this section you should understand:

 What is meant by terms like stoma and ostomy;
 what are the different types of ostomy;
 What kind of appliances and accessories are used in these conditions;
 What problems the stoma patient might encounter with these appliances and
accessories; and
 How to deal with prescriptions for ostomy appliances.

Introduction

There are three common types of stoma, but all are formed by bringing part of the digestive
tract (intestine) out to the surface of the abdomen and creating a new opening for the body
to rid itself of waste.

The three types all have different requirements. But in all cases the patient has to come to terms
with a considerable change in body image, and also cope with a body function that used to
be taken for granted but that now needs constant attention. Each type needs different
equipment. Common to all is the need for a bag to collect body waste and a means of attachment
to the body.

Colostomy

This is the most common ostomy, and is created by bringing part of the large intestine
(colon) to the surface of the abdomen. It is performed in patients who have a disease of the
bowel (for example, cancer of the colon).

Because the main function of the colon is to absorb liquid from the digested food contents as
they pass through, the faeces are usually reasonably solid when they are passed through this
type of stoma.

59
Most colostomies are permanent. Sometimes a temporary colostomy is formed, usually in cases
where the bowel needs to be rested to allow itself time to heal. In this case two parts of the
bowel are brought to the surface – the higher part active, and the lower part resting.

These are then rejoined at a later date and the patient resumes normal body activity. This
type of colostomy is often referred to as a loop colostomy or loop-ostomy.

Ileostomy

An ileostomy is formed by removing the entire colon and bringing part of the ileum (small
intestine) to the surface. It is often performed in patients with ulcerative colitis. Because the
food contents of the gut are fairly fluid as they pass through the small intestine, the waste is
liquid and continuous.

60
Urostomy

This differs from the other stoma in that the body waste involved is urine rather than faeces.

It is performed where a patient has bladder problems such cancer of the bladder. A small piece
of bowel is connected to the ureters (the tubes leading from the kidney to the bladder).

An opening is created in the abdomen and the piece of bowel acts as a channel from the ureters
to the outside of the abdomen.

Appliances

The bags (or pouches) needed for each type of stoma vary. This is because the effluent (waste)
differs in consistency according to the site of the stoma. Liquid or semi-liquid waste will require
a drainable pouch – one from which the waste can be drained from an opening in the bag
(closed during use by means of a clip or tap) while more solid waste necessitates a closed
pouch. The table below gives guidance on the types of bag used for each type of stoma.

61
Modern appliances are made from plastic and incorporate modern hypoallergenic adhesives and
skin protection barriers which are resistant to breakdown by intestinal contents or urine.

Today, the patient with a stoma can choose from a wide range of appliances. Initially the choice
of pouch is made in hospital. In the immediate post-operative periods, all patients use drainable
pouches. As the stoma settles down, the patient’s needs will change.

Bags fall into two categories:

One-piece products: These incorporate the seal and the bag in one item. The seal is the part
that sticks the appliance to the body. A one-piece product provides a slim profile.

Two-piece products: In this case the bag is attached to a separate seal (or flange) which is
attached to the body. The bag can therefore be changed without disturbing the skin. The flange
(seal) can be left in place for several days. Patients with sensitive skin benefit from using this
type of appliance.

Accessories

There are a wide range of accessories available for use with these appliances. These include
filters, deodorants, skin-care preparations, stoma caps, bag covers, barrier and protective
wipes, belts, barrier creams and preparations to even out skin folds (fillers).

62
Problems with ostomy products

Skin Irritation

Skin irritation can occur for a variety of reasons. The cause needs to be carefully assessed by a
stoma nurse or the doctor to determine the correct action to be taken.

Possible causes Possible corrective action

Irritant nature of effluent Better fitting pouch. If necessary, protective
powder, paste or skin barriers.
Frequent removal of pouch Check reason for frequent pouch change (e.g.
diarrhoea), consider use of two piece system.
Allergic reaction to adhesive Change to appliance with different adhesive.
Hair Keep shaved, use a skin barrier if infected

Leaking Appliances

A faulty appliance should be rare these days and leakage is more likely to be due to improper
fitting. Circumstances for the stoma patient may change and leakage may just mean that a
different appliance is needed. Patients may need to use a paste to fill and seal skin creases and
depressions. Leakage must be corrected as it can cause damage to the skin.

Ostomy prescriptions

We have looked at what ostomy appliances are, and what they are used for. Many of these
appliances will be prescribed for patients, and you might come across some of these
prescriptions in your pharmacy. Let’s see how you should deal with them.

Dispensing ostomy products under the GMS Scheme

The PCRS produces a document entitled ‘List of Reimbursable Non-Drug Items on the GMS
scheme’. We have seen already in sections 1 and 2 how the GMS scheme operates, and the
importance of coding items in accordance with PCRS requirements.

There is a section in this list on ostomy appliances, which is divided into two parts. The first part
lists the appliances by their classification, in accordance with categories similar to those we
studied earlier on in this section. The second part (which is really just the same list organised in
a different way) lists them in accordance with the names of their manufacturers.

You can also check if an ostomy appliance is allowed on the GMS scheme on the PCRS website
under the “List of Reimbursable Items” option.

63
If you get a GMS prescription for an ostomy appliance you should check in the ‘List of
Reimbursable Non-Drug Items on the GMS scheme’ or on the PCRS website to see if it is allowed.
Remember that the printed list is updated on a regular basis so if you are in any doubt, always
check first with either the IPU or the PCRS before dispensing.

Using the ‘List of Reimbursable non-Drug Items in the GMS scheme’ and the IPU
product on your computer, write down the GMS numbers for the following products
in the spaces provided.

No Product Manufacturer GMS No

1 Lockring 2 Baseplate 22-162 Biotrol

Lockring 2 Transparent drainage bag 22-475
2 Biotrol
Niltac Wipes TR102 420788
3 Convatec

4 Soft wire tie drainage pouch S205 Convatec

5 Urostomy Night Drainage Bag 5550 Hollister

6 Freshaire FA1 Salts

7 Adapt Barrier Ring 48mm 7805 Hollister

8 Nova 2 two piece Flange 1136-12 Dansac

Check your answers with your pharmacist.

When you are endorsing the prescription after dispensing if you claim manually, enter the code
number, and the number of items dispensed. You should supply packs unopened as
received from the supplier, for example for Hollister stoma bags packed in 30s, if 50 are
prescribed, 60 should be supplied and if 100 are prescribed, 90 should be supplied.

In certain cases the PCRS will reimburse you for an ostomy appliance, even if it is not in the
list of non-Drug items. If you’re submitting one of these claims you should contact the PCRS
who will advise you on how to code for the appliance, and attach a copy of the invoice.

Your pharmacy will be paid:

 Reimbursement price + dispensing fee

64
Dispensing ostomy products under the DPS Scheme

Ostomy prescriptions for DPS patients are dealt with in a similar way to GMS
prescriptions.

For ostomy supplies your pharmacy will be paid:

 Reimbursement price + dispensing fee

Dispensing ostomy products under the LTI Scheme

Ostomy products dispensed under the LTI scheme should be dealt with in a similar way
to the GMS scheme.

Your pharmacy will be paid:

 Reimbursement price + dispensing fee

Exercises – stoma appliances

1. Write down the three different types of stoma:

i)

ii)

iii)

65
 2. List three possible causes of skin irritation around a stoma:

i)

ii)

iii)

3. List three ways in which the skin irritation problems that you have listed above can
be remedied:

i)

ii)

iii)

4. List four ostomy products dispensed in your pharmacy:

i)

ii)

iii)

iv)

Check your answers with your pharmacist.

66
Section 17 – Incontinence Appliances
This section should take you approximately QUARTER
OF AN HOUR to complete.

Objectives

By the end of this section you should understand more about incontinence and its causes.

Introduction

Incontinence is defined as a situation which exists when someone voids urine or faeces
without control. In this module we will concentrate on urinary incontinence.

There are many causes of urinary incontinence. Some of the more common causes are
summarised in the table on the next page.

Managing incontinence

There is a wide range of appliances available for urinary incontinence. Most of these are
designed to contain loss of urine, thereby restoring personal dignity.

There are four main types of incontinence appliances available:

1. Absorbent pads, pants, bed covers, etc.;

2. External collectors (e.g. penile sheaths, drip collectors);
3. Invasive devices (e.g. in-dwelling catheters); and
4. Collection systems (e.g. body-worn urinal.)

67
68
Section 18 – Reagent Strips
This section should take you approximately ONE HOUR
to complete.

Objectives

By the end of this section you should understand:

 What is meant by the term reagent strip;
 What are the different types of reagent strips and what are they used for; and
 How to deal with prescriptions for reagent strips.

Introduction

Reagent strips are chemical based products which are used to indicate the presence of a
particular substance, for example, Copper Solution Reagent strip (Clinistix) are used to indicate
the presence of glucose in urine. Reagent strips can be used to diagnose and monitor diseases.

Have a look at the list of reagent strips in the ‘List of Reimbursable non-Drug Items on the GMS
scheme’. They are listed by type, and also by manufacturer.

Testing for glucose

Most of the prescriptions that you will receive for reagent strips are likely to be from diabetic
patients. Diabetic patients who are on insulin therapy can monitor their diabetic control by
making regular measurements of their blood glucose levels using a blood glucose meter
(glucometer). Patients are usually trained to use their blood glucose meter in the diabetic
clinic. Every blood glucose meter has its own specific reagent strip.

There are limits on the amount of test strips that can be dispensed to a patient in any given
month. These limits vary depending on the medication that the patient has been prescribed to
treat their diabetes e.g. a patient on metformin can receive up to 50 test strips per month
whereas there is no limit for a patient who is using insulin to treat their diabetes. Ask your
pharmacist to show you the PCRS circular on the limits on the amounts of test strips that
patients with diabetes can receive.

69
As mentioned in previous sections, prior authorisation by the PCRS is required for patients in
order to receive the Abbott FreeStyle Libre Sensor for monitoring their glucose levels. Glucose
can also be measured in the urine. Very few diabetic patients test for glucose in the urine as
blood glucose testing is more accurate.

What schemes would you expect to get prescriptions for reagent strips on?

List four types of blood glucose meter and the name of the testing strips used with
the:

Blood Glucose Meter Testing strip

Check your answers with your pharmacist

Testing for ketones

Occasionally, some diabetics use a test for ketones. The body will release ketones into the
bloodstream if there is not enough glucose to act as a fuel source and the body then has to
burn fat as a fuel. Ketones are released as the body burns fat.

Ketones are poisonous to the body and are excreted through the kidneys via the urine. The
presence of ketones in the urine is called KETONURIA. If the kidneys receive more ketones
than they can handle, the ketone level will build up in the bloodstream and can cause a serious
condition called KETOACIDOSIS which, if left untreated, can lead to coma and even death.
Patients who have a high ketone level should be advised to contact their GP or diabetic clinic
as soon as possible so that their insulin therapy can be reviewed.

In the exercise at the end of this section you’ll be asked to look up some information on ketone
tests. You should note that BLOOD KETONE STRIPS are ONLY reimbursable when prescribed
for patients with TYPE 1 DIABETES. Type 1 diabetics need insulin to treat their diabetes,
whereas type 2 diabetics can be treated with tablets.
70
Other reagent strips

There are several other reagent strips allowed on the GMS, and you might sometimes see
prescriptions for these. Some of them are listed in the table below.

Have a look in the dispensary and see if you have any of them in stock, and enter
the GMS codes in the section indicated below. If so, read the leaflet enclosed with
the test (if there is one It will explain how the test is used.
Test Brand name GMS No.

Detection of albumin and creatinine in urine Microalbustix Test Strips

Detection of leucocytes, nitrite, pH, glucose, Multistix 10 SG

ketones, bilirubin, blood nitrate, leucocytes
and specific gravity in urine
Test for protein and glucose in urine Uristix

You might find that customers ask for advice on the correct use of the various reagent tests.

All the manufacturers produce very informative product literature on their tests. See if you
can order a copy of some of these – it will provide valuable background information on the
tests.

Some reagent tests you might come across are not allowed on the GMS. These would tend to
be tests for pregnancy, ovulation, drug screening or helicobacter pylori. Have a look on the
dispensary shelves or in a suitable reference source (e.g. BNF/MIMS) for some of these.

71
Exercise – reagent strips

List 12 blood glucose testing strips allowed on the GMS and write down the appropriate GMS
code:

Glucose Testing Strip GMS Code

1.
2.
3.
4.
5.
6.
7.
8.
9.
10
11.
12.

There are a variety of different ketone tests allowed on the GMS. Using your Non-Drug list and
a suitable reference source, enter one example from each category, and include the GMS
code:

i) Urinalysis – Multiple Test Strips

ii) Urinalysis – Single Test Strips

iii) Blood Ketone Test Strips

72
Section 19 – Month’s End Procedures
This section should take you approximately ONE HOUR
to complete.

Objectives

By the end of this section you should understand how the various month’s end procedures
for your claims and paperwork operate.

Introduction

Throughout this module we have been referring to ‘Month’s End Procedures’. These are the
administrative procedures you carry out at the end of the month to ensure prompt and correct
payment from the PCRS for the prescriptions you’ve been dispensing all month. These month’s
end procedures are very important, so we’re going to look at them all together in one section.

It’s important to realise that just because these are called month’s end procedures that doesn’t
mean you leave them all until the very end of the month. You should be checking and
verifying your prescriptions as you go along, and allow yourself plenty of time at the end of
the month to make sure all the final administrative details are properly attended to.

There are two ways to submit your month’s end claims – electronically and manually.

Electronic claims

Throughout this module we’ve been looking at how the different prescription schemes
work, and we’ve looked in detail at how you code your dispensed prescriptions to show
the PCRS what you’ve dispensed.
This is important, as it shows you how the schemes work, and how the PCRS pays your
pharmacy for the items you have dispensed. If you are submitting your claims manually to the
PCRS you must code all of your claims as outlined for each of the prescription schemes.

However, most pharmacies send in their claims electronically, so you probably won’t be hand
(or manually) coding most of these prescriptions at all. Electronic claims are easier for you and
easier for the PCRS as well.

73
How electronic claiming works

When you get a prescription, you enter it into your computer and generate the medicine
labels. The computer stores this information, and also uses it to build up a patient medication
record (PMR), to generate a daily printout and generate a unified claim form. But it can also
group all the information together in a claim file so you can transmit it to the PCRS. The PCRS
computer then analyses all this information, and uses it to work out what you should be paid.

What schemes can be claimed electronically

The following schemes can be submitted electronically:

 Single month GMS;
 Repeat GMS;
 Hospital Emergency
 DPS;
 LTI
 Stock Orders;
 High Tech; and
 Health Amendment Act.

Special coding instructions for electronic claims – GMS, DPS AND LTI

Earlier in the module we looked at the GMS codes that should be used for extemporaneous
products and ULMs. Some ULMs and other products that are allowed on the DPS/LTI/Health
Amendment Act schemes do not have a GMS code. They must be given a code if you are
submitting your claims electronically:

Item Fee and VAT Details Electronic code

Ostomy/Urinary 1 x fee 0% VAT 77770

Ostomy/Urinary 1 x fee 21% VAT 77771

ULMs (not on ULM list) 1 x fee 0% VAT 77750

ULMs (not on ULM list) 1 x fee 21% VAT 77751

The above codes are not valid on the GMS scheme. If you submit your claims manually then
these claims would be included in the exception items (all claims under than fully coded) for
each of the schemes.

74
Verifying electronic claims

Before any electronic claims can be transmitted to the PCRS all the information in the claim
files must be checked. This process of checking is called verification. Your computer system will
sort all your dispensed prescriptions into the various scheme categories (GMS, GMS Repeat,
DPS etc.). It will then list the prescriptions in numerical order, and tell you the code and quantity
for each item dispensed. You have to check that all details on this list are correct, and once
you are satisfied that this is so, you lock the information. This is what is meant by verifying the
prescription.

The different computer systems have slightly different ways for storing,
sorting and verifying prescription details. Get a copy of the user’s manual
for your system and read up the section on verifying and claims procedures.

You should verify your prescriptions all through the month, every few days, as you don’t
want to have to start in to this task with hundreds of prescriptions at the end of the month.

Once all your prescription details for each of the schemes have been verified you can transmit
the details to the PCRS.

Paperwork

Earlier in the module we looked in detail at submission procedures for the various scheme types.
Basically, regardless of the scheme, you need to:
 Check all the prescriptions and claim forms are fully and correctly completed
(including that they are hand coded if you submit your claims manually);
 Check all the required extra information (photocopies of invoices, prescriptions etc.)
are included;
 Divide the prescriptions and claim forms into the different scheme types and
number them; and
 Complete a summary form, attach it to the claim bundles and forward to the PCRS.

Even if you are submitting your claims electronically you also have to send in the original
prescriptions and claim forms as well.

GMS, DTSS and Stock Orders

Collect together and number all your GMS Prescriptions, Hospital Emergency Prescriptions,
DTSS Prescriptions and Stock Orders. Number them (so that the numbers match the numbers
that they are identified by on your computer verification) and fill in the details on the summary
form as shown here.

75
76
Note that GMS exception includes the Hospital Emergency Scheme. If you are sending your claim
electronically you shouldn’t have any exceptions other than the Hospital Emergency Scheme.

Make sure each separate category is tagged together in the same bundle.
The pharmacist must sign the claim form. Keep a copy of the summary claim form and
enclose the rest with the prescriptions and claim forms in the special yellow bag provided by the
PCRS.

LTI, HAA and EEA claims

Collect together and number all your LTI and HAA claims, and EEA prescriptions and claims.
Number them (so that the numbers match the numbers that they are identified by on your
computer verification) and fill in the details on the summary form as shown on the next page.
Note that exception claims are those which are not fully coded; these only arise for manual
claims.

Make sure each separate category is tagged together in the same bundle.

Keep a copy of the summary claim form and enclose the rest with the prescriptions and claim
forms in the special yellow bag provided by the PCRS.

77
78
High Tech claims

Collect together and number all your High Tech claims and delivery dockets. Number them
(so that the numbers match the numbers that they are identified by on your computer
verification) and fill in the details on the summary form as shown below. Keep a copy of the
summary claim form and enclose the rest with the claim forms.

79
DPS claims
Collect together and number all your DPS claims. Number them (so that the numbers match the
numbers that they are identified by on your computer verification) and fill in the details on the
summary form as shown on the next page. Note that exception claims are those which are not
fully coded; these only arise for manual claims.

Make sure each separate category is tagged together in the same bundle.

Keep a copy of the summary claim form and enclose the rest with the prescriptions and claim
forms in the special yellow bag provided by the PCRS.

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Opioid substitution treatment claims

Collect together and number all of your opioid substitution treatment prescriptions. Number
them and fill in the details on the summary form as shown below.

Keep a copy of the summary claim form and enclose the rest with the claim forms and
post them to the PCRS.

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Hardship Scheme

You should have sent off any hardship scheme claims directly to the local HSE office during the
course of the month.

Submission deadlines

Earlier in the module we looked in detail at submission deadlines for the various schemes. Now
let’s pull them all together, so you can be sure to have all your paperwork submitted on
time.

Early payment
If you wish to avail of the early payment option you must submit your claims by the end of the
3rd working day of the following month. The pharmacy will then be paid by the 21 st or 22nd of
the month.

Regular payment

If you don’t wish to avail of the early payment option you must submit your claims by the end
of the 7th day of the following month. You will then be paid within seven weeks.

Manual claims are paid this way.

Regardless of whether you submit your claims electronically or manually the relevant paperwork
must be received by the PCRS by the 5th day of the following month.

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