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Sodium Chloride/Normal Saline Nasal drops??

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  • Sodium Chloride/Normal Saline Nasal drops??

    Please can a community pharmacist advise me?

    A community pharmacist has requested that our GPs prescribe 'Normal Saline nasal drops' rather than 'Sodium Chloride 0.9% nasal drops' - he says that he won't get re-embursed for the latter by the PPA.

    I have no idea if he is correct - I can't find either in the Drug Tariff.

    Happy to change our formulary if necessary but would appreciate confirmation that his facts are correct!

    Thanks.

  • #2
    Re: Sodium Chloride/Normal Saline Nasal drops??

    Originally posted by Scamp View Post
    Please can a community pharmacist advise me?

    A community pharmacist has requested that our GPs prescribe 'Normal Saline nasal drops' rather than 'Sodium Chloride 0.9% nasal drops' - he says that he won't get re-embursed for the latter by the PPA.

    I have no idea if he is correct - I can't find either in the Drug Tariff.

    Happy to change our formulary if necessary but would appreciate confirmation that his facts are correct!

    Thanks.
    No. They aren't.
    NASAL DROPS - SODIUM CHLORIDE 0.9% are listed in the Drug Tarif as an appliance in part IXA - it depends only on how the pharmacist chooses to label and endorse the script.

    There are unfortunately inconsistencies between GP and pharmacy systems - your pharmacists "pick-list" probably historically defaults to a brand that isn't listed in the drug tarif (only five manufacturers are) and the only way round it that he has found is to label as normal saline nose drops which defaults to an allowed manufacturer.
    Editing the "pick list" on pharmacy PMR systems is a PITA for end users. He'll need to phone tech support to get it sorted when he has an hour or two to spare - and tech support isn't busy fixing non- functioning systems.

    Jeff

    Jeff

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    • #3
      Re: Sodium Chloride/Normal Saline Nasal drops??

      Thanks.

      It's a while since I worked in the community so I have no idea about these things anymore!

      Comment


      • #4
        Re: Sodium Chloride/Normal Saline Nasal drops??

        Here's what the PSNC says on the matter:
        "Normal Saline Nasal Drops/Sodium Chloride Nose Drops are not listed in Part VIII of the Drug Tariff so contractors must endorse prescriptions for this product with information on what has been dispensed to ensure correct payment.

        There are currently two options available to contractors dispensing this product:

        1. Sodium Chloride 0.9% Solution (Part VIII, Category E Product). If the product is dispensed extemporaneously, pharmacies can endorse and claim an extemporaneous dispensing fee. Payment is based on the Part VIII Price.

        2. Dispense a product listed in Part IXA of the Drug Tariff. A number of manufacturers of Normal Saline Nasal Drops have registered their products as medical devices. We are currently unaware of any Sodium Chloride Nasal Drops that are licensed as medicinal products. The nasal drops that can be dispensed can be found in Part IXA of the Drug Tariff under the heading ‘Nasal Drops – Sodium Chloride 0.9%’

        Contractors should endorse the name of the manufacturer (not the supplier) on the prescription. If the prescription is endorsed with the manufacturer of a normal saline nasal drops 0.9% product not listed in the Drug Tariff, a copy of the prescription will be returned to the contractor marked disallowed."

        (Extract from Welcome to PSNC- Speaking for Community Pharmacy )
        Ze genuine Article, present & perfect!

        Comment


        • #5
          Re: Sodium Chloride/Normal Saline Nasal drops??

          After several returned scripts, we now endorse 'tubilux' as this seems to be generally available.
          johnep

          Comment


          • #6
            Re: Sodium Chloride/Normal Saline Nasal drops??

            Originally posted by johnep View Post
            After several returned scripts, we now endorse 'tubilux' as this seems to be generally available.
            johnep
            That's right.
            If there is more than one brand listed then you need to endorse the brand dispensed.
            If there's only one listed no endorsing - as paid by default.

            If it helps anyone new...

            Drugs are automatically allowed, unless blacklisted.
            Dressings/Appliances/Reagents/devices are only allowed if listed in the tariff. (Part IX)
            (sometimes the tariff lists a specific brand in part IX, any other is not allowed)
            Some things that you might think are drugs are actually appliances because they are licenced through the medical devices licensing rather than drugs. You can spot these as they have the "CE" mark on them.

            Similar for Scotland I think, but the tariff sections are numbered differently.

            Advice to anyone new - have a read of the NPA guides to the drug tariff and the tariff itself. Yes, it is boring, but the devil is in the detail. You run the risk of not being paid correctly, or dispensing products that are more expensive than reimbursement.

            By the way, can anyone explain why 'branded generics' are being recommended by PCTs, instead of standard generic prescribing?
            47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
            2018 AD : Modern Man : I shopped, I clicked, I collected.
            How times change.

            If you find you have read something that has upset or offended you an anyway please unread it at once.

            Comment


            • #7
              Re: Sodium Chloride/Normal Saline Nasal drops??

              Originally posted by Pharmanaut View Post
              That's right.

              Advice to anyone new - have a read of the NPA guides to the drug tariff and the tariff itself. Yes, it is boring, but the devil is in the detail. You run the risk of not being paid correctly, or dispensing products that are more expensive than reimbursement.

              By the way, can anyone explain why 'branded generics' are being recommended by PCTs, instead of standard generic prescribing?
              Anyone who went to Portsmouth until recently had the benefit of being lectured to on the subject by Ian Jones; a man who made understanding the Drug Tariff his life's work!

              Branded generics may be being recommended by a few PCT's for several reasons:

              They are getting prescribing advice support from the company, or have done some similar deal.

              They don't have adequate (or any) pharmaceutical advice and the Finance Dept has been persuaded that X's "generics" are of standard quality and "much better" than the "rubbish" some pharmacists use.

              It's a tie-up with the branded generic company's long acting formulation.

              Comment


              • #8
                Re: Sodium Chloride/Normal Saline Nasal drops??

                Well dispensing Drs used to use ashbourne because they were promoted to them as being cheaper than originals and of course there were 'kick backs'.
                Branded generics are taking advantage of DT prices being higher than purchase prices so they can say will save money. usually only a short term gain. But once on pts record----.
                johnep

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                • #9
                  Re: Sodium Chloride/Normal Saline Nasal drops??

                  Originally posted by the old merlin View Post
                  Anyone who went to Portsmouth until recently had the benefit of being lectured to on the subject by Ian Jones; a man who made understanding the Drug Tariff his life's work!

                  Branded generics may be being recommended by a few PCT's for several reasons:

                  They are getting prescribing advice support from the company, or have done some similar deal.

                  They don't have adequate (or any) pharmaceutical advice and the Finance Dept has been persuaded that X's "generics" are of standard quality and "much better" than the "rubbish" some pharmacists use.

                  It's a tie-up with the branded generic company's long acting formulation.
                  Ian Jones was at Bradford before he moved to Portsmouth.
                  Had Geoff Booth and Ian Jones as lecturers - quite a double act with a lot of dry and wry humour. If I remember correctly he gave us a flow chart of how DT payments worked.
                  47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
                  2018 AD : Modern Man : I shopped, I clicked, I collected.
                  How times change.

                  If you find you have read something that has upset or offended you an anyway please unread it at once.

                  Comment


                  • #10
                    Re: Sodium Chloride/Normal Saline Nasal drops??

                    Re. Branded Generics

                    I know that Discovery (makers of Oxactin, Simvador et al) targetted the finance depts of PCTs directly to push switches to their brands for cost savings to the PCT.

                    Luckily I have never worked for a PCT who has fallen for this! I think it was mainly PCTs with small MM teams and red bank balances that were persuaded to do mass switches.

                    Comment


                    • #11
                      Re: Sodium Chloride/Normal Saline Nasal drops??

                      The PCT i work in fell for this 3 years ago. You wouldn't believe the amount of Lopace(ramipril), Simvador(simvastatin), Felotens(Felodipine) etc. we get through!!!

                      Comment


                      • #12
                        Re: Sodium Chloride/Normal Saline Nasal drops??

                        Scamp is right.

                        It's several years ago now, but just before I left the Head of Finance in the PCT I was working for came to me. He and his team had been to a "jolly" celebrating some anniversary of the auditors and there had been either a presentation or a stand from one of these BG firms.

                        Why, he wanted to know, was I not promoting the use of BG's. I pointed out the problems, and then went on to ask whether or not he considered it appropriate for his team to go to such a function!

                        Never heard what became of it, but I do know that the BG's never went any further.

                        Theoretically, of course, the idea could be sound, if it didn't entirely counter to the principles principles behind the pharmacy contract.

                        Comment


                        • #13
                          Re: Sodium Chloride/Normal Saline Nasal drops??

                          Originally posted by the old merlin View Post
                          Scamp is right.

                          It's several years ago now, but just before I left the Head of Finance in the PCT I was working for came to me. He and his team had been to a "jolly" celebrating some anniversary of the auditors and there had been either a presentation or a stand from one of these BG firms.

                          Why, he wanted to know, was I not promoting the use of BG's. I pointed out the problems, and then went on to ask whether or not he considered it appropriate for his team to go to such a function!

                          Never heard what became of it, but I do know that the BG's never went any further.

                          Theoretically, of course, the idea could be sound, if it didn't entirely counter to the principles principles behind the pharmacy contract.
                          Could someone summarise the problems associated with Branded Generics?

                          An interesting thought...
                          It would be nice if we pharmacists could set up their own BG company with a couple of high-volume SR/XL products, get them promoted into PCTs. We then benefit from the prescribing policy as shareholders and if you are a contractor, you beat the tariff.

                          Wonder what the start up costs are. Assuming that you can contract the manufacturing and packing to one of the generics companies etc. We could go on 'dragons den' with the idea!
                          47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
                          2018 AD : Modern Man : I shopped, I clicked, I collected.
                          How times change.

                          If you find you have read something that has upset or offended you an anyway please unread it at once.

                          Comment


                          • #14
                            Re: Sodium Chloride/Normal Saline Nasal drops??

                            Problems include (I'm sure there are more though!).......

                            Contradicts advice to prescribers to prescribe by generic name.

                            Supply problems - I don't think Discovery deal with all wholesalers, so causes problems for pharmacies.

                            Availability issue for patients - many pharmacies won't stock the branded generic so it limits the ease at which they can access their meds.

                            It's very short-sighted - who knows what's round the corner? (an even cheaper BG from another company; the DT price is reduced to reflect the price of the cheapest BG).

                            P*sses off doctors & patients.

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