[Nov 06]
SPECIAL AUTHORITY TIPS
From Pharmacy Guild;
DISPENSARY TOPICS Volume 9 Number 9....... September 2000
Special Authorities
Where you receive a prescription for a medicine that requires a special authority and the prescriber has signalled that the special authority number is pending:
Check with HPac if the special authority application has been received and if it is likely the application will be successful. If this is confirmed dispense the prescription adding the special authority when it is available.
If HPac can not confirm that an application has been received you will need to contact the prescriber, delay supply of the medicine or charge
DISPENSARY TOPICS Volume 12 Number 6....... June 2003
FREQUENTLY ASKED QUESTIONS
Q1. What do I do if I receive a prescription with a Special Authority number?
If the Special Authority has been annotated on the prescription by the prescriber you should:
* Check the expiry date given to ensure that it is still current
* Check that it follows the appropriate format (5 - 7 numbers)
* Check the patient's Special Authority approval letter if it is available.
* Dispense the Medication
* Submit a claim.
ProClaim will validate this Special Authority number prior to payment by reference to the HealthPAC Special Authority database. If the number can be found on the database, is still current and is being used for the designated medicine the item will be reimbursed.
Q2. What should I do if the Special Authority number cannot be validated by HealthPAC?
If it cannot be validated the claim for this item will be rejected. There will be two reasons if the Special Authority number was annotated on the prescription by the prescriber. The first action should be to ascertain how the error has occurred. Is it your error or does the error lie with the information provided?
Pharmacist error
If on data entry the Special Authority number is not entered correctly the claim will be rejected. You will still hold the original prescription, the item will need to be edited to include the correct number and resent.
Prescriber Error
The problem here can be ascertained by reference to the prescriber, the HealthPAC number (0800 243 666) or the patient.
If the patient has a valid Special Authority and the information has not been written on the prescription correctly, e.g. it is a problem with transposition of numbers, the claim for the item can be edited to include the right number and resent.
If an application has been submitted, you will need to wait for the approval in order to ascertain the correct Special Authority number to use. (This will be possible as the authority is valid from the date of application.)
If the problem can not be corrected (e.g. HealthPAC has never had an application for a Special Authority for the patient or the Special Authority number on the prescription has expired) you will need to contact HealthPAC on 0800 243 666, and advise that the correct procedures listed above have been followed, but a correct number has not been available. HealthPAC will provide a temporary Special Authority number.
You will edit the claim to add this temporary number and resend the item. You will then be reimbursed for the medication dispensed.
Q3. What do I do if I am presented with a prescription without a Special Authority number?
If you are presented with a prescription without a Special Authority number and the item requires one there are some options open to you:
* You can contact the prescriber, the patient or HealthPAC on 0800 243 666. If a Special Authority application has been made successfully and the appropriate information (e.g. number and expiry dates) is available you can add this to the claim and be reimbursed accordingly.
* If there is to be a delay in your being able to obtain the information (e.g. an application is pending, no application has been received, you are unable to contact anyone to ascertain the correct information) you can:
* Delay supply of the medication until the appropriate documentation can be sourced if you are comfortable that the patient can wait; or
* Supply the medicine at the patient's cost; or
* Supply the medication as an "ethical supply" because in your professional judgment the patient will be at serious risk without the pharmaceutical. In this situation you should, if possible, follow the steps already outlined to obtain the correct Special Authority number before sending in your claim.
If this cannot be done you will need to contact HealthPAC at 0800 243 666 for a temporary Special Authority number to enable reimbursement to be effected.
Note:
HealthPAC will approve a temporary Special Authority number to cover "ethical supply" only in the following circumstances:
* The prescriber could not be contacted.
* The prescription was presented during hours that the HealthPAC 0800 number was not operational.
* The patient was at serious risk without the medication, such as a life threatening condition or imminent hospitalisation. Examples of where this would apply are an hyperglycaemic event when appropriate insulin is not available, or a risk of kidney graft rejection without immediate availability of immunosuppressants.
"Ethical supply" does not cover medicines where it is unlikely there would be a serious deterioration in the patient's condition due to a delay in receiving the medicine, such as a prescription for a statin. We do not expect "ethical supply" under Special Authority to be a frequent occurrence. It is designed as a last resort to protect patients at risk.
Temporary numbers issued to cover prescriber error or the ethical supply situations will remain valid for the life of the prescription.
It is important with the administration of Special Authority numbers that any additions or changes made by you are initialed by you on the prescription (hard copy), and dated and timed. By doing this in an audit situation it is obvious for which information you are taking responsibility.
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