Questions and answers for pharmacists
Pharmaceutical Schedule rules
PHARMAC determines if a brand switch fee will be applied to a brand change on the basis of specified criteria. The criteria include requirements that the medicine is used long-term by patients, there is a large patient group and there has been no recent brand change. It is only used if there is a need to support a difficult brand change.
When there is a brand switch fee available, pharmacists can claim one brand switch fee per patient. Pharmacists cannot claim a brand switch fee on a PSO or BSO.
The fee can be claimed at the first dispensing of the new brand after sole supply begins even if the brand was changed earlier.
Who can order medicines on a BSO?
A BSO is used to obtain bulk supplies for registered private hospitals.
For rest homes and other facilities that are not registered as hospitals, practitioners should use an individual prescription or PSO.
What medicines can be ordered on a BSO?
Any reasonable monthly quantity of any pharmaceutical, provided all requirements in the listing are met.
If the listing states ‘only on a prescription’, 'not on a BSO', has a Retail Pharmacy Specialist restriction, or the pharmaceutical requires a Special Authority, it is not funded on a BSO. The only exception to this is ivermectin which can be obtained on a BSO with a valid Special Authority for one patient.
Dietitians with a prescribing endorsement can prescribe Special Foods and approved nutrician-related medicines. Vitamin D (cholecalciferol) and Zinc sulphate (50 mg elemental) are the only prescription classed medicines that dietitians can prescribe.
Nurse Practitioners are authorised prescribers under the Medicines Act 1981. They can legally prescribe any prescription medicine relevant to their scope of practice. Nurse practitioners can apply for Special Authority where they meet the applicant criteria.
Registered Nurse Prescribers - can legally prescribe from a list of medicines determined by the Nursing Council. They cannot apply for Special Authority.
You can check on the Register of Nurses to see if a nurse is authorised to prescribe.
The medicine must be within the prescriber’s scope of practice and the prescription must be for the pregnant woman or her baby under the midwife’s care (eg contraception, NRT).
Who can order medicines on a PSO?
Any prescriber – including a dentist, midwife and others. See the definition of Prescriber in Section A: General Rules of the Pharmaceutical Schedule.
As for a prescription, the medicines ordered must be within the scope of practice of the prescriber.
What medicines can be ordered on a PSO?
Those medicines used for the purposes stated in Rule 1.3.2e. The products and quantities ordered must be within the limits specified in the individual product listing.
Designated rural practices can order any reasonable quantity of any product provided all requirements in the listing are met. If the listing states ‘only on a prescription’ or the pharmaceutical requires a Special Authority, it is not funded on a PSO.
How do I dispense antibiotics on a PSO for the Rheumatic Fever Prevention Programme?
Rule 1.3.4 allows practitioners to order multiple courses of antibiotics for their patients via PSO that are more than normally allowed on a PSO.
Special Authority (SA) applications are processed by Sector Services at the Ministry of Health. If approved, they then provide a SA number.
Sector Services phone: 0800 243 666 option 1.
When Original Pack (OP) is specified, the whole pack must be claimed for, even if only part of the pack is dispensed. Pharmacists should dispense in the smallest number of whole packs possible. If the pharmacist dispenses an amount smaller than a whole pack, the remainder of the pack is automatically claimed and must be discarded.
1.Hydrocortisone 1% cream. Prescription is for 100 g. Pharmacist could dispense 3 or 4, 30 g tubes or dispense 100 g from a 500 g pot, claiming 100 g only.
2. Prednisolone oral liquid. Prescription is for a total of 20 ml. The pharmacist may dispense 20 ml from the 30 ml bottle and discard the remainder. The remainder must be claimed, so cannot be used for another prescription.
Wastage may be claimed on a number of medicines including liquid antibiotics and s29 medicines. Note that for Cost Brand Source (CBS) or OP dispensings the whole pack can be claimed, so wastage does not apply.
Wastage is optional, but if claimed, the wastage quantity claimed must be discarded.
DHB hospital pharmacists may claim the unused portion of products labelled as PCT or PCT only.
We expect pharmacists to minimise wastage by:
- Claiming only when the unused portion is unlikely to be used.
- Dispensing a smaller quantity if:
- the difference is less than10%, and
- it won’t have a clinical effect on the treatment
- Using variable dispensing periods, see Rule 4.4.3
1. Antibiotic liquid:
- Prescribed 5 ml three times a day for 7 days, total 105 ml – dispense 100 ml, no wastage claimed.
- Prescribed 1 ml three times a day for 7 days, dispense 21 ml, claim remaining 79 ml.
2. S29 – solid dose form: Prescribed 1 tablet per day, pack size 100 tablets. Dispense 30 with two repeats. Can claim dispensings of 30, 30, and 40. For a chronic condition in a regular patient, consider claiming only the dispensed quantity, and not claiming wastage .
If wastage or OP does not apply, pharmacists can consider:
- dispensing a smaller quantity of whole packs
- variable dispensing periods, see Rule 4.4.3
No, they are not funded. Patients should discuss the need to test with their doctor. If a meter is needed, patients can pay for a meter at their pharmacy or contact the meter supplier, Pharmaco on 0800 glucose.
Only one meter per patient is funded per 5 years. If the patient loses the meter or it is damaged, a replacement is not funded. It may be covered by household insurance. If the meter is faulty, contact the supplier to ask for a replacement.
Eye preparations funded for use in eye. Exceptions are in the individual listing. The only current exceptions are:
- Chloramphenicol eye drops (Chloroptic) – for use in the ear
- Pilocarpine eye drops – for use orally
- Ciprofloxacin eye drops - for use in the ear, if endorsement criteria are met
If the prescription is written by or recommended by a Specialist (including VRGP) any quantity for any indication will be funded.
If written by another prescriber – must be one capsule prescribed and prescription endorsed (certified condition or patient’s condition) to be funded.
If the 250 mg tab clarithromycin is prescribed, we suggest pharmacists let the prescriber know the 500 mg tablet is funded.
Clarithromycin 500 mg tablets, up to a maximum of 14 tablets per prescription, are funded for the treatment of H. pylori when prescribed in combination with a proton pump inhibitor and either amoxicillin or metronidazole.
Insulin pump consumables – my patient is using more packs than usual
Patients can get funding for up to 13 packs only per year. Each pack should last one month. If patient is likely to use more than this, ask the prescriber to write to PHARMAC.
Insulin priming - My patient uses a small amount of insulin to prime the needle before each injection. Can I claim for this?
The priming quantity is not funded. The number of vials is calculated on the doses required over three months.
For questions around eligibility of patients or coding prescriptions, contact the Ministry of Health(external link).
Ministry of Health phone: 0800 855 151 option 2.
At the usual dose, one tube should last 3 months. One per month for hygiene reasons is not funded.
Varenicline tartrate – the Special Authority has expired and my patient has not accessed all 12 weeks of treatment?
If it is too soon for a renewal (less than 12 months from original application), we may consider granting further approval for the remainder of the 12 weeks. The applicant should contact PHARMAC to discuss.
- Inhaler quantity limits?
- Eye drops – number of drops per ml?
- Prescriptions for multiple patients (eg antifungals, lice and scabies treatments)?
This information and more is available in the DHB procedures manual(external link).
Why can the price of the medicine from my usual wholesaler be more than what I will be reimbursed once dispensed?
We have no control over what your wholesaler charges for an individual item. Contact your wholesaler to discuss.
Note that any additional charges to the patient must be in accordance with your CPSA contract.
Visit PHARMAConline for printed copies.
For a new pharmacy, or to change your address, call or email PHARMAC with the pharmacy’s details.
Last updated: 23 January 2020