GMS Scheme Non-Dispensing Fee Claims

Pharmacists may claim a non-dispense fee where in their professional judgement it is not appropriate to dispense an item to a patient.

When claiming a non-dispensing fee, the reason for claiming should be recorded clearly (some vendor systems will have a built in feature for this). In this instance, PCRS will pay these claims. However, a non-dispensing fee claim will be rejected if the same reason is repeatedly cited without a GP contact or if the rationale provided is deemed to be insufficient in demonstrating professional judgment.

Details of the non-dispensing fee is set out in the 1996 CPC Agreement and is quoted as follows:
‘Fee for not dispensing medicines which the pharmacist in his professional judgment considers to be in the patients interest not to dispense the medicine concerned….community pharmacist be paid the appropriate dispensing fee for exercising professional judgment in such instances, subject to satisfactory evidence being supplied to support claims for payment’.

A non-dispensing fee can be claimed multiple times. In instances where an item is being claimed for a non-dispensing fee repeatedly over several months for a patient, the prescriber should be notified to bring to their attention the unnecessary prescribed items. However, it should be noted that if claiming greater than three consecutive months, substantiating evidence must be provided that the prescriber was contacted, and the item is intended to be recommenced. Where a patient has been discontinued a medication, a non-dispensing fee must not be claimed. Future claims may be rejected without evidence as set out in the contract.

HSE PCRS Circular 020/19 describes situations where claiming a non-dispensing fee is not considered acceptable and do not reasonably demonstrate that professional judgment was exercised.

The following examples are of where a non-dispense fee could be claimed:

• The patient has sufficient supply until the following month e.g. original pack dispensing of 28 and 30 pack size;
• Medication not dispensed following pharmacist consultation;
• Identification and prevention of adverse drug reactions e.g. Atorvastatin with Clarithromycin; and
• Prevention of an unintended accumulation of medicines surplus to patient’s needs.