Questions and answers for pharmacists
Here are answers to some of the questions you ask us.
On this page
Why is Methylphenidate ER – Teva not listed with the other extended release formulations?
We widened access to the Methylphenidate ER – Teva in October 2020. It can now be used as a first line treatment for ADHD, the same as the immediate and sustained release formulations. We’ve put these together in the Schedule because prescribers must use the same Special Authority form to apply for access to these medicines.
Other extended release formulations (Concerta or Ritalin LA) can only be used as a second line treatment. They require a different Special Authority form, so we’ve kept them separate.
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).
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 855 066
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.
- 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.
- 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 than 10%, and
- it won’t have a clinical effect on the treatment
- Using variable dispensing periods, see Rule 4.4.3
- 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.
- 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 458 267 (or 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.
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, the prescriber will need to apply for a special authority waiver.
Insulin priming - My patient uses a small amount of insulin to prime the needle before each injection. Can I claim for this?
If priming is included in the prescription, you can dispense it. In general, this would not be more than 2 units per dose.
For questions around eligibility of patients or coding prescriptions, contact the Ministry of Health(external link).
Ministry of Health phone: 0800 855 066.
At the usual dose, one tube should last 3 months. One per month for hygiene reasons is not funded.
- 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 Community Pharmacy Service Agreement (CPSA).
Visit PHARMAConline for printed copies.