Out of Pocket Expenses Scrutiny

Published: Tue, 11/06/18

Dear PharmaPlus Member,

It has come to our attention that the NHSBSA are placing additional scrutiny over out of pocket (OOP) expenses and some pharmacies have been investigated for their Out of Pocket (OOP) expense claims. It is important to understand when we are able to make a ‘justified’ claim.

Out of Pocket expense claims are only valid if:

1. Made only ‘in exceptional circumstances’

2. Made only where the drug is ‘not required to be frequently supplied by the contractor’

3. The contractor has ‘taken all reasonable steps to avoid claiming’

If NHS England deem the OOP expenses to not be valid they can:

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1. Issue a breach notice as there was a breach of the terms of service that is not capable of remedy

2. Recover OOP expenses claimed inappropriately as overpayments

For more information please see information on the PSNC Website.

Regards,

PharmaPlus

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