Reimbursed medicines lists accounting system for public

contributors

Warsaw

October 2007

Basic duties of a pharmacy

Regulation of the Minister of Health of 18 October 2002 on basic conditions for running a pharmacy. (Dz. U. of 2002 No 187, item 1565)

§ 10. 1. In particular, a pharmacy keeps a documentation of:

1) purchase of medicinal products and medical devices, in accordance with separate regulations;

2) sale of medicinal products and medical devices, in accordance with separate regulations;

Prescriptions storage period

§ 24. Regulation of the Minister of Health of 17 May 2007 on medicinal prescriptions (Dz. U. of 2007 No 97, item 646)

1. Prescriptions shall be stored in a pharmacy in an organised way, grouped according to the date of dispensing a prescription, as well as – according to an entity obliged for reimbursement.

2. For the purpose of The Main Pharmaceutical Inspectorate or the National Health Fund controls, prescriptions shall be stored for 5 years, counting from the end of the year they were dispensed.

Reimbursed drugs lists accounting procedure

A pharmacy receives reimbursement of a medicine or medical device issued to a beneficiary for free or on the basis of partial payment after submitting the following documents, no more frequently than every two weeks, to the entity obliged to finance health care benefits from public funds: - overall lists of dispensed prescriptions subject to reimbursement and - information containing data on the reimbursed medicines and medical devices turnover, resulting from dispensed prescriptions subject to reimbursement from the National Health Fund, transferred in a form of electronic messages,

art. 63 of the Act of 27 August 2004 on health care benefits financed from public funds

Lists of dispensed prescriptions subject to reimbursement

Overall lists of prescriptions for medicines and medical devices subject to reimbursement shall be submitted by a pharmacy to entities obliged to finance benefits from public funds at the seat of competent Voivodeship department of the National Health Fund, or through the post, in a written form, or on a data carrier which allows saving and reading the information in a digital way, with the information saved on the carrier, or through temporary data teletransmission,

Regulation of the Minister of Health of 28 September 2004 on the ways and deadlines for submitting overall lists of dispensed prescriptions subject to reimbursement, as well as a model list of

prescriptions subject to reimbursement by pharmacies to the entities obliged to finance benefits from public funds

Overall lists of prescriptions for medicines and medical devices subject to reimbursement shall be submitted by a pharmacy twice a month, observing the following deadlines:

1) For the period between 1 and 15 of a given month – no later than five working days after the settlement period conclusion;

2) For the period after 16 till the end of the month – no later than five working days after the settlement period conclusion.

Lists submission deadlines

Pharmacies shall collect information containing data on the reimbursed medicines and medical devices turnover, resulting from dispensed prescriptions subject to reimbursement from the National Health Fund and the national budget.

These data shall be collected and stored in electronic form.

Information containing data on the reimbursed medicines and medical devices turnover (electronic message)

Regulation of the Minister of Health of 28 September 2004 on the scope of necessary information collected and transferred by pharmacies to the entities obliged to finance benefits from public funds

Pharmacies shall transfer data resulting from dispensed prescriptions subject to reimbursement from the National Health Fund to the Voivodeship department of the National Health Fund, competent on account of the pharmacy location.

Data resulting from dispensed prescriptions subject to reimbursement shall be transferred in a form of electronic messages.

A form of data transfer

Construction of a message has been specified in the Annex to the Regulation of 28 September 2004 on the scope of necessary information collected and transferred by pharmacies to the entities obliged to finance benefits from public funds

Contents and construction of a message

1) registration of the fact of sending an electronic message at a pharmacy; 2) transferring information through a delivery on a carrier which allows reading the information in an electronic way or through message teletransmission, 3) registration of the fact of receiving the electronic message transferred by a pharmacy; 4) confirming the fact of receiving the message or the reason for rejecting the message.

Stages of transferring a message

Confirmation of message transfer

Confirmation of receiving an electronic message is transferred to a pharmacy which sent a message, alongside with a date of reception or rejection.

Errors and irregularities in a message

Errors or other irregularities concerning some prescriptions found in a message, among the data on reimbursed medicines and medical devices turnover, cannot determine the rejection of data on the turnover concerning other prescriptions which have been transferred in this message in a correct form.

Data on the reimbursed medicines and medical devices turnover resulting from dispensed prescriptions subject to reimbursement from the National Health Fund and national budget shall be submitted by a pharmacy (in a form of electronic messages) twice a month, observing the following deadlines:1) For the period between 1 and 15 of a given month – no later than five working days after the settlement period conclusion;2) For the period after 16 till the end of the month – no later

than five working days after the settlement period conclusion.

Message transfer deadlines

Analysis of lists and messages, as a condition for reimbursement. Analysis deadline.

After the analysis of overall lists of prescriptions and data included in electronic messages by a pharmacy, no later than 15 days since receiving the list, an entity obliged to finance health care benefits from public funds carries out reimbursement.

In the case of not meeting the aforementioned deadline by the entity obliged to finance benefits from public funds, pharmacies are entitled to statutory interest.

Errors in transferred information and their impact on reimbursement date

In the case of not transferring, or transferring at variance with the Act, the information included in particular prescriptions for reimbursed medicines and medical devices, information necessary to process data by NFZ and information containing data on the reimbursed medicines and medical devices turnover resulting from dispensed prescriptions subject to reimbursement from the National Health Fund (message),  

a reimbursement date may be extended until a pharmacy transfers complete data.

NFZ control competences and pharmacy duties related to control

In particular, a pharmacy is obliged to:- make the documentation, which a pharmacy is

obliged to keep under separate regulations, available to be controlled by pharmaceutical supervision authorities or under their order;

- send the information included in the contents of particular dispensed prescriptions for reimbursed medicines and medical devices to an entity referred to in (2).

art. 62 of the Act of 27 August 2004 on health care benefits financed from public funds

Pharmacies are obliged to make prescriptions available to be controlled by the entity obliged to finance benefits from public funds and transfer necessary information containing data on the reimbursed medicines and medical devices turnover resulting from dispensed prescriptions subject to reimbursement from the National Health Fund and national budget

art. 189 of the Act of 27 August 2004 on health care benefits financed from public funds

A pharmacy manager or a person authorised by the manager in a written form, makes prescriptions available to be controlled in an organised way, arranged according to the dates they were dispensed and grouped according to the entity obliged to reimburse.

Entities authorised to control may appeal for making prescriptions and documentation containing information with their estimation available for inspection 30 days from the date they were dispensed, at the earliest, and for no longer than 30 days

For the purposes of inspections, prescriptions are made available to inspection by a pharmacy for 5 years, counting from the end of the year they were dispensed.

§ 1 of the Regulation of the Minister of Health of 28 September 2004 on the mode of making prescriptions dispensed by beneficiaries and related information available to an entity obliged to finance benefits form public funds

Prescription for reimbursed medicines and medical devices dispensing inspection includes examining the regularity of actions of persons giving out medicines, including:- regularity of dispensing and estimating prescriptions;- regularity of the amount of medicines given out, including the size of packaging given out;- observing the prescription dispensing deadlines.

§ 26 of the Regulation of the Minister of Health of 17 May 2007 on medicinal prescriptions

The scope of prescription dispensing inspections

Post-inspection recommendations

If, as a result of an inspection, irregularities concerning the issuing and dispensing prescriptions have been found, the Fund gives post-inspection recommendations, obliging the inspected entity to inform about undertaken actions concerning post-inspection recommendations within 14 days.

Thank You for Your attention!