BRIGHTON & HOVE NICOTINE REPLACEMENT THERAPY (NRT) VOUCHER SCHEME
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1 BRIGHTON & HOVE NICOTINE REPLACEMENT THERAPY (NRT) VOUCHER SCHEME A voucher scheme is commonly used instead of, or sometimes as well as, GP prescriptions (FP10) and PGDs. The Brighton & Hove nicotine replacement therapy (NRT) e-voucher scheme follows the protocols outlined in the Standard Operating Procedure for use of Nicotine Replacement Therapy (NRT) to ensure patient safety comes first. This e-voucher scheme is open only to participating pharmacies that are contracted by Brighton and Hove City Council to provide stop smoking services in Brighton & Hove. Please note that this scheme does NOT apply to varenicline (Champix) & buproprion (Zyban) both are Prescription Only Medicines (POMs). What is the NRT E-voucher scheme? All NRT products are classified as General Sales List products. They can therefore be supplied directly from pharmacies or other licensed premises without a prescription. The e-voucher is normally issued by a stop smoking advisor who assesses suitability of clients attending the local stop smoking service. This allows the client to access stop smoking medications at prescription costs instead of the recommended retail price. The NRT is issued by a pharmacist. The aim of the e-voucher scheme is to enable clients to easily access NRT when attending a stop smoking programme at the reduced cost of a prescription only. Brighton and Hove City Council s standard operating procedures for use of Nicotine Replacement Therapy should be followed and adhered to at all times to assure patient safety. How does the e-voucher scheme work? Under the scheme, a trained stop smoking advisor recommends the supply of NRT using an e- voucher that is issued to a pharmacy participating under the scheme of the client s choice. The participating pharmacy must be signed up the Brighton & Hove City Council s locally commissioned services for smoking cessation. Product selection is based on a discussion between the client and the advisor, the range available and consideration of potential contra-indications. The pharmacist makes the final decision as to whether NRT can be dispensed to the client (or in rare circumstances can recommend an alternative form after discussing it with the client & the advisor who made the initial recommendation). The range of NRT products available on the Council s formulary is on page 5 of this document. E-vouchers for NRT can be accepted at any locally commissioned pharmacy providing smoking cessation within Brighton & Hove. 1
2 Who can issue the e-voucher? A trained stop smoking advisor who is approved to issue NRT under this scheme can issue e- vouchers to the clients they are supporting. The approval is granted by the Public Health Tobacco Control and Projects Commissioner, Brighton & Hove City Council Please note that advisors do not have to be from a clinical background but must be NCSCT certified and have received face-to-face training in line with the NCSCT training standards 1 to recommend NRT supply under this protocol and keep their knowledge and skills up to date. When should the e-voucher be issued? When a client is motivated to quit After background information has been attained and any relevant medication assessment has been taken and documented. Any necessary information, including any other medication currently being taken by the client, should be identified on the e-voucher for the pharmacist to aid their assessment before they agree to administer NRT (refer to the Brighton and Hove City Council Standard operating procedure for the use of nicotine replacement therapy (NRT) products) After agreement with the client of the most clinically appropriate choice of NRT After the client has been made aware of the potential side effects of stopping smoking (refer to the Brighton and Hove City Council Standard operating procedure for the use of nicotine replacement therapy (NRT) products) When the client has decided on a firm quit date and it is recorded accordingly When no contra-indications of NRT are present E-voucher s must be issued in accordance with the Brighton & Hove Standard Operating Procedure for the use of NRT. This SOP is reviewed biannually. Copies are provided to all trained stop smoking advisors approved by the Public Health Tobacco Control and Projects Commissioner and pharmacies. A copy is also available on PharmOutcomes. Advisors should keep up to date with their knowledge on medications. This can be done by searching the latest summary of products and characteristics (SPC) of each individual NRT all of which are available on the NCSCT website. 2 How to complete the e-voucher Refer to training resources available on PharmOutcomes - A guide for using the NRT e-voucher in PharmOutcomes for health trainers - A guide for using the NRT e-voucher supply in PharmOutcomes for pharmacy
3 A guide for frequency of issuing an e-voucher for NRT This table below is only a guide for stop smoking advisors based on a typical standard treatment programme. The table outlines two scenarios which are based on supply limits outlined in the standard operating procedures for use of NRT. Session 1 Initial Assessment Session 2 Quit date NRT scenario 1 NRT scenario 2 1 weeks supply of NRT 2 weeks supply of NRT Session 3 Post-quit - week 1 Session 4 Post-quit - week 2 Session 5 Post-quit week 3 Session 6 4 week quit appointment post quit week 4 Session 7 Post quit week 5 Session 8 Post quit week 6 Session 9 Post quit week 7 Session 10 Post quit week 8 Session 11 Post quit week 9 Session 12 Post quit week 10 Total amount of medication: 12 weeks supply (per product) 2 weeks supply of NRT Total amount of medication: 12 weeks supply (per product) 3
4 The amount of NRT per voucher: A maximum of two product items can be recommended on one voucher No more than 2 weeks supply should be dispensed up to four weeks post quit date, including a second product for combination therapy (depending on suitability). Following the four week post quit date the total prescribed should not exceed four weeks How much will NRT cost? Clients will pay a prescription charge for each product. As of January 2017 this is The stop smoking advisor issuing the NRT must ascertain from the client if they are exempt from prescriptions and note this in PharmOutcomes as well as the reason for exemption. If the client pays for prescriptions The client will pay one prescription fee for four weeks supply of each recommended product (maximum two products) The stop smoking advisor issuing the NRT will mark on the e-voucher if a prescription charge is due at the time of dispensing the e-voucher The Declaration of Exemption section should be recorded in PharmOutcomes. Collect any NHS fees (equivalent to the standard prescription charge) Limited time value of the voucher: The advisor should inform the client that they must collect their NRT products from the nominated pharmacist within seven days of issue. Any attempts to redeem after that may result in refusal All advisors must make sure they complete the e-voucher correctly and note the correct provision date in PharmOutcomes Pharmacists must ensure that the issue date is completed and that the voucher is presented within the seven day time scale NRT can only be issued to a client if there is a NRT referral pending in PharmOutcomes for the nominated pharmacist Details of record keeping Records must be kept for at least two years. Reimbursement to pharmacies: A professional fee of 1.13 is paid for each voucher presented (up to four weeks supply). This fee will increase to 1.24 from 1 April 2017 The pharmacy is reimbursed at the drug tariff price as per the DM&D plus VAT at 5% for the NRT product supplied. Where a product is not listed in the drug tariff, the trade price plus VAT at 5% in chemist and druggist will be paid. 4
5 NRT available through the voucher scheme NRT Gum Nicotinell 2mg gum Fruit (96) Nicotinell 2mg gum Mint (204) Nicotinell 4mg gum Ice Mint (96) Nicorette 2mg gum Original & all flavours (30) Nicorette 2mg gum Original & all flavours (105) Nicorette 4mg gum Original & all flavours (105) Nicorette 2mg gum Icy White (105) Nicorette 4mg gum Icy White (105) Nicorette 6mg gum (105) Niquitin CQ 2mg gum (96) Niquitin CQ 4mg gum (96) NRT Inhalator (4) (20) Refills (36) NRT Lozenge Nicotinell 1mg Lozenge Mint (36) Nicotinell 1mg Lozenge Mint (96) Nicotinell 2mg Lozenge Mint (36) Nicotinell 2mg Lozenge Mint (96) Niquitin CQ 2mg Original & Mint (36) Niquitin CQ 2mg Original & Mint (72) Niquitin CQ 4mg Original & Mint (36) Niquitin CQ 4mg Original & Mint (72) Niquitin CQ mini 1.5mg Cherry (60) Niquitin CQ mini 4mg Mint (60) Nicorette Cools 2mg (20) Nicorette Cools 2mg (80) Nicorette Cools 4mg (80) NRT Sublingual tablets Nicorette 2mg microtab (100) NRT Patches Nicorette Invisipatch 16 hrs 10, 15 and 25mg Nicotinell TTS 10 patch (24 hrs) 7mg Nicotinell TTS 20 patch (24 hrs) 14mg Nicotinell TTS 30 patch (24hrs) 21mg Nicotinell TTS 30 patch (24hrs) 21mg (21) NiQuitin CQ (24 hrs) 7mg/14mg/21mg NiQuitin (24 hrs) 21mg (14) NRT Nasal Spray Nicorette nasal spray 10ml NRT Oral Spray Nicorette oral spray 1mg/metered dose (Quickmist) Quickmist 1mg dose Mouthspray 26.4ml (13.2ml x 2) All products on the formulary should be made available by the pharmacist at any time. It is the pharmacist s responsibility to ensure that these products are in stock, unless there is a manufacturer supply problem. 5
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