Changes in the implementation of prescriptions in pharmacies. The National Health Fund warns against errors

• The Ministry of Health has proposed, in an amendment to the regulation on prescriptions, changes regarding prescriptions for free medicines for seniors or children
• The changes would consist in the fact that a person dispensing a medicinal product from a pharmacy or a pharmacy point could correct the prescription by supplementing it with the additional authorization code "DZ" or "S"
• This would make it possible without the need for the person who issued the prescription to make any corrections.
• - From the point of view of the National Health Fund, there are obstacles that prevent the introduction of the consulted change to the amendment of the provisions of the regulation on prescriptions - said Jakub Szulc, vice-president of the National Health Fund, in his position

The draft amendment to the regulation on prescriptions has been submitted for public consultation and comment. The text of the amendment:

§ 1. In the Regulation of the Minister of Health of 23 December 2020 on prescriptions (Journal of Laws of 2023, items 487, 1734 and 2372 and of 2024, item 991), in § 8, paragraph 1, point 1 shall read as follows:

"1) the patient's additional entitlement code, except for the patient's additional entitlement codes specified in item no. 5, 8 and 9 of Annex No. 1 to the Regulation – the person issuing the prescription determines it based on the documents referred to in § 12 presented by the person presenting the prescription or based on data on the age of the beneficiary, which the person issuing the prescription has or which they can independently determine; the person issuing the prescription includes this code in the Prescription Fulfillment Document or on the reverse of the paper prescription and includes this code in the electronic message referred to in Art. 45 sec. 2 of the Reimbursement Act, transmitted to the provincial branch of the Fund".

§ 2. The regulation shall enter into force after 14 days from the date of announcement.

As stated in the OSR, the amendment solves the problem of the current impossibility of correcting a prescription by the person filling it in a public pharmacy or pharmacy point in such a way as to supplement the missing additional entitlement code in order to obtain a free medicinal product/drug, food for particular nutritional uses or medical device, on a prescription for a minor (code "DZ") or a senior (code "S").

It is recommended to enable the person filling the prescription (the person issuing the medicinal product, food for particular nutritional uses or medical device from a pharmacy or pharmacy point) to correct the content of the prescription by supplementing it with the additional authorization code "DZ" or "S" - we read in the OSR content.

Moreover, the bill’s initiator justifies that the effect of the introduced change will be the possibility of filling a prescription showing the indicated incompleteness, free of charge, in a public pharmacy or a pharmacy point (after the prescription is refilled in a pharmacy), without the need for the person who issued it to correct the prescription.

Thus, the possibility of verifying the patients' entitlements was added based on data on the age of the beneficiary, which the person performing the service has or can determine. The justification indicates that such data may be the data on the patient's age resulting from the PESEL number, which in the vast majority of cases results directly from the content of the prescription.

So far, the National Health Fund has submitted its comments as part of the opinion (as of May 6). On behalf of the Fund, Vice-President Jakub Szulc responded, emphasizing that in the context of the proposed change in the regulation concerning the extension of pharmacist rights to the possibility of supplementing the additional rights code "S" and "DZ", the additional right "S" is not an absolute right, granted solely due to the patient's age.

This is due to the fact that in some cases, such as prescribing medicines containing the active substances rivaroxaban and dabigatran, receiving free medicines is a conditional entitlement and can only be determined by a doctor who has access to the medical records, information about the condition and the course of treatment of the patient - he explained.

Moreover, the vice-president noted that the introduction of the proposed amendment would in some cases result in "unlawful actions of a pharmacist or pharmacy technician due to the lack of adequate knowledge about the patient's treatment".

At the same time, he noted that this type of prescription refill in a pharmacy would require clarification of the scope of liability in the event of dispensing a medicine with undue reimbursement by supplementing the additional authorisation code in the pharmacy for a person who does not meet the reimbursement indications.

- In light of the current regulations, prescription liability for prescribed drugs (including financial liability to the Fund) rests with the healthcare provider or the authorized person issuing the prescription. Therefore, a situation where the "S" code on the prescription would be supplemented at the stage of fulfilling the prescription to a person without appropriate indications should not result in the prescriber's guilt, because the doctor did not decide to prescribe the drug within the scope of this additional authorization. On the other hand, assigning responsibility for supplementing the additional authorization "S" to a person fulfilling the prescription in a pharmacy, without simultaneously providing them with legal means confirming the doctor's will - as to the use of the medicinal product within the scope of specific reimbursement indications, also seems inappropriate - demonstrated vice-president Szulc.

As he pointed out, from the point of view of the National Health Fund, there are obstacles that prevent the introduction of the consulted change to the amendment to the provisions of the regulation on prescriptions, in such a way that the additional entitlement code "S" and "DZ" would be supplemented solely on the basis of the patient's PESEL number when dispensing medicines in a pharmacy.

Moreover, the obstacle is the lack of a parallel definition of the scope of responsibility for the changes made in the case of medicines for which reimbursement with the "S" entitlement is conditional.

- At the same time, in the event of the intention to supplement the amended provision with exclusions concerning the above-mentioned conditional reimbursement and further processing of the amendment, out of caution we submit for consideration the conditionality of supplementing the additional "S" and "DZ" entitlement only in situations where the doctor has confirmed his will to prescribe the drug with reimbursement by including information directly on the prescription about the application of a discounted payment, i.e. a flat rate, 30% or 50% of the patient's payment - summed up the vice-president of the National Health Fund.

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