Falsified Medicines Directive (FMD) FAQs

Falsified Medicines Directive Q & A

How does FMD work if stock is “loaned” to another pharmacy to fulfill a prescription or stock is transferred from one pharmacy to another (within the same body corporate)? (New!)

If a full, active pack, i.e. one which has not been decommissioned, is to be loaned or transferred, the pack should be decommissioned by the receiving pharmacy when they supply the medicine to the patient. The pharmacy that loans or transfers the item does not need to use the FMD system in relation to the medicine prior to the loan or transfer, but they could choose to verify the product.

If a split pack of medicine, which has already been decommissioned, is loaned or transferred, the receiving pharmacy should be notified of this, so they do not attempt to decommission the product.

What happens if the UK Brexits without a deal (a “hard-Brexit”)? (New!)

If Brexit happens without an agreement with the other member states of the European Union, the UK hub’s connection to the European hub (where all the UI data is uploaded by manufacturers etc.) will be suspended at some point, which will prevent the UK hub operating. In this circumstance, the legal obligations to comply with FMD would be removed by the Government for all actors in the UK supply chain.
The MHRA has also stated that packs containing the FMD safety features would still be accepted in the UK, provided that they are in line with other UK packaging requirements. In the interests of public safety, Government will evaluate the options for a future UK falsified medicines regulatory framework, taking into account the investment already made by stakeholders.

Do I have to verify and decommission medicines I supply via a Patient Group Direction or as an emergency supply? (New!)

Yes, supplies of any prescription medicines will need to be verified and decommissioned before they are supplied to the patient.

 

Are food supplements, such as Ensure, and gluten-free foods covered by FMD? (New!)

No.

Will we need two types of scanners – one for “normal” 1D barcodes and one for 2D barcodes? (New!)

No. 2D barcode scanners will also scan normal 1D barcodes.

How will FMD help identify dispensing errors? (New!)

If an integrated PMR / FMD system is used, the software will be able to check whether the products scanned match the items on the prescription/dispensing label. If there is a mismatch, the user will be alerted by the software, thus reducing the likelihood of incorrectly selected products being dispensed to patients.

Do I need a separate internet connection for FMD? (New!)

FMD systems will not specifically need a separate internet connection from the pharmacy’s main connection (e.g. HSCN or N3), but the systems could operate on a separate connection if desired.

My internet/broadband is slow. Will that affect the system? (New!)

No. The system is designed to work on a very low internet speed.

What happens if a counterfeit is detected? (New!)

You will get a message to say the medicine is not in the UK hub (and therefore a suspected
counterfeit). The UK hub will automatically alert the MHRA; however, you should also contact the MHRA by completing a Yellow Card report. It is also good practice to notify the wholesaler/supplier. Physically check all stock (shelves, fridge, controlled drugs cupboard,
returns area, prescriptions waiting for collection etc.) for medicines with the same batch number and quarantine them until further instructions are issued by the MHRA.

 

What happens if the barcode is damaged or the scanner can’t read the barcode? (New!)

The unique identifier must be visible on the medicinal product in a human-readable format in case the barcode is unreadable by the scanner. You can manually enter the code to authenticate the medicine. However, if the scanner can’t read the 2D barcode and you can’t read the human-readable code because of damage, it is recommended that the medicine is not supplied to the public.

What happens if the system/internet connection fails? (New!)

If the UK hub is unavailable, the software interface or computer programme, for medicines authentication will record the scanned codes and they will be authenticated when the UK hub is back up and running. In the meantime, medicines can be supplied as normal. If the local FMD system fails, a record of the UIs would need to be made of any products supplied to patients, so they could be decommissioned once the FMD system is operational again.

 

What if a patient is not at home when a delivery is attempted, and the medicines come back to the pharmacy? (New!)

The pharmacist would make a professional decision and risk assessment.

Potential options are:

  • to store the medicine safely at the pharmacy for delivery the next day
  • to recommission the medicines and then decommission again before
    the next delivery attempt.

What if I forget to decommission? (New!)

Revisit training and process to ensure these instances are very small.

What do I do when disposing of out-of-date or damaged stock? (New!)

If the stock is damaged, decommission the stock first before disposal. If the stock is out-of-date, you do not need to decommission it as the system will know that the stock is expired; just dispose of it as usual.

If I need to supply a medicine to a patient in an emergency, do I need to authenticate it first? (New!)

If you need to administer a medicine in an emergency, e.g. adrenaline, you may not have time to authenticate it before administration, so you should administer the medicine first and authenticate later. If you are simply making an emergency supply of a medicine, the medicine should be authenticated before being given to the patient in the normal way.

How will FMD work for robots? (New!)

Robotic suppliers are currently working on this. Please check with your individual system for further details.

How will the system deal with recalls?

If a medicine is recalled, the manufacturer or parallel distributor will update the system (both at European and UK hub level), marking the relevant batch numbers as being recalled. Pharmacies will also receive recall information from the manufacturer/MHRA in the normal way. If a pharmacy omits to return the recalled medicine and tries to dispense it at a later date, when the barcode is scanned, the system will indicate that the product has previously been recalled. You must not dispense such medicines to patients.

How will the system deal with expired/out-of-date medicines? (New!)

The 2D barcode contains the expiry date of the product. If you attempt to dispense the product after the expiry date has passed, the system will alert you to the fact that the medicine has expired. You must not dispense such medicines to patients.

Will my wholesaler decommission for me or can I decommission stock when I receive the stock from the wholesaler? (New!)

No. Decommissioning within pharmacies has to occur “at the time of supplying it to the public”. This means that decommissioning needs to occur in the process as close to the supply to the patient as possible. Decommissioning when stock is received would not fulfil this criterion. In addition once decommissioned, stock can only be re-commissioned within 10 days. This would mean that anything decommissioned more than 10 days ago could not be returned to the wholesaler.

Wholesalers can decommission products for a range of healthcare professionals, public service bodies and other organisations that use or supply medicines as an occasional part of their work, but community and hospital pharmacies are specifically excluded from this.

I have a Wholesale Dealer’s Authorisation. What does this mean for me? (New!)

Not only will you have to abide by the regulations for pharmacies, but you will need to abide by the regulations for wholesalers as well. This will involve numerous different steps and we recommend that you read the Delegated Regulation [2016/161] to ensure that you will be familiar with the rules you will have to work to.

Will I still be able to return products to my wholesaler? (New!)

This will depend upon your wholesaler’s terms and conditions, but in general, as long as the stock has not been decommissioned and the anti-tampering device is still intact, returns processes should be unaltered by FMD. Wholesalers will have to verify the status of any products returned to them, so products that do not have an “active” status would not be accepted back.

Will manufacturers and wholesalers be able to see data on products I have dispensed? (New!)

No. The Delegated Regulation is clear that all parties that are connected to the repositories system, including manufacturers, wholesalers and pharmacies, have sole responsibility, ownership and access to any data that they generate. This data is not shared with any other parties, other than DHSC/MHRA, where necessary.

The only exception is the status (“active”/“inactive”) of products’ UIs, which is available to any party that has a relevant pack in their possession.

The UK hub will maintain an audit trail of when and where product information was uploaded and accessed, and where and when UIs are decommissioned. This data cannot be shared with other parties, other than with the express written permission of the data owner. The only exception is when there is an investigation into an incident of potential falsification.

How long will it take to authenticate a medicine? (New!)

The maximum response time of an individual repository, such as the UK hub, is 300 milliseconds. If the system has to check repositories in other Member States, each stage will take a maximum of 300 milliseconds.

Who owns the data held in the system? (New!)

Manufacturers, wholesalers and pharmacists only have ownership of, and access to, the data they generate when they interact with the UK hub. This means that pharmacists own the data that they create and no one else can access or use it, except the MHRA and DHSC for auditing and investigation purposes.

Who has access to the data? (New!)

The MHRA or DHSC can request access to specific data from the UK hub for supervisory purposes or when investigating potential incidents of falsification.

Will bulk packs still be manufactured? (New!)

Yes. These will be treated as split packs.

 

Will I have to link scans/UIs to patient records on my PMR system? (New!)

There is not a specific requirement within the Delegated Regulation to record or link unique identifiers to particular patients. No patient- specific information will be captured or stored within the repositories system, including the UK hub.

PMR systems may in the future allow UIs to be linked to the records of patients to improve pharmacovigilence and product recalls.

What happens if the ATD gets broken? What if I need to break the ATD to assemble a medicine? (New!)

If you need to open a pack, either to split the quantity or to prepare or label the product, you will need to check the ATD and decommission the pack before it is opened. The pack can then be dispensed and supplied to patients in the normal way, including in MDS.

When checking the anti-tampering device at the time of dispensing, pharmacy staff will be looking to see that the product does not appear to have been tampered with. This will depend on the nature of the device or format used to seal or secure the packaging.

Products with packaging where the anti-tampering device has clearly been broken cannot be supplied to patients (unless this was done by the dispenser as part of the process of assembling the medicine).

Wholesalers have to verify products that are returned to them, including inspecting anti-tampering devices. It is unlikely that they would accept back products which have broken anti-tampering devices.

Will I still be able to do MDS? (New!)

Yes. Packs of medicines will have to be verified and decommissioned before they are opened to be repacked in an MDS.

Will this mean that I get paid for (exactly) what I scan? (New!)

The Delegated Regulation gives Member States the flexibility to use information derived from unique identifiers for the purposes of reimbursement, pharmacovigilence and pharmacoepidemiology. At present, the Department of Health and Social Care do not intend to use the flexibility for the purposes of pharmacy reimbursement.

Will I still be able to use PI products? (New!)

Yes. Parallel traded products will have to re-packaged and re-labelled for the intended country of use. This will include applying a new unique identifier and 2D barcode (linked at batch level to the original UI) and replacing the ATD if it has been broken. They will then be treated in the same way as a pack originally manufactured for the UK market. Note that the position of parallel traded products after the UK leaves the EU has yet to be clarified.

What happens if a pack has a 2D barcode, but it is not recognised by the UK hub? (New!)

Some medicines marketed in the UK already have 2D barcodes, but their details will not be included in the UK hub, e.g. some generic medicines manufactured in India, where a separate medicines authentication system is already in place. If these products are scanned, the UK hub will not recognise them, but unless the dispenser has any concern about the authenticity of the product, they can continue to be supplied to patients, as now. FMD compliant packs will have an anti-tampering device and a 2D barcode, so packs with a 2D barcode but no anti-tampering device will not be FMD compliant packs and will not need to be scanned. Further advice on how to identify which packs should be scanned can be found on this page.

What happens if the pack doesn’t have a 2D barcode? (New!)

There will still be many packs without 2D barcodes in the supply chain when the FMD requirements come into effect on 9th February 2019. These packs will still be able to be dispensed and supplied but they will not be required to be decommissioned.

Some packs are already appearing with 2D barcodes as manufacturers make changes in advance of the FMD requirements.

How will I deal with liquids? (New!)

These will be decommissioned whenever the anti-tamper device has been broken, i.e. when the bottle has been opened.

 

Will I still be able to use split packs? (New!)

Yes. Packs that are going to be split will have their ATD checked and be decommissioned at the point at which they are first opened. The remainder of the pack can be dispensed without further checking at a future point, as it will have already been decommissioned. Pharmacy staff will need to mark these packs to indicate they have already been decommissioned.

 

Where and when do I have to check the ATD and decommission the product? (New!)

Pharmacies will be required to authenticate products, which means visually checking the anti-tampering device (ATD) and performing a verification and decommissioning scan, “at the time of supplying it to the public”. At the time of supply is not an instant, but a period of time, from when a pack is selected, to when the patient (or their representative) has the pack. The ATD check must take place during that period, as must the decommissioning.

One way in which the authentication process can be handled is by using an FMD system which stores the UIs of multiple packs or items dispensed on a prescription and associates this data with a single code which would be printed on a label attached to the dispensing bag.
Using this approach, products would be scanned and verified during assembly, then, at the final hand-over to the patient or representative, the single code on the dispensing bag would be scanned and this would trigger the decommissioning of the products on the UK hub.

The precise process will depend on each contractor’s SOPs and may vary depending on whether the patient (or their representative) is present or not. It is important to note that the check of the ATD and the decommissioning scan may occur at different points in that process.
Decommissioning should happen as close to the time of supply to the patient as possible, but there are other important considerations.
Disruption to the dispensing workflow could jeopardise safety. Emptying out bags to scan packs in front of the patient could compromise patient privacy and poses problems if any pack fails to authenticate for any reason.

What are recommissioning and the 10-day rule? (New!)

Before medicines are handed to patients, they need to be verified and decommissioned. This means that the product’s status in the UK hub is changed by the dispenser from “active” to “inactive – dispensed”. This prevents the same UI (Unique Identifier) being authenticated by any other pharmacy (or dispensing entity). This process of decommissioning UIs is at the heart of FMD.

If for some reason the product is not then supplied to a patient, there is an opportunity to reverse the status of a decommissioned UI (recommissioning). This can only take place in the following circumstances:

  • The recommissioning takes place in the same location as the original decommissioning (i.e. within the same pharmacy)
  • The recommissioning is done not more than 10 days after the decommissioning
  • The product has not expired
  • The product has not been marked by the UK hub as recalled, withdrawn, stolen or intended for destruction
  • The product has not been supplied to the public.

If a decommissioned product is not collected by the patient and it is not possible to recommission it, e.g. it is more than 10 days after decommissioning, the legislation says the product cannot be returned to stock or supplied to another patient, so it will have to be disposed of.

Do I need to verify medicines when I receive them from the wholesaler/manufacturer? (New!)

There is no requirement to do this, but you can do so if you wish.

What will change for pharmacy contractors? (New!)

Community pharmacy contractors will be required to ensure that all their pharmacies are connected to the UK Medicines Verification System (the UK hub), including having appropriate software and hardware (scanners etc.) as needed.


Standard operating procedures will need to be changed to ensure that all relevant prescription medicines are authenticated and decommissioned prior to hand-over to patients. Processes will be needed to deal with any unexpected results and with recommissioning (reverse decommissioning), where necessary.

What is the difference between verification and decommissioning? (New!)

Verification: A medicine can be scanned to verify it is in the UK hub and that it is not marked as dispensed, expired or recalled. This can be done at any point the medicine is in stock and does not change the status of the medicine in the UK hub. Wholesalers will do this using an ad hoc, risk-based approach, e.g. if a medicine comes from a different supplier than usual or if a medicine is returned by a pharmacy.
Decommissioning: When supplying a medicine to a member of the public, the medicine will be scanned to verify it is in the UK hub and that it is not marked as dispensed, expired or recalled.


Decommissioning: causes the status of the medicine to be marked as “inactive – dispensed”, meaning if the same number is scanned again, it will be flagged to the person scanning it. Community pharmacies must do this for all relevant medicines dispensed or supplied.

Will I still be able to return products to my wholesaler?

This will depend upon your wholesaler’s terms and conditions, but in general, as long as the stock has not be decommissioned and the anti-tampering device is still intact, we expect the returns process to be unaltered. Wholesalers will have to verify the status of any products returned to them, so products that do not have an “active” status would not be accepted back.

I have a Wholesale Dealer’s Authorisation. What does this mean for me?

Not only will you have to abide by the regulations for pharmacies but you will need to abide by the regulations for wholesalers as well. This will involve numerous different steps and we recommend that you read the Delegated Regulation [2016/161] as soon as possible to ensure that you will be familiar with the rules you will have to work to.

Will my wholesaler decommission for me? Can I scan when I receive the stock?

No. Decommissioning within pharmacies has to occur “at the time of supplying it to the public” [Article 22]. This means that decommissioning needs to occur in the process as close to the patient as possible. Decommissioning when stock is received would not fulfil this criterion. In addition once decommissioned, stock can only be re-commissioned within 10 days (see “10-day rule”). This would mean that anything decommissioned more than 10 days ago could not be returned to the wholesaler.

Wholesalers can decommission products for a range of healthcare professionals, public service bodies and other organisations that use or supply medicines as an occasional part of their work [Article 23], but community and hospital pharmacies are specifically excluded from this.

Can I still sell data to IMS?

Pharmacy contractors will be able to sell dispensing data generated by their PMR systems in the normal way, but it is likely that commercial restrictions will be placed on the use of individual pack data derived from the FMD system, in line with the data ownership rules outlined above.

Who can see/use FMD information in the pharmacy?

As FMD will affect dispensing, all pharmacy staff involved in the dispensing process will need to be trained to follow FMD protocols on verification / decommissioning of products. It is expected that dispensing software / PMRs will be updated so that they ask for and receive the live status of product unique identifiers during the prescription assembly process.

Will manufacturers and wholesalers be able to see data on products I have dispensed?

No. The Delegated Regulation is clear that all parties that are connected to the repositories system, including manufacturers, wholesalers and pharmacies, have sole responsibility, ownership and access to any data that they generate. This data is not shared with any other parties, other than the National Competent Authority, where necessary.

The only exception is the status (“active”/“inactive”) of products’ UIs, which is available to any party that has a relevant pack in their possession.

Each national medicines verification system will maintain an audit trail of when and where product information was uploaded and access, and where and when UIs are decommissioned. This data cannot be shared with other parties, other than with the express written permission of the data owner. The only exception is when there is an investigation into an incident of potential falsification.

Will I still be able to use PI products?

Yes. Parallel traded products will have to re-packaged and re-labelled for the intended country of use. This will include applying a new unique identifier and 2D barcode (linked at batch level to the original UI) and replacing the ATD if it has been broken. They will then be treated in the same way as a pack originally manufactured for the UK market. Note that the position of parallel traded products after the UK leaves the EU has yet to be clarified.

Will this mean that I get paid for (exactly) what I scan?

The Delegated Regulation gives Member States the flexibility to use information derived from unique identifiers for the purposes of reimbursement, pharmacovigilence and pharmacoepidemiology [Article 39]. At present, the Department of Health and Social Care do not intend to use the flexibility for the purposes of pharmacy reimbursement.

Will I have to link scans/UIs to patient records on my PMR system?

There is not a specific requirement within the Delegated Regulation to record or link unique identifiers to particular patients. No patient-specific information will be captured or stored within the repositories system, including the national verification systems.

In due course, some PMR systems may allow UIs to be linked to the records of patients to improve pharmacovigilence and product recalls.

What happens if ATD gets broken? What if I need to break the ATD to assemble a medicine?

If you need to open a pack, either to split the quantity or to prepare or label the product, you will need to check the ATD and decommission the pack before it is opened. The pack can then be dispensed and supplied to patients in the normal way, including in MDS trays.

When checking the anti-tampering device at the time of dispensing, pharmacy staff will be looking to see that the product does not appear to have been tampered with. This will depend on the nature of the device or format used to seal or secure the packaging. Products with packaging where the anti-tampering device has clearly been broken cannot be supplied to patients (unless this was done by the dispenser as part of the process of assembling the medicine).

Wholesalers have to verify products that are returned to them, including inspecting anti-tampering devices. It is unlikely that they would accept back products which have broken anti-tampering devices.

What happens if the pack doesn’t have a 2D barcode?

There will still be many packs without 2D barcodes in the supply chain when the requirements for authentication under the Falsified Medicines Directive come in to effect in February 2019. These packs will still be able to be dispensed and supplied but they will not be required to be decommissioned.

Some packs are already appearing with 2D barcodes (as well as linear barcodes) as manufacturers and packagers change over in advance of the FMD requirements.

What’s an aggregated code?

Using aggregated codes is one way in which the FMD process could be made more efficient within pharmacies, especially when dispensing multiple medicines for the same patient.

During the dispensing process you could link information from the UIs of all of the packs for that patient together. This could be linked to a single aggregated code printed on the bag label. When the bag is being handed to the patient or their representative, the bag-label barcode would be scanned and this would trigger the decommissioning of all the packs in a single operation, avoiding having to empty the bag out in front of the patient and scanning each pack individually.

Will I still be able to do MDS?

Yes. Packs will have to be checked and decommissioned before they are opened to be repacked in MDS trays.

What is FMD?

The European Falsified Medicines Directive (commonly known as FMD) [2011/62/EU] has been brought in to address the issue of falsified medicines entering the legitimate medicines supply chain across Europe. Falsified medicines include those with little or no active ingredients, the wrong active ingredients, fake or tampered packaging, and those where products and/or packaging have been stolen for re-use or re-sale.

Although unlicensed internet sites have now become the main route for trading falsified medicines to the public, regulatory authorities continue to find and report falsified medicines in the supply chain. Such products pose an unacceptable risk to patients, as well as undermining confidence in the genuine products supplied by manufacturers, wholesalers and pharmacies.

Under the Directive, all new packs of prescription medicines placed on the market in Europe from February 2019 onwards will have to bear two safety features: a unique identifier(UI) in the form of a 2D data matrix (barcode) and an anti-tampering device (ATD).

FMD aims to introduce a pan-European system through which pharmacies (and other “dispensing entities”) can authenticate prescription medicines before they are handed to patients. Manufacturers will upload valid UI codes to a relevant National Medicines Verification System (NMVS) and pharmacies will be able to check the status of each pack during the dispensing process. The system will be notified of products known to have been recalled, withdrawn, stolen or tampered with. A European Medicines Verification System(EMVS) will act as a hub, linking the national systems together and allowing parallel trading of medicines to continue. Pharmacies will also have to check that the ATD is still intact.

Scanning and authentication of packs will come in to effect across Europe from Saturday 9th February 2019, following the publication of a Delegated Regulation [2016/161] which set out details for the unique identifiers, the national verification systems and the responsibilities of manufacturers, wholesalers and pharmacies.

Which other countries are doing this?

FMD will be introduced in 32 countries – the 28 (current) Member States of the EU, plus the four members of the European Free Trade Area (Iceland, Norway, Liechtenstein, Switzerland). Under the Delegated Regulation, Belgium, Greece and Italy have six-year derogations until 2025 as they already have verification systems in place. Belgium has already indicated that it will not take up its derogation.

What’s been done so far across Europe?

Policy work on FMD has been going on for around a decade, leading up to the adoption of the EU Directive in 2011. Pharmacy bodies, including the National Pharmacy Association and the Royal Pharmaceutical Society were involved in this through the Pharmaceutical Group of the European Union (PGEU), the European pharmacy association. Further work on technical details of serialisation and the verification systems saw the Delegated Regulation published in February 2016. It will come in to force across Europe from February 2019.

The development of the European and national verification systems is being led through a stakeholder model involving the five main sectors (or “constituencies”) of the supply chain – research-based manufacturer, generic manufacturers, parallel traders, wholesalers and pharmacies – working alongside the European Commission and national competent authorities (Health Ministries and regulators).

At a European level, the European Medicines Verification Organisation (EMVO) has been established by the European associations representing the five sectors. As well as establishing the central European Medicines Verification System (EMVS), which is now up and running, the EMVO has developed the blueprint model for national verification systems. This is designed to promote harmonisation and reduce costs.

Under the blueprint model, three companies have been chosen to bid for Blueprint Service Provider (BSP) contracts to run national medicines verification systems. These are AegateArvarto and SolidSoft Reply. Each has experience in providing large-scale IT projects, including serialisation. Note: Since the start of the process Aegate has withdrawn from the market.

National stakeholder associations across Europe have worked to establish their own National Medicines Verification Organisations which then invited the Blueprint Service Providers to tender to operate the NMVS.

What’s in scope and out-of-scope?

Almost all prescription medicines with a Marketing Authorisation are in scope of FMD, with only a few specialist products, radionuclide kits and medicinal gases being out-of-scope. All non-prescription medicines are out-of-scope, with the exception of two omeprazole products (which were subject to falsification in the past).

Unlicensed products, including specials and clinical trial supplies, are out-of-scope, but any licensed products being incorporated in to them (such as ingredients for specials) would have to be authenticated and decommissioned before they could be used.

Medical devices are out-of-scope, but separate changes are being made to regulation of medical devices.

What information is encoded in the unique identifier?

Each individual pack of a prescription medicine will need to carry a unique identifier (UI) encoded via a 2D data matrix (barcode). If the pack size permits it, the pack will also carry the same information in human-readable text, printed adjacent to the 2D-code where possible.

The unique identifier will consist of [Article 4]:

  • Product code: the name, common name, pharmaceutical form, strength, pack size and pack type
  • Serial number: randomised numeric or alphanumeric sequence of up to 20 characters
  • National reimbursement number: national identifying code, if required by Member State [note: unlikely to be used in UK]
  • Batch number
  • Expiry date

Because this information will be printed and encoded on every pack, it can also be used for some activities in pharmacy, such as stock re-ordering, stock rotation and accuracy checking.

How is the unique identifier used to authenticate products?

Pharmacies and wholesalers who have a pack in their possession will be able to scan the UI and send this information to their National Medicines Verification System. The NMVS will send back the current status of the product. If the status is “active” then the product can be dispensed in the normal way, as long as the anti-tampering device is also undamaged (unless it is required to be broken in order to assemble or prepare the medicine).

If the NMVS sends back a message that the pack is “inactive”, then it cannot be supplied to a patient. The system will also indicate why the pack is inactive, such as “already been dispensed”, “recalled”, “withdrawn”, “stolen”, “locked (temporarily inactive during investigations)”. Pharmacies will need to have processes in place to deal with these situations, which could include making reports to regulatory bodies, if required.

What is the 10-day rule?

Before medicines are handed to patients, they need to be authenticated (i.e. have their UI scanned and verified against the NMVS) and, if successfully verified, they are then decommissioned. This means that the product’s status in the NMVS is changed by the dispenser from “active” to “inactive – dispensed”. This prevents the same UI being authenticated by any other pharmacy (or dispensing entity). This process of decommissioning UIs is at the heart of FMD.

If for some reason the product is not then supplied to a patient, there is an opportunity to reverse the status of a decommissioned UI. This can only take place in the following circumstances [Article 22]:

  • The reversal takes place in the same location as the original decommissioning (i.e. within the same pharmacy)
  • The reversal is done not more than 10 days after the decommissioning (commonly known as the “10-day rule”)
  • The product has not expired
  • The product has not been marked by the NMVS as recalled, withdrawn, stolen or intended for destruction
  • The product has not been supplied to the public.

What’s been done so far in the UK?

In the UK, a National Medicines Verification Organisation was formally established under the name SecurMed UK in July 2016. It is governed by five voting directors, one from each of the sectors. Pharmacies are represented jointly by the National Pharmacy Association (NPA) and the Company Chemists Association (CCA), through a single director. SecurMed UK has appointed its Blueprint Service Provider, Arvarto, and signed contracts to implement the UK FMD system in July 2018.

The Department of Health and Social Care has established an FMD Implementation Advisory Board, which brings together a wide range of stakeholders from right across the whole of the medicines supply chain and the many health professionals who supply medicines to the public. Community pharmacy is closely involved with this Advisory Board and its working groups.

What is the UK FMD Working Group for Community Pharmacy and what is its position on FMD?

In order to align the interests of community pharmacies, the UK FMD Working Group for Community Pharmacy has been formed, bringing together the main community pharmacy bodies and pharmacy negotiators. This Working Group receives regular updates from Department of Health and Social Care and MHRA officials.

It has been active in preparing a communications plan and mapping the processes that will need to change within community pharmacies in order to implement FMD.

The Community Pharmacy Working Group has been working to ensure that implementing FMD that will be straightforward, the system will be easy to use and it will have minimal impact on pharmacy working practices. It should also be implemented at minimum cost to pharmacy contractors.

The UK voted to leave the EU; will we still have to do FMD?

The European Directive and the Delegated Regulation are binding on all EU and EEA Member States. Switzerland is also adopting FMD and pack serialisation. As it currently stands, FMD scanning will come in to effect before the UK leaves the European Union.

How will this be enforced?

Enforcement of FMD in Member States is the responsibility of national competent authorities. In the UK this is the Department of Health and Social Care, responsible for updating legislation and setting out penalties; the MHRA, responsible for enforcement for manufacturers and wholesalers; and the General Pharmaceutical Council / Pharmaceutical Society of Northern Ireland, responsible for enforcement for community pharmacies. Pharmacists have a general duty to comply with prevailing medicines legislation while carrying out their professional work.

What will change for pharmacy contractors?

Community pharmacy contractors will be required to ensure that all their pharmacies are connected to the UK Medicines Verification System, including having updated software and hardware (scanners) as needed.

Standard operating procedures will need to be changed to ensure that all relevant prescription medicines are authenticated and decommissioned during the dispensing process, prior to hand-over to patients. Processes will be needed to deal with any unexpected results and with reverse decommissioning, where necessary.

Who will pay for this (in pharmacy)?

The EU Delegated Regulation [2016/161] makes it clear that the costs of establishing the repositories system (i.e. the European and national verification systems and their governing bodies) is to be borne by manufacturers (i.e. research-based companies, generic manufacturers and parallel traders). It is expected that this will be done through a licensing arrangement linked to the right to upload data to the national repositories.

Community pharmacies (and wholesalers) will be required to pay for any “physical scanning equipment” that is required for reading unique identifiers [Article 32]. They will also have to pay for any software upgrades that are required to connect with their national verification system and to make use of the data they receive (i.e. the status of UIs they have scanned).

Each of the four national community pharmacy negotiators (PSNC, CPS, CPW and CPNI) is working to ensure that contractors’ FMD-related costs are recognised in future NHS funding settlements.

Where and when do I have to check the ATD and decommission the product?

Pharmacies will be required to authenticate products, which means visually checking the anti-tampering device and performing a verification and decommissioning scan, “at the time of supplying it to the public”. At the time of supply is not an instant but a period of time, from when a pack is picked, to when the patient (or their representative) has the pack. The ATD check must take place during that period, as must the decommissioning. It may be that during assembly, the barcodes are scanned and linked to an aggregated barcode (see “What is an aggregated code?”) placed on the dispensing bag. Decommissioning can then be accomplished by scanning the aggregated barcode before hand-over to the patient (or their representative).

The precise process will depend on each contractor’s SOPs and may vary depending on whether the patient (or their representative) is present or not. It is important to note that the check of the ATD and the decommissioning scan may occur at different points in that process. Decommissioning should happen as close to the time of supply to the patient as possible, but there are other important considerations. Disruption to the dispensing workflow could jeopardise safety. Emptying out bags to scan packs in front of the patient could compromise patient privacy and poses problems if any pack fails to authenticate for any reason.

Will I still be able to use split packs?

Yes. Packs that are going to be split will have their ATD checked and be decommissioned at the point at which they are first opened [Article 28]. The remainder of the pack can be dispensed without further checking at a future point as it will have already been decommissioned.

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