PharmaCare Policy Manual 2012

On this page…


1 Introduction to B.C. PharmaCare

2 Provider Enrollment in PharmaCare

  • Section 2.1 to 2.2 (PDF)—PharmaCare provider enrollment
  • Section 2.3 to 2.7 (PDF)—about PharmaNet, connecting to PharmaNet, changes to PharmaNet connections, PharmaNet outages, fan-out messages

3 Claims Submission

For response and intervention codes, see Appendix A (PDF) and Appendix B (PDF).

  • Section 3.1 (PDF)—which claims to submit on PharmaNet
  • Section 3.2 to 3.6 (PDF)—patients (identifying patients, PHNs, other insurers, restricted claimants, out of-province and out-of-country prescriptions)
  • Sections 3.7 to 3.11 (PDF)—medical practitioners (Prescriber IDs & Practitioner Reference IDs, authorized prescribing, practising status/restrictions, BC Prescription Review Program)
  • Sections 3.12 to 3.17 (PDF)—products (drug and product identification numbers, correct quantities, Drug Use Evaluation (DUE), drug monograph information, claim reversals, discontinuations)

4 Offline (Manual) Claims

  • Section 4 (PDF)—claims by offline pharmacies, suppliers and patients

5 Pricing Policies & Product Reimbursement

  • Sections 5.1. to 5.5 (PDF)—maximum days’ supply, refilling too soon, refilling same day, travel supplies, correct units of measure
  • Section 5.6 to 5.12 (PDF)—pricing policies (e.g., maximum pricing, actual acquisition cost, reduced mark-ups for high-cost drugs, retail pricing, full payment policy, low cost alternative program, reference drug program)
  • Sections 5.13 to 5.23 (PDF)—policies regarding reimbursement for specific products (compounds, diabetes items, high-cost injectable drugs, smoking cessation products, ostomy supplies, prosthetics & orthotics, etc.) and for multiple dosage/strength drugs

6 Understanding PharmaCare Benefit Status

  • Section 6 (PDF)—PharmaCare benefit status, Health Canada’s Special Access Programme, Special Authority coverage, Collaborative Prescribing Agreements, drug review process.

7 Coverage Plans

8 Pharmacy Fees & Subsidies & Provider Payment

  • Section 8.1 to 8.3 (PDF)—about fees and subsidies, dispensing fees, Frequency of Dispensing policy
  • Section 8.4 to 8.6 (PDF)—clinical services fees, special services fees, Trial Prescription program
  • Section 8.7 to 8.10 (PDF)—Plan B capitation fees, methadone for maintenance, medication review services, publicly-funded vaccines
  • Section 8.11 to 8.12 (PDF)—Rural Incentive program, payments to pharmacies

9 Privacy

  • Section 9.1 to 9.7 (PDF)—positive identification of patients, confidentiality undertakings, access to patient information, wireless access, patients records, protective words, PharmaNet security

10 Audit

11 Contacts for Practitioners & Providers


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