8.11 Rural Incentive Program

General Policy Description

Rural pharmacies that meet certain criteria can apply to receive a subsidy for each claim submitted for any month in which the volume of claims submitted and paid (fully or partially) by PharmaCare is below a specific threshold. Payments are made directly to the pharmacy by PharmaCare.

Policy details

Program overview

Under the program, rural pharmacies receive a subsidy for each claim submitted if the volume of claims submitted and paid (fully or partially) by PharmaCare during the month is below a specific threshold. 

Payments are made directly to the pharmacy by PharmaCare on a monthly basis.

Pharmacies do not have to change the way in which claims are submitted. 

Qualifying criteria

The enhanced program is extended to rural community pharmacies and telepharmacies if the

• Pharmacy applies for the program; and 
• Pharmacy is the only pharmacy in the community; and 
• Next nearest pharmacy is more than a 25 km driving distance away; or
• Next nearest pharmacy requires paid ferry travel to access it; and
• Number of PharmaCare claims submitted by the pharmacy does not exceed 1700 per month

Telepharmacies that receive operational subsidies from a Health Authority are not eligible for the program.

Subsidies

Pharmacies with lower monthly claim volumes receive a larger subsidy for each claim.

If PharmaCare‐paid claims for a particular month exceed 1,700, no subsidy is paid.

The subsidies, calculated and paid monthly, are based on a sliding scale:

• The maximum is $10.50 per claim.
  With each additional claim made within a month, the per-claim amount for the month decreases.
• The minimum subsidy is $3.00 per claim.

For example, a pharmacy that submits 425 PharmaCare‐paid claims over the course of a month will receive a subsidy of $8.63 per claim. A pharmacy that submits 1,700 PharmaCare‐paid claims in a month will receive a subsidy of $3.00 per claim.

Payment limits

Payments cannot be made for partial months.

New pharmacies become eligible for the subsidy the month following the month in which their application is accepted.

Procedures

Complete the Application for the Rural Incentive Program (HLTH 5384)(PDF, 514KB) or contact the PharmaNet Help Desk to request a form. 

Tools and Resources

Application for the Rural Incentive Program (HLTH 5384)(PDF, 514KB)