2.6 Dealing with PharmaNet Network Outages

If PharmaCare knows that PharmaNet is going to be unavailable—for example, to make emergency changes—the PharmaNet Help Desk attempts to notify affected users, either by telephone (if the number of users affected is limited) or through a fan-out message (if all users will be affected).

Emergency change windows are communicated using a fan-out message, should time permit.

Regular change window

An eight-hour maintenance interval is scheduled every Thursday morning, from 12:01 am to 8 am. This change window is required for routine and scheduled maintenance on PharmaNet.

Any alteration to this regular change window is communicated in the PharmaCare Newsletter.

Occasionally, PharmaNet is unavailable. Network disruptions can arise from power cuts, problems with regional or core routers, phone line problems, an unexpected spike in transaction volumes, or failures/errors in computer hardware or software.

Normally, the first sign of a network disruption is a message from the local system after it attempts to communicate with PharmaNet but fails. The system then notifies you that the network is unavailable (with error messages such as “timeout” or “not connected to host”).

Pharmacies have two options when PharmaNet is unavailable (“down”):

1. Dispense prescriptions offline—Enter prescriptions into your local system until PharmaNet is available. This option allows you to operate almost normally but you will not have access to Drug Use Evaluation (DUE) or adjudication results until PharmaNet becomes available.
   •  ​When PharmaNet is back online, your local system sends the accumulated transactions as a batch to PharmaNet for DUE checking and adjudication.
   • As soon as convenient, review the DUE results and take action as appropriate.
     Refer to Dispensing offline below for details.
2. Stop dispensing prescriptions until PharmaNet is back online. This disrupts pharmacy business but may be necessary if, for example, your local system is also inoperable.

Device providers can submit claims for adjudication once PharmaNet is operational again.

Processing prescriptions offline calls on professional judgment in treating each patient. Pharmacists must also decide how to deal with payments.

Since there are no pre-set deductibles for Fair PharmaCare, it may be difficult for pharmacies to anticipate an individual’s level of PharmaCare coverage.

Offline payment options

When operating offline, a pharmacy can flag a claim as “pay provider” or “pay cardholder.” When the batched claims are transmitted to PharmaNet and claims are adjudicated, the pharmacy (provider) or patient (cardholder) is reimbursed appropriately.

Offline payment options

Pay cardholder	Collect payment from the patient. PharmaCare will automatically reimburse the patient appropriately.
Pay provider	Do not collect payment from the patient. PharmaCare will automatically reimburse the pharmacy.

You may choose to dispense the full prescription or an emergency supply that will tide the patient over until PharmaNet is operational again.

Pharmacy software restricts your ability to process a prescription without the patient PHN. When PharmaNet is unavailable, a PHN search is not possible, and a PHN cannot be assigned. 

To process a prescription claim offline when PHN is unknown

1. Submit the prescription claim as usual, entering 0009999999998 as the PHN.
   Once PharmaNet is online, the local system submits the batched transaction to PharmaNet. PharmaNet will reject it.
2. When PharmaNet rejects the batched claim, search for, or assign, a valid PHN as if processing the prescription normally.
3. Re-submit the claim on PharmaNet.
   Note: PharmaNet will return the patient medication history and Drug Use Evaluation (DUE) results.
4. As soon as convenient, review the medication history and DUE results, and take appropriate follow-up action as required.