Minor Ailments and Contraception Service (MACS)

On this page: Pharmacist requirements and procedures | SA requests | List of minor ailments | Booking system | Training | Q&As | CareConnect | Resources

Pharmacist requirements and procedures

Pharmacists must complete the PPMAC Regulatory Education module to provide MACS. To claim the MACS fee, they must comply with the standards, limits and conditions set out in the BC Health Professions Act Bylaws Schedule F, Part 8 – Pharmacist Diagnosing and Prescribing, and with the requirements of Minor Ailments and Contraception Service — Section 8.14, PharmaCare Policy Manual. Clinical and practice requirements are outlined by the College of Pharmacists of BC.

To claim the MACS fee, a pharmacist must also:

• Carry out MACS with the patient (or their legal representative) in person—not by telephone or other electronic means
• Provide MACS in a suitable area that the patient accepts as respectful of their right to privacy and that meets their requirements for cultural safety
• Document MACS in accordance with the requirements of Minor Ailments and Contraception Service — Section 8.14, PharmaCare Policy Manual, including using the MACS Form (PDF) or their own form that captures the same information

Pharmacists prescribing in HAs and PCNs

Pharmacists in health authorities and primary care networks can leverage their expertise to prescribe.

Pharmacists that receive a prescription from another pharmacist should fill the prescription as usual and enter in the prescribing pharmacist's name as the prescriber. They cannot claim a MACS assessment fee.

MACS and Plan W clients

Pharmacists are reminded that Plan W covers a variety of over-the-counter (OTC) items that can be recommended as part of MACS or during a regular pharmacy visit. If a pharmacist recommends a Plan W OTC item as part of a MACS assessment, they should:

• Document the recommended item on the MACS form only
• Submit the claim for the OTC in PharmaNet to have it covered under Plan W

If Plan W OTC items are recommended outside of MACS, pharmacists must use the Plan W OTC Recommendation form and enter the medication in PharmaNet.

Ensuring Plan W coverage of OTC medications for FNHA clients is a component of culturally safe pharmacy practice.

View the full list of First Nations Health Benefits (Plan W): Over-the-counter drugs

Steps for pharmacists

1. Inform the patient of the service, confirm the patient's coverage and clinical eligibility, and obtain consent.
2. Review the patient's PharmaNet profile.
3. Determine the nature of the patient’s symptoms, and assess their medical and medication history.
4. Recommend appropriate treatment, which may include medication, self-care advice, and/or advice to see other health care professionals.
5. Provide advice about taking the prescribed or recommended medication, advise them of any potential side effects or interactions, and ensure they know what to do if symptoms do not improve.
6. Establish, implement, document and inform the patient of their follow-up and monitoring plan.

Note that PharmaCare will not reimburse a medication review service claim and a MACS claim for the same patient from the same day. Details are in Minor Ailments and Contraception Service — Section 8.14, PharmaCare Policy Manual.

Submitting a claim

A MACS claim must be entered in PharmaNet on the same day the service is provided. The corresponding PIN and College Registration Identification (Reg ID) of the pharmacist who provided MACS must be included.

Each ailment has 4 PINs to cover the possible outcomes of a MACS assessment. PINs and their descriptions are available on the PINs web page and in the MACS conditions, PINs and drugs reference guide (PDF). The pharmacist must enter the 10-digit pharmacy phone number at the start of the SIG field.

PINs are also required when providing MACS to ineligible patients or virtually. For non-benefit MACS, the pharmacist must enter the minor ailment assessed, at the start of the SIG field, in addition to the phone number .

Special Authority (SA) requests

MACS expands the opportunities for pharmacists to submit SA requests (e.g., through eForms). Pharmacists may request SA coverage for a patient when:

• Prescribing for minor ailments or contraception
• Recommending OTC medications, such as acetaminophen or NRTs
• Adapting a prescription
• Applying for exceptional Plan Z coverage
• Dispensing vancomycin following a hospital stay, or
• Working in a clinical setting in collaboration with a prescriber and with access to the patient’s full medical record (accessing only PharmaNet is insufficient)

List of minor ailments

Booking system

Pharmacies are required to use the provincial booking system to manage MACS appointment bookings, rather than their own systems. Pharmacies are encouraged to also provide MACS to patients who come into the pharmacy without booking an appointment. The MACS booking system is based on the GetVaccinated/ImmsBC booking system platform, and the pharmacist interface is very similar.

Pharmacies with ImmsBC admin access can log in to ImmsBC Classic to input appointment details. To request access, visit the BC Immunization Portal on the BC Pharmacy Association (BCPhA) website, whether or not you are a BCPhA member.

Training

1. The College of Pharmacists of BC's  PPMAC Regulatory Education module is mandatory for pharmacists participating in MACS.

2. UBC Continuing Pharmacy Professional Development offers free, accredited clinical education modules on several minor ailment conditions to licensed B.C. pharmacists. Courses include:

• Prescribing for Minor Ailments –Introduction - with modules on:
  • Infectious diseases (uncomplicated UTI, impetigo)
  • Dermatology (atopic/eczema, allergic and contact skin rashes, hives, insect bites and stings)
  • Eye, ear, nose and throat (conjunctivitis and allergic rhinitis)
  • Gastrointestinal and oral (GERD, hemorrhoids, cold sores and oral thrush)
  • Pain (musculoskeletal sprains and strains, dysmenorrhea)
• Allergic Rhinitis
• MACS: Acne Vulgaris
• MACS: Dyspepsia
• MACS: Fungal Skin Infections
• MACS: Headache
• MACS: Oral Ulcers
• MACS: Shingles
• MACS: Threadworms and Pinworms
• MACS: Tobacco Use Disorder
• MACS: Vaginal Candidiasis
• UTIs Simple answers for burning questions
• Contraception Part I – Hormonal Contraception, LARC, and Permanent Contraception
• Contraception Part 2 – Emergency Contraception 
• Case-Based Learning – Contraception
• Case-Based Learning – Emergency Contraception

To access these and more courses, visit the UBC MACS on Canvas course catalog. 

3. medSask’s Minor ailment and self-care guidelines are free to B.C. pharmacists and pharmacy students through the BC Pharmacy Association (BCPhA) website. They include treatment algorithms and patient assessment checklists. If you do not have a BCPhA account/are not a member, you can sign up for a complimentary account. Note that medSask materials may not reflect the standards, limits and conditions set out by the College of Pharmacists of BC, or PharmaCare requirements for the MACS fee.

The BCPhA's MACS Orientation course includes case studies in urinary tract infections, shingles, cold sores and contraception. Refer to MACS Education & Resources page.

Q&As

Q: Can pharmacies opt out of billing PharmaCare for a MACS provided in-pharmacy to a B.C. resident?

A: No, pharmacies cannot opt out of claiming PharmaCare-funded services in order to charge a patient directly, unless the pharmacy is not registered with PharmaCare (i.e., have opted out of all PharmaCare services, including drug billing). This is consistent with PharmaCare's Full Payment Policy.

Q:  Can a pharmacy charge patients directly for MACS if the patient is not eligible for MACS or if the service is out of scope?

A: Yes. Patients who are not eligible can choose to receive the service from pharmacies under a private-pay model. In this case, the pharmacy would use one of the non-benefit MACS PINs.

Q: Can pharmacy students provide MACS and claim the MACS fee?

A: No

Q: Does the PS intervention code need to be entered with every claim or just on the first dispense (if dispensed as part of a client's weekly blister pack)?

A: The PS intervention code should be entered on the first dispense and does not need to be entered again for refills. This is similar to using an intervention code for adaptation.

Q: Does the pharmacy need to remove the dispensing fee from each claim if they prescribe for weekly/daily dispensing?

A: Yes. Pharmacies will need to manually remove the dispensing fee or dispense the MACS Rx last, anticipating PharmaNet will reject the dispensing fee due to FOD limits. Note: if the dispensing fee is not claimed to PharmaCare, it will not be passed down to the third-party insurers, as PharmaCare is the first payor.

Q: If MR-PCN and MACS fees are claimed on same day, will MACS be paid?

A: Yes

Q: Are military personnel without MSP eligible for coverage for MACS?

A: Yes

Q: Can a pharmacist add refills when they prescribe?

A: Yes

Q:  Can a patient request a phone consult for MACS and ask their family member to pick up their medication for them?

A: Yes, but phone or virtual consults are not reimbursed by PharmaCare. When providing services that are not eligible for the MACS fee, pharmacists must use a non-benefit MACS PIN.

Q: Can a pharmacist prescribe for minor ailments and claim the MACS fee if they provide a consultation outside of the pharmacy (for example, as part of an in-home visit)?

A: Yes, if the following conditions are met.

• The prescribing pharmacist is an employee or independent contractor of a PharmaCare-enrolled pharmacy that has PharmaNet access
• The pharmacist checks PharmaNet while physically at the pharmacy before the offsite visit
  • If a pharmacist working offsite needs to re-check PharmaNet, they may call their pharmacy for someone onsite to check
  • No offsite (remote) access to PharmaNet is permitted
• The pharmacist submits the claim at the PharmaCare-enrolled pharmacy on the day of the MACS assessment

Q: Is a pharmacy paid the MACS fee for consulting with a client about emergency contraception?

A: Yes. Pharmacists can use the contraception PINs for emergency contraception, if the patient wishes to have an assessment. Patients may also choose to self-select emergency contraception without a MACS, in which case, the fee may not be claimed.

A note about CareConnect

Pharmacists are not required to use CareConnect, but they are strongly encouraged to sign up, as it provides access to lab results that can be invaluable in informing a clinical assessment.