PharmaCare Policy Manual

• Section 1 About PharmaCare

• Section 2.1 PharmaCare Enrolment
• Section 2.2 Non-Pharmaceutical Supplier Participation Agreement (Removed)¹
• Section 2.3 What is PharmaNet?
• Section 2.4 Connecting to PharmaNet
• Section 2.5 Changes to PharmaNet Connections
• Section 2.6 Dealing with PharmaNet Network Outages
• Section 2.7 Fan-Out Messages

¹Non-pharmaceutical suppliers now enroll as device providers under the Provider Regulation.

For response and intervention codes, see Appendix A (PDF, 222KB) and Appendix B (PDF, 215KB).

• Section 3.1 Which Transactions to Submit on PharmaNet
• Section 3.2 Patients: Identification
• Section 3.3 Patients: Personal Health Numbers
• Section 3.4 Patients: Other Payers
• Section 3.5 Patients: Restricted Claimant Program
• Section 3.6 Patients: With Out-of-Province and Out-of-Country Prescriptions
• Section 3.7 Medical Practitioners: Prescriber IDs & Practitioner Reference IDs
• Section 3.8 (Removed)
• Section 3.9 Medical Practitioners: Authorized Prescribing
• Section 3.10 Medical Practitioners: Practicing Status and Practitioner Restrictions
• Section 3.11 Medical Practitioners: BC Prescription Review Program
• Section 3.12 Drug and Product Identification Numbers
• Section 3.13 Correct Quantities
• Section 3.14 Drug Use Evaluation (DUE)
• Section 3.15 Drug Monograph Information
• Section 3.16 Claim Reversals
• Section 3.17 Prescription Discontinuations
• Section 3.18 Claims for Drug Cost Exceeding $9,999.99
• Section 3.19 Recording Adverse Drug Reaction and Allergy Information in PharmaNet

• Section 4.1 Claims by Offline and Out-of-Province Providers
• Section 4.2 Manual Patient Claims

• Section 5.1 Maximum Days Supply Policy
• Section 5.2 Refilling Prescriptions Too Soon Policy
• Section 5.3 Refilling Prescriptions on the Same Day Policy
• Section 5.4 Travel Supply Policy
• Section 5.5 Correct Quantities Policy
• Section 5.6 Maximum Pricing Policy
• Section 5.7 Actual Acquisition Cost Policy
• Section 5.8 High-Cost Drugs Policy
• Section 5.9 Retail Pricing Policy
• Section 5.10 Full Payment Policy
• Section 5.11 Low Cost Alternative Program
• Section 5.12 Reference Drug Program (RDP)
• Section 5.13 Compounded Prescriptions
• Section 5.14 Insulin
• Section 5.15 Needles and Syringes
• Section 5.16 Blood Glucose Testing
• Section 5.17 Insulin Pumps
• Section 5.18 Insulin Pump Supplies
• Section 5.19 Reimbursement for Non-Returnable High-cost Injectable Drugs
• Section 5.20 Smoking Cessation Program Policy
• Section 5.21 Ostomy Supplies
• Section 5.22 Prosthetics and Orthotics
• Section 5.23 Pricing Exceptions Where Multiple Dosage Forms or Strengths Are Available

• ​Section 6.1 Benefit Status Types
• Section 6.2 Health Canada’s Special Access Program Drugs
• Section 6.3 Special Authority Coverage
• Section 6.4 Collaborative Prescribing Agreements
• Section 6.5 Drug Review Process

• Section 7.1 Plans Overview
• Section 7.2 Fair PharmaCare
• Section 7.3 Long-term Care (Plan B)
• Section 7.4 Recipients of Income Assistance (Plan C)
• Section 7.5 Cystic Fibrosis (Plan D)
• Section 7.6 Children in the At Home Program (Plan F)
• Section 7.7 Psychiatric Medications (Plan G)
• Section 7.8 Palliative Care (Plan P)
• Section 7.9 Medication Management (Plan M)
• Section 7.10 Smoking Cessation Program (Plan S)
• Section 7.11 British Columbia Centre for Excellence in HIV/AIDs (Plan X)
• Section 7.12 First Nations Health Benefits (Plan W)
• Section 7.13 Assurance (Plan Z)

• Section 8.1 About Pharmacy Fees and Subsidies
• Section 8.2 Dispensing Fees
• Section 8.3 Frequency of Dispensing Policy: Fee Limits
• Section 8.4 Clinical Services Fees
• Section 8.5 Special Services Fees
• Section 8.6 Trial Prescription Program
• Section 8.7 Capitation Fees for Plan B (Long-term Care)
• Section 8.8 Methadone Maintenance Payment Program
• Section 8.9 Medication Review Services
• Section 8.10 Pharmacist Administration of Drugs and Vaccines
• Section 8.11 Rural Incentive Program
• Section 8.12 Payments to Providers
• Section 8.13 Payments for Patient Support Fees
• Section 8.14 Minor Ailments and Contraception Service (MACS)
• Section 8.15 Rapid antigen test kit distribution

• Section 9.1 Positive Identification of Patients
• Section 9.2 Confidentiality Agreements
• Section 9.3 Access to Patient Information
• Section 9.4 Wireless Access
• Section 9.5 Patient Records
• Section 9.6 Protective Words
• Section 9.7 PharmaNet Security

• Section 10.1 PharmaCare Audit Policies

• Section 11.1 PharmaNet Help Desk
• Section 11.2 Information Support, Health Insurance BC
• Section 11.3 PharmaCare Information Line
• Section 11.4 PharmaCare/PharmaNet Medical Practitioner Line
• Section 11.5 PharmaCare Website

• Appendix A Response Codes — PharmaNet adjudication response codes
• Appendix B Intervention Codes — PharmaNet intervention and exception codes
• Appendix C Reference Codes — Practitioner ID reference codes