3.1 Which Transactions to Submit on PharmaNet

General Policy Description

Some transactions (claims and/or information) must be submitted in PharmaNet; some transactions may be submitted in PharmaNet at the provider’s discretion; other transactions must not be submitted in PharmaNet.

Manually submitted claims are entered into PharmaNet by Health Insurance BC (HIBC).

On this page:

Overview

Most transactions for pharmacy products or services delivered or dispensed directly to a patient (e.g., prescription drugs and clinical services) must be submitted in PharmaNet. 

A pharmacy’s Office-Use Medication (O-Meds) transactions must also be submitted in PharmaNet.

Transactions for pharmacy products or services that are not delivered or dispensed directly to a patient (e.g., stock transfers, returns) should be recorded only on the pharmacy’s local system. 

Transactions that must be submitted in PharmaNet include:

• All claims for prescription items, including compounded prescriptions
• Claims for blood glucose test strips
• Claims for insulin pump supplies
• Claims for the specific nicotine replacement therapy (NRT) products covered under the Smoking Cessation Program
• Claims for clinical services, including pharmacist adaptation and renewal of prescriptions, administration of publicly funded vaccines and medication review services 
• Sales of O-Meds to clinics/practitioners

>> For details, refer to Transactions that must be submitted on PharmaNet

Transactions that should not be submitted on PharmaNet include:

• Stock transfers from one pharmacy to another, including emergency supplies of narcotics and controlled drugs
• Sales of inventory to other pharmacies
• Transfers of inventory from a pharmacy to a long-term care facility
• Drug returns to wholesalers

>> For details, refer to Transactions that should not be submitted on PharmaNet

Transactions that may be submitted on PharmaNet OR submitted manually include:

• Claims for prostheses and orthoses
• Claims for ostomy supplies for patients
• Claims for insulin pumps

>> For details, refer to Transactions that may be submitted on PharmaNet OR submitted manually

Transactions that must be submitted manually include:

• Claims for patients using out-of-province (OOP) sites that are enrolled in PharmaCare (because these sites cannot connect to PharmaNet) 

>> For details, refer to Section 4—Offline (Manual) Claims

Policy details

Transactions that must be submitted on PharmaNet

Claims for prescription medications

All prescription medications dispensed in B.C. community pharmacies must be entered in PharmaNet, whether or not the product or patient is covered by PharmaCare.

Recording all dispenses in PharmaNet ensures that 

• A patient’s current medication history is available to authorized healthcare practitioners 
• Authorized healthcare practitioners can accurately identify potential drug-to-drug interactions and check for previous adverse effects from specific drugs

Prescription medications include both compounded prescriptions and medications sold to clinics for office use (refer to Office-Use Medications).

Claims for NRT products covered under the Smoking Cessation Program

To obtain PharmaCare coverage for nicotine replacement therapies for a patient, pharmacies must enter a claim in PharmaNet at the time of purchase using the pharmacist’s Pract ID and the appropriate product information number (PIN).

>> For details, refer to Section 5.20—Smoking Cessation Program Policy.

Claims for clinical services

Pharmacy claims for clinical services must be entered in PharmaNet with the appropriate intervention codes and/or PINs.

>> For details, refer to Section 8.4—Clinical Services Fees
>> For details, refer to Section 8.9—Medication Review Services
>> For details, refer to Section 8.10—Pharmacist Administration of Drugs and Vaccines

Office-use medications (O-Meds)

All O-Meds sold to clinics/practitioners by a community or hospital outpatient pharmacy must be transmitted in PharmaNet using the pharmacy’s unique O-Med PHN and the corresponding keyword designated for that pharmacy. 

O-Med PHNs

A pharmacy that has not been assigned a unique O-Med PHN may obtain one by phoning the PharmaCare Help Desk.

Keywords associated with the O-Med PHN can be changed using the Patient Keyword Maintenance (TCP) transaction. 

Prescriptions for a practitioner’s personal use must be dispensed using the practitioner’s own PHN, not the pharmacy’s O-Med PHN. 

O-Med medication histories

Any questions regarding O-Med medication histories (or any other medication history) on PharmaNet should be directed to the College of Pharmacists of BC (CPBC). 

A pharmacy may use the last-15-prescriptions option (TRR) to review the PharmaNet medication history for its O-Med PHN. 

Dispensing O-Meds

When transmitting claims to PharmaNet for O-Meds, pharmacists should use: 

• O-Med PHN and keyword 
• Date of dispense 
• Intervention Code UA (to eliminate the DUPLICATE message if dispensing the same DIN on the same day) 

PharmaNet returns an error message for O-Med transactions because claims for O-Meds are not adjudicated by PharmaCare. 

PharmaNet does return Drug Use Evaluation messages for O-Med transactions. 

​Reversing O-Med transactions

To reverse an O-Med transaction, use the O-Med PHN, the keyword, and the Intervention Code RE. 

>> For more information, refer to Section 3.16—Claims Reversals

Claims for insulin pump supplies

Only providers may submit claims for insulin pump supplies (i.e., infusion sets/kits and reservoirs/cartridges). Patients cannot submit manual claims for insulin pump supplies.

>> For coverage details, refer to Section 5.18—Insulin Pump Supplies
>> For procedures, refer to the PharmaCare Claims For Insulin Pump Vendors Quick Reference Guide (PDF, 1.2MB)

Transactions that should NOT be submitted on PharmaNet

Stock transfers from pharmacies

Stock transfers include the sale of drug inventories to other pharmacies, including emergency supplies of narcotics and controlled drugs, the transfer or sale of drugs to long-term care facilities and returns of stock to drug wholesalers.

Stock transfer functions are unique to each pharmacy’s local software; direct any questions to your pharmacy software vendor rather than to the PharmaNet Help Desk. 

Stock transfer transactions must not be transmitted in PharmaNet. The record of such transactions must be captured on the local pharmacy system only. 

A pharmacy must not use its O-Med PHN or assign a PHN through PharmaNet for the purpose of stock transfers.

Sale of inventory to other pharmacies

The sale of drug inventory between pharmacies should only be recorded in the local system and should not be transmitted on PharmaNet. The local system software must record the sale of emergency quantities of all drug inventories.

Transfer of inventory from a pharmacy to a long-term care facility

The transfer of inventory to a long-term care facility for future use by the facility should only be recorded in the local system. The stock transfer must not be transmitted in PharmaNet.

The facility’s pharmacist should transmit the patient and prescription information in PharmaNet only when medication is dispensed to a patient in a long-term care facility.

Pharmacy stock returns to wholesaler

The return of drug inventory to the wholesaler should only be recorded on the local system and should not be transmitted in PharmaNet.

Transactions that may be submitted in PharmaNet OR submitted manually

Claims for prostheses and orthoses

Claims for prostheses and orthoses may be made by device providers such as prosthetists, orthotists, ocularists, anaplastologists, mastectomy fitters and/or their companies or businesses if they are enrolled in the appropriate sub-class.  

>> For more information, refer to the Prosthetic and Orthotic Policy Manual

Claims for ostomy supplies

Pharmacy and device providers enrolled in the appropriate sub-class may submit claims for ostomy supplies.

>> For details, refer to Section 5.21—Ostomy Supplies

Claims for insulin pumps

Device providers enrolled in the appropriate sub-class may submit claims for insulin pumps for eligible patients.

>> For details, refer to Section 5.17—Insulin Pumps

Additional information that can be added to a patient’s PharmaNet medication history

Over-the-counter (OTC) and no-public-access (NPA) medications

At the discretion of a pharmacist or medical practitioner, over-the-counter (OTC) and no-public-access (NPA) medications may be added to a patient’s medication history. 

Pharmacists must use their CPBC licence numbers in the Pract ID field and “P1” in the Pract ID Ref field.

As with prescription drugs, entering OTC and NPA medications on a patient’s medication history allows monitoring of medications and use of the Drug Use Evaluation (DUE) function.

​Procedures

• Procedures for all users
• Procedures for pharmacists

Procedures for all users

Submitting transactions in PharmaNet 

If you have access to PharmaNet, enter the transaction in your local system and then submit it in PharmaNet.

Submitting a manual claim for a product or service

If you are enrolled as a PharmaCare provider but do not have access to PharmaNet:

• Submit a manual claim for the product or service, or
• Provide the patient with sufficient information and documentation (i.e., receipts) so that they may submit a manual claim to PharmaCare.

>> For details, see Section 4—Offline (Manual) Claims.

Procedures for pharmacists

Entering OTC and NPA medications in PharmaNet

1. In the Pract ID field, enter your pharmacy’s CPBC licence number.
2. In the Pract ID Ref field, enter P1.