3.1 Which Transactions to Submit on PharmaNet
General Policy Description
Some transactions (claims and/or information) must be submitted on PharmaNet; some transactions may be submitted on PharmaNet at the provider’s discretion; other transactions must not be submitted on PharmaNet.
Manually-submitted claims are entered into PharmaNet by Health Insurance BC.
Most transactions for pharmacy products or services delivered dispensed directly to a patient (e.g., prescription drugs and clinical services) must be submitted on PharmaNet.
A pharmacy’s Office-Use Medications (O-Meds) transactions must also be submitted on PharmaNet.
Transactions for pharmacy products or services that are not delivered dispensed directly to a patient (e.g., stock transfers, returns) should only be recorded only on the pharmacy’s local system.
Transactions that must be submitted on 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, pharmacist-administered publicly funded vaccines and Medication Review Services
- Sales of O-Meds to clinics/practitioners
>> For details, see Transactions that must be submitted on PharmaNet below.
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 residential care facility
- Drug returns to wholesalers
>> For details, see Transactions that should NOT be submitted on PharmaNet below.
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, see Transactions that may be submitted on PharmaNet OR submitted manually below.
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, see Section 4–Offline (Manual) Claims.
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 on PharmaNet ensures that
- A patient’s current medication history is available to authorized health care practitioners
- Authorized health care 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 (see Office-Use Medications below).
To obtain PharmaCare coverage for nicotine replacement therapies for a patient, pharmacies must enter a claim on PharmaNet at the time of purchase using the pharmacist’s Pract ID and the appropriate Product Information Number (PIN).
>> For details, see the procedures included in Section 5.20–Smoking Cessation Program Policy.
Pharmacy claims for clinical services must be entered on PharmaNet with the appropriate intervention codes and/or PINs.
>> For details, see Section 8.4–Clinical Services Fees.
>> For details, see Section 8.10–Payment for Publicly Funded Vaccinations.
>> For details, see Section 8.9–Medication Review Services.
All O-Meds sold to clinics/practitioners by a community or hospital out-patient pharmacy must be transmitted on PharmaNet using the pharmacy’s unique ‘O-Med PHN’ and the corresponding keyword designated for that pharmacy.
A pharmacy that has not been assigned a unique O-Med PHN may obtain one by phoning the PharmaNet 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 number.
If the pharmacy dispenses a high volume of O-Meds, the return of a full record (TRP transaction) on PharmaNet may take longer than five seconds.
When transmitting claims to PharmaNet for O-Meds, pharmacists should use:
- Their O-Med PHN and keyword
- The date of dispense
- The 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, see Section 3.16–Claims Reversals.
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, see Section 5.18–Insulin Pump Supplies.
>> For detailed procedures, see the PharmaCare Claims For Insulin Pump Vendors Quick Reference Guide (PDF, 1.2MB).
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 residential care facilities and returns of stock to drug wholesalers.
Stock transfer functions are unique to each pharmacy’s local software. Please direct any questions to your pharmacy software vendor rather than to the PharmaNet Help Desk.
Stock transfer transactions must NOT be transmitted on 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.
The sale of drug inventory between pharmacies should only be recorded on 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.
The transfer of inventory to a residential care facility for future use by the facility should only be recorded on the local system. The stock transfer must not be transmitted on PharmaNet.
The facility’s pharmacist should transmit the patient and prescription information on PharmaNet only when medication is dispensed to a patient in a residential care facility.
The return of drug inventory to the wholesaler should only be recorded on the local system and should not be transmitted on PharmaNet.
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, see the Prosthetic and Orthotic Policy Manual (PDF, 850KB).
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.
Submitting transactions on PharmaNet
If you have access to PharmaNet, enter the transaction in your local system and then submit it on 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.
Entering OTC and NPA medications on PharmaNet
- In the Pract ID field, enter your pharmacy’s CPBC licence number.
- In the Pract ID Ref field, enter P1.