8.4 Clinical Services Fees
Last updated on November 20, 2024General Policy Description
PharmaCare pays pharmacies enrolled as PharmaCare providers set amounts for providing clinical services associated with prescription adaptation by a pharmacist for residents of B.C.
Clinical services fees can be claimed whether or not the drug or the patient is covered by PharmaCare.
The maximum amount PharmaCare reimburses a pharmacy for any combination of medication reviews, clinical services (e.g., prescription adaptation), and drug and vaccine administrations for the same patient, on the same day is $78.00.
Policy details
Eligibility
Any pharmacy that is a PharmaCare provider can claim the clinical services fee. The client they provide the clinical service to does not need to be covered by PharmaCare.
Definition of prescription adaptation
Fees can only be claimed for prescription adaptation as defined by the College of Pharmacists of BC Professional Practice Policy 58 (PPP-58):
- Renewing a prescription
- Changing the dose, formulation or regimen of a prescription
- Making a therapeutic drug substitution within the same therapeutic class
PharmaCare may recover clinical services fees paid for services that are not consistent with the PPP-58 definition of prescription adaptation.
Clinical services fees must be claimed when a clinical service has been performed. For adaptations, a clinical services fee can be claimed on the first dispense of the adapted prescription, and not on any refills.
Ineligible claims
A clinical services fee cannot be claimed:
- For emergency fills
- For emergency contraceptives
- For refills of an adapted prescription. Only a dispense fee can be claimed for refills
- For contacting a physician to clarify a concern, amend a prescription, or dispense an interchangeable drug
Maximum clinical services fee
The maximum clinical services fee for adaptation is
- $10.00 for a prescription renewal or for changing a dose, formulation, or regimen
- $17.20 for making a therapeutic substitution
Maximum number of fees
The Ministry pays a maximum of two clinical services fees per drug, per person during a six-month period.
Payment schedule
Clinical services fees are paid monthly.
Full payment policy
The Full Payment Policy applies to clinical services fees. This means that pharmacies cannot solicit or accept additional payment from a patient or any other party for services associated with prescription adaptation. If the pharmacy requests or accepts any such fees or payments, PharmaCare may recover all clinical services fees paid to the pharmacy and may refuse to pay additional clinical services fees to the pharmacy.
Relationship between dispensing and special services fees
Special services fees cannot be claimed for a prescription for which a clinical services fee is being claimed.
If the situation is consistent with the College of Pharmacists of BC’s Professional Practice Policy 58, and the pharmacist is adapting the prescription in a situation in which the alternative is to refer a patient back to the prescriber, it is appropriate to claim a clinical services fee. If however, the pharmacist decides it is in the patient’s best interest to refer them to the prescriber without filling the prescription, the pharmacist can not claim a clinical services fee, but may be eligible for a special services fee, if the prescription would have been a PharmaCare benefit for that patient.
Procedures
Submitting claims for prescription adaptation
Clinical services fees are paid based on the number of claims a pharmacy submits with specific intervention codes (below). Do not submit the clinical services fee amount with the claim.
To submit a claim for a clinical services fee:
- PRACT ID Ref field: enter P1 (for College of Pharmacists of BC)
- PRACT ID field: enter your College ID.
- SIG (directions) field: enter Adapted at the beginning of the field (unless leveraging PharmaNet PPM version 70 software, which automatically marks the record as an adaptation), and additional directions after. Putting "adapted" at the beginning lets other health practitioners easily recognize it is not the original prescription.
- Include the appropriate clinical services fee intervention code. Clinical services fees will not be paid for claims that do not have the appropriate intervention code.
| Code | Description |
|---|---|
| NI | dosage change |
| NJ | formulation change |
| NK | directions for use modified |
| NL | renewal of prescription |
| NM | therapeutic substitution |
Reconciling clinical services claims with payments
Pharmacies can call the PharmaNet Help Desk to find out whether a claim for clinical services has been accepted (paid) or rejected (not paid).
Help Desk staff can access payment and claim details for specific pay periods, and can fax a copy of these details (with patient identifiers removed) if requested.
Procedure for entering emergency fill and emergency contraceptive claims
Use the following procedure to submit claims for an emergency fill or for emergency contraceptives. These claims are not eligible for a clinical services fee.
- In the PRACT ID Ref field, enter P1 — College of Pharmacists of BC.
- In the PRACT ID field, enter your College ID.
- Include the appropriate intervention code.
| Code | Description |
|---|---|
| NN | emergency supply of medication |
| NO | emergency contraceptive |