8.4 Clinical Services Fees

Patients do not need to be covered by PharmaCare to qualify for reimbursement of clinical services fees.

Fees are paid only for prescription adaptation as defined by the College of Pharmacists of BC Professional Practice Policy 58 (PPP-58). That is:

1. Renewing a prescription.
2. Changing the dose, formulation or regimen of a prescription.
3. Making a therapeutic drug substitution within the same therapeutic class.

PharmaCare may recover clinical services fees claimed for services that are not consistent with the PPP-58 definition of prescription adaptation.

Claims for emergency fills, and emergency contraceptive claims are not eligible for payment of clinical services fees. See Procedures below.

The maximum clinical services fee is

• $10.00 for a prescription renewal or for changing a dose, formulation, or regimen
• $17.20 for making a therapeutic substitution

The Ministry pays a maximum of two clinical services fees per drug, per person during a six-month period.

All pharmacies enrolled as PharmaCare providers qualify to receive clinical services fees.

Clinical services fees are paid monthly.

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.

Clinical services fees are paid in addition to the normal dispensing fee.

Special services fees are not paid for a prescription for which a clinical services fee is paid.

Clinical services fees are paid based on the number of claims a pharmacy submits with specific intervention codes. Do not submit the clinical services fee amount itself with the claim.

To submit a claim eligible for a clinical services fee:

1. In the PRACT ID Ref field, enter P1 (for College of Pharmacists of BC)
2. In the PRACT ID field, enter your College ID.
3. At the beginning of the SIG ("directions") field, type Adapted.
   
   It is important that the word "Adapted" appear at the beginning of the SIG field. This ensures other health care practitioners can easily recognize that this is not the original prescription.
    
4. Include the appropriate clinical services fee intervention code listed below to flag the claim for clinical services fee payment. Clinical services fees will not be paid for claims lacking an appropriate intervention code.

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.

Please 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.

1. In the PRACT ID Ref field, enter P1 — College of Pharmacists of BC.
2. In the PRACT ID field, enter your College ID.
3. Include the appropriate intervention code.

If the situation is consistent with the College of Pharmacists of BC’s Professional Practice Policy 58, and you are adapting the prescription in a situation where the alternative is to refer a patient back to the prescriber, it is appropriate to enter a clinical services fee intervention code. If, however, you decide it is in the patient’s best interest to refer them to the prescriber without filling the prescription, you are not eligible for 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.

PharmaCare will not pay both a clinical services fee and special services fee for a single claim.

No. Clinical services fee are paid only if there are no refills left on the original prescription. Refills authorized under the original prescription are eligible for the usual dispensing fee only.

No. Because you are not performing an adaptation as defined in the College of Pharmacists of BC’s Professional Practice Policy 58, you would not be eligible for a clinical services fee.

An adaptation fee can only be charged once, at the time of the adaptation. Refills on adapted prescriptions are not eligible for adaptation fee claims.