8.14 Minor Ailments and Contraception Service
Last updated on April 23, 2024Effective June 1, 2023, pharmacists in British Columbia are enabled to prescribe for certain minor ailments and contraception through Ministerial Order 114/2023 (PDF).
General Policy Description
B.C. pharmacies can submit claims to PharmaCare for providing a Minor Ailments and Contraception Service (MACS) to eligible patients. MACS can only be provided by pharmacists who have completed the PPMAC Regulatory Education module, and for the minor ailments listed in Schedule A of Ministerial Order 114/2023 or for contraception.
MACS is provided through a private in-person visit during which the pharmacist conducts a comprehensive assessment and offers clinical advice and treatment for minor ailments and/or contraception needs. The pharmacist may prescribe medications, offer non-prescription medications, make non-pharmacological recommendations, and/or advise the patient to seek medical attention from a physician or other health care professional.
This policy standardizes how PharmaCare MACS is delivered across B.C. For details on standards, limits and conditions, and other information related to diagnosing or prescribing, refer to the College of Pharmacists of BC’s Pharmacist Prescribing for Minor Ailments and Contraception (PPMAC).
Policy Details
Pharmacists should ensure they know the entire contents of this section of the PharmaCare Policy Manual before delivering and submitting claims for MACS.
1. Determining patient eligibility
Before conducting MACS for a consenting patient for which a claim will be submitted, pharmacists must ensure the patient is eligible for PharmaCare coverage of the service.
To be eligible to receive PharmaCare-covered MACS, the patient must meet all criteria in the table below:
| The patient must | Notes |
|---|---|
| Be a resident of B.C. | Must have a permanent address in B.C., verified by a B.C. driver’s licence, BC Services Card or other ID |
| Have a BC Personal Health Number (PHN) | B.C. residents with a PHN are eligible, even if they are not covered by or registered with PharmaCare, such as beneficiaries of Non-Insured Health Benefits and Canadian Armed Forces |
| Not be covered under PharmaCare Plan B (Long-term Care) | Patient is under the care of another healthcare provider |
| Have a clinical need for service | Patient must self-identify as having a minor ailment listed under Schedule A of the Pharmacists Regulation or a contraception need, and must initiate a request for MACS |
Time interval between assessments
The minimum time interval between assessments for the same minor ailment or for contraception for the same eligible patient is three days. For example, if a claim was submitted on Monday, the 3-day interval would be Tuesday to Thursday, and an assessment can be eligible for another PharmaCare claim for the same minor ailment or contraception for the same patient on Friday. Claims are adjudicated in monthly batches.
Minor ailments and contraception - PINs and description
| Condition | PIN Description (PA – Pharmacist Assessment) (HCP – healthcare provider) |
PINs1 |
|---|---|---|
| Acne, mild | PA acne-RX | 98890001 |
| PA acne-RX other HCP | 98890002 | |
| PA acne-no RX | 98890003 | |
| PA acne-no RX other HCP | 98890004 | |
| Allergic rhinitis | PA allergy-RX | 98890005 |
| PA allergy-RX other HCP | 98890006 | |
| PA allergy-no RX | 98890007 | |
| PA allergy-no RX other HCP | 98890008 | |
Conjunctivitis
|
PA pink eye-RX | 98890009 |
| PA pink eye-RX other HCP | 98890010 | |
| PA pink eye-no RX | 98890011 | |
| PA pink eye-no RX other HCP | 98890012 | |
| Contraception | PA contraception-RX | 98890013 |
| PA contraception-RX other HCP | 98890014 | |
| PA contraception-no RX | 98890015 | |
| PA contraception-no RX other HCP | 98890016 | |
Dermatitis
|
PA dermatitis-RX | 98890017 |
| PA dermatitis-RX other HCP | 98890018 | |
| PA dermatitis-no RX | 98890019 | |
| PA dermatitis-no RX other HCP | 98890020 | |
| Dysmenorrhea | PA menstrual pain-RX | 98890021 |
| PA menstrual pain-RX other HCP | 98890022 | |
| PA menstrual pain-no RX | 98890023 | |
| PA menstrual pain-no RX other HCP | 98890024 | |
Fungal infections
|
PA fungal infx-RX | 98890029 |
| PA fungal infx-RX other HCP | 98890030 | |
| PA fungal infx-no RX | 98890031 | |
| PA fungal infx-no RX other HCP | 98890032 | |
| GERD/dyspepsia | PA GERD/dyspepsia-RX | 98890033 |
| PA GERD/dyspepsia-RX other HCP | 98890034 | |
| PA GERD/dyspepsia-no RX | 98890035 | |
| PA GERD/dyspepsia-no RX other HCP | 98890036 | |
| Headache | PA headache-RX | 98890037 |
| PA headache-RX other HCP | 98890038 | |
| PA headache-no RX | 98890039 | |
| PA headache-no RX other HCP | 98890040 | |
| Hemorrhoids | PA hemorrhoid-RX | 98890041 |
| PA hemorrhoid-RX other HCP | 98890042 | |
| PA hemorrhoid-no RX | 98890043 | |
| PA hemorrhoid-no RX other HCP | 98890044 | |
| Herpes labialis (cold sores) | PA cold sore-RX | 98890045 |
| PA cold sore-RX other HCP | 98890046 | |
| PA cold sore-no RX | 98890047 | |
| PA cold sore-no RX other HCP | 98890048 | |
| Impetigo | PA impetigo-RX | 98890049 |
| PA impetigo-RX other HCP | 98890050 | |
| PA impetigo-no RX | 98890051 | |
| PA impetigo-no RX other HCP | 98890052 | |
| Oral ulcers (canker sores, aphthous ulcers) | PA canker sore-RX | 98890053 |
| PA canker sore-RX other HCP | 98890054 | |
| PA canker sore-no RX | 98890055 | |
| PA canker sore-no RX other HCP | 98890056 | |
| Oropharyngeal candidiasis (oral thrush) | PA oral thrush-RX | 98890057 |
| PA oral thrush-RX other HCP | 98890058 | |
| PA oral thrush-no RX | 98890059 | |
| PA oral thrush-no RX other HCP | 98890060 | |
| Musculoskeletal sprains and strains | PA MSK pain-RX | 98890061 |
| PA MSK pain-RX other HCP | 98890062 | |
| PA MSK pain-no RX | 98890063 | |
| PA MSK pain-no RX other HCP | 98890064 | |
| Shingles (herpes zoster) | PA shingles-RX | 98890065 |
| PA shingles-RX other HCP | 98890066 | |
| PA shingles-no RX | 98890067 | |
| PA shingles-no RX other HCP | 98890068 | |
| Nicotine dependence | PA nicotine-RX | 98890069 |
| PA nicotine-RX other HCP | 98890070 | |
| PA nicotine-no RX | 98890071 | |
| PA nicotine-no RX other HCP | 98890072 | |
| Threadworms or pinworms | PA pinworm-RX | 98890073 |
| PA pinworm-RX other HCP | 98890074 | |
| PA pinworm-no RX | 98890075 | |
| PA pinworm-no RX other HCP | 98890076 | |
| Urinary tract infection (uncomplicated) | PA UTI-RX | 98890077 |
| PA UTI-RX other HCP | 98890078 | |
| PA UTI-no RX | 98890079 | |
| PA UTI-no RX other HCP | 98890080 | |
| Urticaria, including insect bites | PA hives/bites-RX | 98890081 |
| PA hives/bites-RX other HCP | 98890082 | |
| PA hives/bites-no RX | 98890083 | |
| PA hives/bites-no RX other HCP | 98890084 | |
| Vaginal candidiasis (yeast infection) | PA yeast infx-RX | 98890085 |
| PA yeast infx-RX other HCP | 98890086 | |
| PA yeast infx-no RX | 98890087 | |
| PA yeast infx-no RX other HCP | 98890088 |
1Refer to the submitting claims section
Minor ailment and contraception services not eligible for MACS fee
PharmaCare will not pay pharmacies the fee for MACS provided to ineligible patients or for virtual services. When providing services that are not eligible for the MACS fee, please use the appropriate non-benefit PIN shown below.
| Service description | PIN |
|---|---|
| Non-benefit MACS | 98890089 |
| Virtual non-benefit MACS | 98890090 |
Federally insured B.C. residents
PharmaCare will pay pharmacies for MACS provided to federally insured B.C. residents, including individuals insured under Non-Insured Health Benefits, Veteran Affairs Canada and Canadian Armed Forces, as long as their insurance does not cover a service that is the same as MACS.
| Service description | PIN |
|---|---|
| MACS for federally insured B.C. residents | 9800091 |
2. Required activities for MACS
When a pharmacist delivers MACS, they must do so in accordance with the standards, limits and conditions defined by the BC Health Professions Act Bylaws Schedule F, Part 8 – Pharmacist Diagnosing and Prescribing. In addition, the pharmacist must:
- Conduct a consultation with the patient or their legal representative*, if applicable, in person (and not by telephone or any other electronic means)
- Provide MACS in a suitable area that the patient accepts as respectful of their right to privacy, and meets their requirements for cultural safety
- Document the assessment in accordance with the requirements of this policy
For MACS to be eligible for PharmaCare reimbursement, the following activities must be carried out and documented on the MACS form:
- Inform the patient of the service, ensure their coverage eligibility and clinical eligibility, and obtain informed consent before initiating the service.
- Review the patient's PharmaNet profile.
- Determine the nature of the patient’s symptoms and assess their medical and medication history.
- Recommend appropriate treatment, which may include medication, self-care advice, and/or advising the patient to see other appropriate health care professional(s)(HCP), if necessary.
- Provide advice on how to take the prescribed or recommended medication, any potential side effects or interactions, and what to do if the symptoms do not improve.
- Establish, implement, document and inform the patient of their follow-up and monitoring plan. This may include:
- Informing the patient of the need for follow-up with the pharmacist to monitor the effectiveness and safety of treatment;
- Monitoring the patient for any adverse drug events and the patient’s response to treatment;
- Stopping drug therapy if it is not effective or the risks outweigh the benefits; and
- Informing the patient when to seek medical attention from another health care provider.
*In BC, an acceptable legal representative for a patient must be acting under a representation agreement under the Representation Agreement Act or a committee appointed under the Patients Property Act. Whenever someone is acting on a patient’s behalf, the pharmacy must retain documentation of that person’s right to act as the patient’s legal representative.
3. Documenting MACS
Pharmacies that submit MACS claims must retain complete documentation to support their claim.
Documenting MACS:
- Provides patients, caregivers, other healthcare professionals and, in rare cases, the BC Coroners Service, with accurate, complete, and current information about the assessment and recommendations
- Provides auditable proof that an eligible MACS occurred
Required documentation
Following are the minimum documentation requirements for a PharmaCare claim:
- The full name of the patient, patient phone number, and PHN
- Confirmation of informed consent
- The minor ailment of concern or contraception request
- Confirmation of PharmaNet check
- Confirmation of patient eligibility
- Patient assessment, including a description of signs and symptoms, review of relevant medical history and medications, and diagnosis. If a diagnosis is outside the scope of the pharmacist, it can be indicated as “advised to see another healthcare provider as out of scope”
- Recommendations, including:
- Whether a prescription was issued
- Whether the patient was advised to see another healthcare provider, and
- Details of prescription and/or other recommendations, including non-pharmacological or self-care strategies
- Monitoring and follow-up plan
- Notification to primary care provider, if applicable, including date and method of notification. Any notification must be on the same day the MACS was conducted.
- Pharmacy name, phone number, and address; printed name of pharmacist and licence number; pharmacist signature and date signed. The date signed must match the date of the MACS service delivery
A sample MACS form (under Resources below) is included as a reference. Pharmacies may use the template to record required information or create their own forms. Claims for MACS will be subject to recovery if the form does not include all the required information.
Document retention and storage
Documents must be retained on paper or electronically in the same manner as other patient records. For more information, see Provider Recordkeeping Requirements.
4. Claiming MACS fees
If MACS is provided to an eligible patient, pharmacies must not request or accept additional fees or payment from the patient or a third-party payer.
To support a claim, the completed and original MACS form must be retained in a manner accessible for audit.
PharmaCare will pay pharmacies $20 for each MACS provided to an eligible patient. The MACS fee will be included in the $78 PharmaCare maximum daily limit. (See note below regarding medication reviews.)
The claim must be submitted to PharmaNet on the date the MACS is provided. The appropriate PIN and College Registration Identification (Reg ID) of the pharmacist who provided the MACS must be submitted with the claim.
The pharmacy must enter the 10-digit pharmacy phone number at the start of the SIG field to facilitate sharing of information within the patient’s circle of care.
Medication Review Services and MACS
PharmaCare will not reimburse a medication review service claim and a MACS claim for the same patient if both are conducted on the same day.
Frequent dispensing
PharmaCare will not reimburse pharmacies for dispensing fees when they prescribe medications for daily and/or frequent dispensing.
Procedures
Submitting claims
Claims for MACS must be entered in PharmaNet on the date of the assessment, using the appropriate PIN. Contraception and each minor ailment have a set of four PINs that indicate whether a Schedule I drug was prescribed and whether the patient was advised to seek medical attention from another health care professional.
Use PINs with RX for assessments that resulted in a Schedule 1 drug being prescribed and the patient was not advised to seek medical attention from another healthcare professional.
Use PINs with RX other HCP for assessments that resulted in a Schedule 1 drug being prescribed and the patient was advised to seek medical attention from another healthcare professional.
Use PINs with no RX for assessments that resulted in a non-prescription recommendation and/or non-pharmacological advice and the patient was not advised to seek medical attention from another healthcare professional.
Use PINs with no RX other HCP for assessments that resulted in a non-prescription recommendation and/or non-pharmacological advice and the patient was advised to seek medical attention from another healthcare professional.
“Other HCP” would mean an escalation of care to a physician, nurse practitioner, urgent primary care centre, or emergency department. If a patient is advised to visit a physiotherapist, massage therapist, or other allied health professional for complementary care, this would not be included in reasons to use the other HCP PINs.
To submit a claim for MACS (see below for non-benefit claims):
- In the Days Supply field, enter 1.
- In the Quantity field, enter 1.
- In the Drug Cost field, enter 0.
Entering zero in the Drug Cost field ensures the fee does not appear on the patient's receipt. - In the DIN/PIN field, enter the appropriate PIN.
- In the SIG field, in the first 20 spaces in the field and in front of any other information in the field, enter the 10-digit phone number (including area code) of the pharmacy where the service took place. Other healthcare professionals will use this number to contact you to request patient information.
If the pharmacy phone number is not entered in the first 20 characters of the SIG field, the claim will not be reimbursed. - In the Prescriber ID field, enter the College Registration Identification (Reg ID) of the pharmacist who provided the service to the patient.
Consult your software vendor to determine any other requirements for payment reconciliation.
To submit a claim for a non-benefit or virtual non-benefit assessment:
Complete the steps above; however, for step 5, enter the pharmacy phone number and the ailment assessed in the SIG field.
Prescriptions for Schedule 1 drugs resulting from MACS
Prescriptions resulting from MACS must include the same requirements of a prescription as set out by the College of Pharmacists of BC.
Please use the following procedure when submitting prescriptions for Schedule 1 drugs resulting from a MACS assessment.
- In the PRACT ID Ref field, enter P1 — College of Pharmacists of BC.
- In the PRACT ID field, enter the prescribing pharmacist’s College ID.
- Include the PS intervention code.
| Code | Description |
| PS | Professional Care Service |
PharmaNet response code for MACS claims
Reconciling payments
Please call the PharmaNet Help Desk about specific claims. The PharmaNet Help Desk has access to payment and claim details and can fax or mail these details (with patient identifiers removed).
Audit
All claims to PharmaCare are subject to audit and any amount associated with a disallowed claim will be recovered.
For information on PharmaCare audit policies, see Section 10—Audit of this manual.
Resources
Related links
- Minor Ailments and Contraception Service (MACS) for health professionals
- SoP 2022/2023
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