5.3 Refilling Prescriptions on the Same Day Policy

General Policy Description

PharmaCare does not cover multiple fills of the same prescription for the same client on the same day unless an appropriate intervention code is entered in PharmaNet.

Policy Description

Coverage policy

PharmaCare does not cover drug costs or dispensing fees for multiple fills for the same DIN/PIN at the same pharmacy on the same day for the same client, except in certain circumstances with the associated intervention code entered in PharmaNet.

Lost or broken prescriptions

A lost or broken prescription fill processed with the intervention code MR—Item Lost or Broken is eligible for coverage, even when refilled the same day as the initial prescription fill.

PRN supply claims for non-Plan B clients

When dispensing a prescription for a regular compliance-packed dose plus an extra PRN (“take as needed”) supply of a drug for a client not covered under Plan B, pharmacists should dispense the PRN portion in separate compliance packaging.

To permit the correct adjudication of the same day/same client PRN supply, use the intervention code CD – Therapeutic Duplication when entering the claim for the separate PRN portion.

The same day fill of the PRN claim, as with any other claim, must be supported by the physician’s authorization, which must be retained in the pharmacy’s prescription file.

PRN supply claims for Plan B clients

Pharmacies dispensing same day PRN (“take as needed”) supply claims to Plan B clients may use the intervention code MY – LTC Prescription Split for Compliance.

Claims for the same drug on the same day for a patient and their pet

When both a client and their pet need the same drug on the same day and the pet’s prescription is filled first, PharmaNet interprets the subsequent ,client prescription as a duplicate and rejects it. Although the claim record is removed from PharmaNet, the medication history record for the drug is not. So, if the claim is then re-entered with an intervention code, two fills of the medication will show on the client’s medication history.

When a pharmacy needs to fill a prescription for the same drug on the same day for both a client and their pet, the pharmacy should fill the client’s prescription first to prevent the potential for duplicate fill inaccuracies in the patient’s medication history.

If no prescription for that PHN and drug has been filled earlier in the day, submit the:

• Client's prescription first
• Pet's prescription second. Include the veterinarian's Practitioner ID, the Reference Code V9 and the intervention code UF – Patient Gave Adequate Explanation.
• If the patient’s prescription was filled earlier in the day, submit the claim for the pet’s prescription. Include the veterinarian’s Practitioner ID, the Reference Code V9 and the intervention code UF – Patient Gave Adequate Explanation.
• If the pet’s prescription was filled earlier in the day submit the claim for the patient’s prescription. Include the intervention code UF – Patient Gave Adequate Explanation.
• If you forget to enter the UF intervention code and the claim is rejected, contact the PharmaNet Data Quality Team to correct the problem before you re-submit the prescription claim with the UF code.