2.3 What is PharmaNet?

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What does PharmaNet do?

PharmaNet is a secure computer network that links all B.C. community pharmacies and other authorized sites to a central set of databases.

PharmaNet access is available, upon request, to community and hospital pharmacies, hospital emergency departments, hospitals, designated mental health facilities, medical practices, and non pharmaceutical and medical device suppliers that are enrolled as device providers with PharmaCare. The levels of permission to access PharmaNet vary.

>> Learn more about the information each type of user can access in Section 9—Privacy.

PharmaNet maintains various types of information, including:

• Patient demographic information
• Patient medication histories
• Drug information 
• Drug-to-drug interaction information
• Patient clinical information (e.g., allergies, adverse drug reactions) when reported by patients and recorded by pharmacists or authorized physicians and their supervised staff 
• Historical patient claims information
• PharmaCare adjudication rules

The PharmaNet patient profile does not capture information about:

• Drugs dispensed outside community pharmacies, or purchased outside B.C. or over the Internet
• Over-the-counter medications (unless specifically entered)
• Discontinuations (unless the prescriber or patient has advised the pharmacist)
• Drugs entered under the wrong Personal Health Number (PHN)
• Samples provided through physician offices

PharmaNet helps pharmacists to identify and warn patients about potentially harmful medication interactions, unintended duplications, and risks from the misuse of prescription drugs.

The use of PharmaNet is not intended as a substitute for professional judgment. Information on PharmaNet is not exhaustive and cannot be relied upon as complete. The absence of a warning about a drug or drug combination is not an indication that the drug or drug combination is safe, appropriate or effective for any given patient. Health care professionals should confirm information obtained from PharmaNet, and ensure no additional relevant information exists, before making patient care decisions.

When a claim is submitted on PharmaNet, the following is displayed:

• A patient medication history showing medications dispensed in the previous 14 months (or, if preferred, the last 15 dispenses), as well as any over-the-counter medications that may have been recorded
• Drug Use Evaluation (DUE) alerts regarding any potential drug therapy or dispensing problems

>> Learn more in Section 3.14—Drug Use Evaluation.

• All clinical conditions and adverse drug reactions previously recorded on PharmaNet

On request, current patient education drug monographs can also be provided by PharmaNet.

>> Learn more in Section 3.15—Drug Monograph Information.

How does PharmaNet adjudicate claims?

All prescriptions* dispensed in B.C. community pharmacies must be entered on PharmaNet, whether or not:

• The patient is covered by PharmaCare
• The pharmacy is enrolled as a provider in the PharmaCare program

*HIV/AIDS medications are entered in PharmaNet only when they are dispensed at a community pharmacy. HIV/AIDS medications dispensed at the British Columbia Centre for Excellence are not entered in PharmaNet.

All claims sent by device providers who are connected to PharmaNet must also be submitted via PharmaNet.

At the time an item is dispensed, the provider transmits a claim on PharmaNet and includes the following information:

• Patient (e.g., patient’s PHN)
• Prescriber 
• Pharmacy or device provider (e.g., the pharmacy Site ID assigned by PharmaCare, security qualifiers)
• Prescription/product information (e.g., product cost, DIN, quantity, days’ supply, drug cost, dispensing fee) 

PharmaNet uses the information to adjudicate the claim according to current PharmaCare policies. When adjudicating a claim, PharmaNet:

• Validates the provider’s security authorizations 
• Checks whether the patient has a protective word on their PharmaNet record
• Checks the patient’s eligibility for PharmaCare coverage 
  • does the patient have MSP coverage? 
  • which PharmaCare plan is the patient eligible for? 
  • does the patient have any pharmacy or prescriber restrictions?
• Checks the product’s eligibility as a PharmaCare benefit for the patient
  • is the product a benefit? 
  • Is it included in the plan(s) for which the patient is eligible? 
  • does the product have any restrictions? 
• Determines the cost distribution
  • how much, if any, of the cost is covered by PharmaCare? 
  • how much, if any, will count toward the deductible? 
  • how much, if any, of a dispensing fee will be paid by PharmaCare? 
  • what portion of the cost is the patient responsible to pay (“co payment”)?

For patients covered under the income-based Fair PharmaCare plan, PharmaNet accumulates any eligible amount of a claim towards the family’s or individual’s annual deductible and family maximum. 

Based on the patient’s plan and deductible requirement (if any) and the patient's total expenditures to date, PharmaNet returns the adjudication result to the provider using standard response/status codes of the Canadian Pharmacists Association (CPhA). These codes indicate how the claim was adjudicated or why it was rejected.

The provider’s local software reports the cost distribution on the prescription receipt. 

Note: A provider does not need to know which PharmaCare plan the patient is covered under in order to submit a claim on PharmaNet.

In certain cases, pharmacists and device providers may enter an “intervention” or “exception” code to bypass normal adjudication rules (e.g., for duplicate prescriptions).

>> For the authoritative list of response/status and intervention/exception codes, refer to the Canadian Pharmacists Association (CPhA) Pharmacy Claim Standard. Copies of the Pharmacy Claim Standard may be purchased from Canadian Pharmacists Association at service@pharmacists.ca. 

Why do providers need a local, on-site system?

PharmaNet does not replace the need for on-site systems, also known as local systems.

Local systems act as  “front ends,” or the means to access PharmaNet. Local systems may also provide non-PharmaNet features strictly for provider operations.

Providers must use local-system software that a software vendor has had tested and deemed compliant by the Ministry of Health before they can connect to PharmaNet.

>> For more information, refer to Section 2.4—Connecting to PharmaNet.

>> For information on changing your local system software, refer to Section 2.5—Changes to PharmaNet Connections.

Each approved local system software vendor has signed a Service Level Agreement with Health Data Access Services. This agreement sets out problem severity levels and resolution targets. Your software vendor can provide a copy of the agreement on request.

How are claims submitted?

Processing a PharmaCare claim involves both your local system and PharmaNet.

Your local system interface determines how a claim is entered. Your software vendor can provide any information you may need.

Learn more about PharmaNet transactions and adjudication in PharmaNet professional and software conformance standards.

For information on using your local system, contact your software vendor or consult your system documentation.