Rx Pricing
The fee charged for a compound purchased from an external pharmacy
$12.15
The type of insurance with a K number
Veterans Affairs Canada (VAC)
The co-payment structure for ABC Group 1 and Group 66
Co-pay is 30% of the total Rx price up to $25.00 Max 100 day supply
The type of plan where a client presents a ‘drug card’ to the pharmacy and pays the entire cost of the prescription at the pharmacy, a cheque/direct-deposit is issued to the client for the portion that was covered
A deferred payment plan
The claim is submitted online Response message will say "Deferred Payment: Patient to pay Pharmacy"
The fee structure used for a prescription if the drug is listed on the ABCDPL
BP + 7.5% + 7% (max $100) + $12.15
The type of insurance would a Member of Parliament and their family members., which provides 80% coverage
Public Service Health Care Plan PSHCP
The lifetime maximum co-pay for ABC Palliative Care Drug Plan
$1000
An amount paid 100% out of pocket before the plan starts paying (typically resets annually)
a deductible
The price used in the pricing calculations if the AAC of a drug is $105.00/100 from McKesson and is listed on the iDBL for $1.0000 per tablet
MLP for drugs listed on the iDBL ($1.000/tab)
The federal insurance plan that supports resettled refugees and victims of human tracking
Interim Federal Health Program (IFH)
The pay structure for AISH
100% coverage (no co-pay) iDBL
The intervention code used when Mom and Dad both have an insurance plan at work to coordinate benefits for a prescription for their child
DB (private)
The fee structure used for the prescription if the drug is listed on the iDBL
MLP + 3% + 7% (max $100) + $12.15
The "___" number for a person who serves in the Canadian Forces (DND)
M number
The provincial plan covers 75% of medical equipment for Albertan's with chronic illnesses
Alberta Aids to Daily Living (AADL)
The program where after 3 dispenses of chronic medications, dispensing should be for a 90 to 100-day supply
Maintenance Medication Program (MMP)
The total Rx price for a compound with an AAC of $10.00 made in-store
$10.00x1.075x1.07 = $11.5025+$18.45 = $29.95
The steps prior to billing a compound online to PSCHP
Phone to verify compound eligibility prior to submitting the compound claim online Client’s information (name, coverage number, date of birth) Compound information Final quantity and/or strength of the compound Final form Name, strength and quantity of each ingredient Prescription instructions
A patient who has cancer has a prescription for 2 drugs. Where does she obtain them, and who pays for them? 1. Gemcitabine (oral tablets for pancreatic cancer) 2. Metoclopramide (oral tablets for nausea)
1. Gemcitabine at an specialty outpatient pharmacy (eg. The Cross Cancer) - no charge to patient 2. Metoclopramide at any pharmacy - covered by their own insurance plan
The use of intervention codes (UP/UQ) to submit a rejected ABC claim
Step Therapy