Rx Pricing
For a compound purchased from an external pharmacy, what fee can be charged?
$12.15
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.
A deferred payment plan.
When the client presents a "drug card" to the pharmacy and the claim submitted online gives the message "Deferred Payment: Patient to pay Pharmacy". Client pays entire cost and is reimbursed the client portion that is covered by their insurance plan (by cheque or direct-deposit)
A patient comes in and asks you to bill his prescription to his insurance. He does not have the card but tells you he has a K number. This is the plan you would bill.
Veterans Affairs Canada (VAC)
The fee structure used for prescriptions, for drugs listed on the ABCDPL
BP + 7.5% + 7% (max $100) + $12.15
Lifetime maximum co-pay for ABC Palliative Care Drug Plan.
$1000
A deductible
The amount paid 100% out of pocket before the plan starts paying (typically resets annually)
Member of Parliament and their family members have this type of insurance. The coverage amount is ______.
Public Service Health Care Plan (PSHCP)
80% coverage.
This price is used in pricing calculations if the AAC of a drug is $105.00/100 from McKesson and is listed on the iDBL for $1.000 per tablet.
$1.000/tab (If it is listed on iDBL we must use that MLP for all prescriptions)
AISH pay structure and the formulary utilized.
100% coverage (no co-pay) iDBL + extras (HSDBS)
Mom and Dad both have an insurance plan at work. Their child has a prescription to be filled. This is whose plan should be billed first.
Bonus: This is the intervention code.
The parent whose birthday comes first in the calendar year.
The second plan is billed using the DB intervention code.
This federal insurance plan supports resettled refugees and victims of human trafficking.
Intermin Federal Health Program (IFH)
The fee structure used for prescriptions if the drug is listed on the iDBL.
MLP + 3% + 7% (max $100) + $12.15
The provincial plan that covers 75% of medical equipment for Albertan's with chronic illnesses.
Alberta Aids to Daily Living (AADL)
What is an MMP?
Maintenance Medication Program. After 3 dispenses of chronic medications, dispensing should be for 90-100-day supply.
A person who serves in the Canadian Forces (DND) comes with a prescription for you to fill. They don't have a card, but you can ask them for their "____" number.
M number.
The total Rx price for a compound with an AAC of $10.00, made-in-store.
$29.95
($10.00x1.075X1.07=$11.5025+$18.45)
A cancer patient has a prescription for 2 drugs; Gemcitabine and Metoclopramide. Each should be obtained from here and ____ pays for them.
1.Gemcitabine - at a specialty outpatient pharmacy (ie. The Cross Cancer) at no charge.
2. Metoclopramide- at any pharmacy - covered by the patients own insurance.
If a claim is rejected from ABC because a drug requires "Step Therapy", you should do this.
Process at pharmacy level with the use of intervention codes.
Prior to billing a compound online to PSCHP this must be done.
Phone to verify compound eligibility prior to submitting the compound claim online.