8.

MedicationReviewServices

[RevisedEffectiveApril1,2014]

GeneralPolicyDescription
B.C.pharmaciescansubmitaclaimtoPharmaCareformedicationreviewservicesprovidedby pharmaciststoeligiblepatients. Amedicationreviewisapatientcareservicethatseekstoenhanceapatientsunderstandingof,and improvethehealthoutcomesof,theirmedicationregimen. Theserviceisprovidedbyapharmacistthroughoneonone,inpersonappointmentduringwhichthe patientandpharmacistidentifyallmedicationsthatthepatientistaking,discusshowthemedications arebesttakenand,whereappropriate,createamedicationmanagementplantoaddressanyissues.At theendoftheappointment,thepharmacistprovidesthepatientwithoneormoredocumentslisting theirmedications. ThispolicystandardizeshowmedicationreviewservicesaredeliveredacrossB.C. Thethreetypesofmedicationreviewserviceseligibleforpaymentare:
MedicationReviewStandard(MRS) MedicationReviewPharmacistConsultation(MRPC) MedicationReviewFollowUp(MRF).

PolicyDetails
Policiesapplicabletoallmedicationreviewservices
Pharmacistsshouldensuretheyarefamiliarwiththeentirecontentsofthissectionofthe

PharmaCarePolicyManualbeforedeliveringandsubmittingclaimsforamedicationreviewservice.
Thissectioncontainsthefollowingpoliciesapplicabletoallmedicationreviewservices:

1Determiningpatienteligibility 2Documentingmedicationreviewservicedelivery 3Obtainingpatientsignatureinacknowledgementsection 4Claimingmedicationreviewservicesfees

1Determiningpatienteligibility
Beforeperformingamedicationreviewserviceforaconsentingpatientforwhichaclaimwillbe

submitted,pharmacistsmustensurethepatientiseligibleforPharmaCarecoverageofthatservice.
Inadditiontothepatienteligibilityrequirementsthatapplytoallmedicationreviewservices(see

tablebelow),therearespecificeligibilitycriteriaforeachtypeofmedicationreviewservice. >>Forspecificeligibilityrequirementsforeachmedicationreviewservice,refertothePatientEligibility forMedicationReviewStandard,PatientEligibilityforMedicationReviewPharmacistConsultation, andPatientEligibilityforMedicationReviewFollowupsections. PharmaceuticalServicesDivision|MinistryofHealth Page11of33

 Tobeeligibletoreceiveanyofthethreemedicationreviewservices(includingfollowup

appointments),thepatientmustmeetallofthecriteriainthetablebelow:
PatientEligibilityCriteriaForAnyMedicationReviewService Thepatientmust BearesidentofB.C. Notes Thatis,theymusthaveapermanentaddressinB.C. verifiedbyaB.C.driverslicence,BCServicesCardorBC CareCardorotherIDcard. B.CresidentswhohaveaB.C.PHNdonotneedtobe registeredfor,orhave,PharmaCarecoveragetobe eligibleformedicationreviewservices. NonInsuredHealthBenefits,VeteransAffairsCanada andCanadianArmedForcesbeneficiariesareeligible formedicationreviewservices. NotbecoveredunderPharmaCarePlanB Medicationreviewservicesforindividualsinresidential carefacilitiesarealreadyfundedthroughPharmaCare PlanB. >>SeeDeterminingpatienteligibilityqualifying medicationsfordetails.

HaveaB.C.PersonalHealthNumber(PHN)

Haveatleastfivedifferentqualifyingmedicationsthat havebeenenteredintoPharmaNet: withinthelastsixmonths,and beforethemedicationreviewserviceisprovided*

*Qualifyingmedicationscanbeenteredinto
PharmaNetonthedayofthemedicationreviewservice iftheyareenteredbeforetheclaimforthemedication reviewissubmitted. >>SeeDeterminingpatienteligibilityclinicalneedfor details. >>SeeDeterminingpatienteligibilityallowable numberofmedicationreviewservicesfordetails. Pharmacistsareresponsibleforcheckingthepatients PharmaNetrecordforpriorservices.

Haveaclinicalneedforservice

Havenotexceededtheallowablenumberof medicationreviewservices

SigntheacknowledgementontheBestPossible MedicationHistoryform

>>SeeObtainingpatientacknowledgementfordetails.

Determiningpatienteligibilityqualifyingmedications
IndividualDINsandPINsmaybecountedonlyonce. AqualifyingmedicationisoneofthefollowingthathasbeenenteredintoPharmaNet:

Aprescriptionmedication Anonprescriptionmedication Anutritionalsupplement(e.g.,cysticfibrosisnutritionalsupplementscoveredunderPlanD) Aprivatelyorpubliclyfundedinjectionsuchasavaccination Note:PrivatelyfundedinjectionsarerecordedinthepatientsprofilewithaDIN;publiclyfunded injectionsarerecordedwithaPIN. Acompoundedmedication(withadiscretePIN) PharmaceuticalServicesDivision|MinistryofHealth Page12of33

Determiningpatienteligibilitynonqualifyingproductsandservices
Productsthatdonotqualifyinclude:

prescriptionswithaDiscontinuedstatusinPharmaNet prescriptionsthathavebeenreversedinPharmaNet prescriptionswithaNotFilledstatusinPharmaNet nondrugsupplies,includingbutnotlimitedto:

bloodglucosetestingsupplies(strips,lancets,needles) insulinpumpsandpumpsupplies(e.g.,infusionkits) medicalsupplies(e.g.,orthoses,prostheses,gloves)

Determiningpatienteligibilityclinicalneed
Whendeterminingapatientseligibilitytoreceivemedicationreviewservices,clinicalneedmustbe

identifiedandclearlydocumentedasoneormoreofthefollowing: prescriberhasrequestedamedicationreview patienthasmultiplediseases patienthasoneormorechronicdiseases patientsmedicationregimenincludesoneormorenonprescriptionmedications patientsmedicationregimenincludesoneormorenaturalhealthproducts(NHPs) patienthasadrugtherapyproblem patientwasrecentlydischargedfromhospital patienthasmultipleprescribers patientisreceivingmedication(s)thatrequirelaboratorymonitoring
Theseventypesofdrugtherapyproblems(DTPs)are:

1. unnecessarydrug 2. needsadditionaldrug 3. ineffectivedrug 4. dosagetoolow 5. dosagetoohigh 6. adversedrugreaction 7. patientselfmanagement(nonadherence)thatis,thepatientisnottakingthedrugappropriately. Determiningpatienteligibilityallowablenumberofmedicationreviewservices

Eligiblepatientsmayreceivecoveragefor:

eitheroneMedicationReviewStandard(MRS)oroneMedicationReviewPharmacist Consultation(MRPC)service(butnotboth)every6months,and uptofourMedicationReviewFollowUp(MRF)servicesevery12months. >>Forspecificeligibilityrequirementsforeachmedicationreviewservice,refertotheRequired ActivitiesforMRS,RequiredActivitiesforanMRPC,andRequiredActivitiesforanMRF.

2

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 Patientswhoreceivemedicationreviewservicesfromdifferentpharmaciesarestillsubjecttothe

coveragelimitsdescribedabove(i.e.,coveragelimitsareperpatientnotperpharmacy).
Toensurecoverageisavailable,pharmacistsshouldreviewapatientsPharmaNetprofileto

determinewhetherthepatienthasreachedtheirmaximumnumberofallowablemedicationreview servicesbeforetheyconductthemedicationreview.
Medicationreviewserviceclaimsinexcessofthemaximumallowablewillnotbereimbursedevenif

theclaimsaresubmittedbydifferentpharmacies.
PharmaNetcannotrejectmedicationreviewserviceclaimsinexcessofthemaximumallowableat

thetimeofsubmission.Theseclaimsareadjudicatedinmonthlybatches.Anyclaimsinexcessofthe maximumallowablefoundatthattimewillbedisallowed.
2Documentingmedicationreviewservicedelivery
PharmaCarerequirespharmaciesthatsubmitaclaimformedicationreviewservicestoretainspecific

documentationtosupporttheirclaim.
Documentingmedicationreviewservices:

providesauditableproofthataneligiblemedicationreviewserviceoccurred providespatients,caregivers,andotherhealthcareprofessionalswithaccurate,complete,and currentinformationaboutapatientsmedications.

ThethreeformsPharmaCarerequiresforuseindocumentingmedicationreviewservicesare: BestPossibleMedicationHistory(BPMH),including: Patientsection HealthCareProfessionalssection DrugTherapyProblemform(DTPform) BestPossibleMedicationHistoryWorksheet Requiredwheneverapharmacistidentifies and/ortakesactiontoresolveapatientsDTP Optional Requiredforallmedicationreviewservices

Eachoftheseformsservesadifferentpurpose.Asaresult,pharmacistsmustcompleteallthe

requiredformsforaspecificmedicationreviewservice.TheRequiredDocumentationsubsection ofeachmedicationreviewsectiondetailsthedocumentsrequired.
Thecontentoftheseformsconstitutestheminimumacceptabledocumentationrequiredfor

PharmaCarecoverageofamedicationreviewserviceclaim.Ifthesedocumentationrequirementsare notmet,theassociatedclaimissubjecttorecovery. >>Fordetails,seetheRequiredDocumentationsectionforeachmedicationreviewservice:MRS RequiredDocumentation,MRPCRequiredDocumentation,andMRFRequiredDocumentation.

PharmaCareprovidestemplatesforallmedicationreviewservicesforms.Pharmaciesmayusethe

templatestorecordrequiredinformation(seeFormtemplatesunderToolsandResourcesbelow)or createtheirownforms.
Pharmaciesthatcreatetheirownformsmustensurethoseformscontainallthetextandfieldtitles

aswellasallthefieldsshowninthePharmaCareversion.Fordetails,seeIfyouarecreatingyourown forms. PharmaceuticalServicesDivision|MinistryofHealth Page14of33

Documentretentionandstorage
Documentsmustberetainedinthesamemannerasotherpatientrecords.

>>Formoreinformation,seethePharmaCarePolicyManual,Section10Audit.
3Obtainingpatientsignatureinacknowledgementsection
PharmaCarecoversmedicationreviewservicesonlyifthepatientortheirlegalrepresentativesigns

theacknowledgementontheBestPossibleMedicationHistory(BPMH)formattheconclusionofthe medicationreviewservice.
Wheneversomeoneelseisactingonapatientsbehalf,thepharmacymustretaindocumentationof

thatpersonsrighttoactasthepatientslegalrepresentative.
Foreachmedicationreviewserviceprovided,thepatientortheirlegalrepresentativemustsign

acknowledgementontheBestPossibleMedicationHistory(BPMH)form. Note:TheHealthProfessionsAct(HPA)andPharmacyOperationsandDrugSchedulingAct(PODSA) bylawsstatethat,forpurposesofcontinuityofcare,pharmacistscanshareinformationabouta patientwithotherhealthcareprofessionalswithinthecircleofcarewithouthavingtoobtainspecific consentfromthepatienttodoso. >>SeeHPABylaws,section71(UseofPersonalInformation)andsection72(DisclosureofPersonal Information)andPODSABylaws,section21(2)(DataCollection,TransmissionofandAccessto PharmaNetData)andsection22(Confidentiality).

4Claimingmedicationreviewservicesfees
Pharmaciesmustnotrequestoracceptadditionalfeesorpaymentsfromanypatientorthirdparty

payerinrelationtoamedicationreviewserviceforwhichafeewill,orhasbeen,claimedfrom PharmaCare.
Onlyonefee(i.e.,MRS,MRPCorMRFfee)canbeclaimedforeachserviceappointment. ThemaximumPharmaCarereimbursesforacombinationofmedicationreviewservices,clinical

services,oradministrationofvaccinesonthesamedayfromthesamepharmacyis$70.
Example:IfapharmacyclaimsanMRPC,thatpharmacycannotbereimbursedforanyotherservice

onthatdayorifapharmacysubmitsaclaimforanMRS,atherapeuticsubstitutionand administrationofavaccineonasingleday,onlytheMRSandvaccineadministrationwillbeeligible forreimbursement.

Toensuremaximumreimbursement,andtopreservetheaccuracyofthepatientsmedication

history,pleasesubmitallclaimswhetherornotyouexpecttheclaimtobereimbursed.
Ifapharmacysubmitsclaimsonseparatedaysforthepurposeofcircumventingthispolicy,any

reimbursementinexcessofthe$70limitissubjecttorecovery. >>SeeMRSClaimsforPayment,MRPCClaimsforPayment,andMRFClaimsforPayment.

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Requiredactivitiesforallmedicationreviewservices
Whenpharmacistschoosetodelivermedicationreviewservices,allthreetypesofmedicationreview

servicesmustbe:

providedbyanauthorizedpharmacistorpharmacystudentunderthesupervisionofanauthorized pharmacist.
providedasaoneonone,inpersonappointment(andnotbytelephoneoranyotherelectronic means), providedinasuitableareathatthepatientacceptsasrespectfuloftheirrighttoprivacy,and providedanddocumentedinaccordancewiththespecificrequirementsofthispolicy. >>Fordetailsonrequiredactivitiesforeachservicetype,seeMRSRequiredActivities,MRPCRequired Activities,andMRFRequiredActivities.
Documentingmedicationreviewservicesthatarenoteligibleforreimbursement
Pharmacistswhoconductamedicationreviewserviceforapatientwhodoesnotmeetthe

PharmaCareeligibilityrequirementsareencouragedtocreatearecordofserviceinPharmaNet.
UsetheMedicationReviewNonBenefitPIN99000504and,intheSIGfield,enterthe10digit

phonenumberofthepharmacywheretheservicetookplacetorecordtheservice.
Theclaimwillnotbepaid,butthepatientsPharmaNetrecordwillindicatetootherhealthcare

professionalsthatamedicationhistoryisavailable. PoliciesandrequiredactivitiesforeachmedicationreviewservicecoveredbyPharmaCare
Thissectionincludesrequiredactivitiesfor:

MedicationReviewStandard(MRS) MedicationReviewPharmacistConsultation(MRPC) MedicationReviewFollowUp(MRF)

MedicationReviewStandard(MRS)

RequiredActivities ForanMRStobeeligibleforPharmaCarereimbursement,thefollowingactivitiesmustbecarriedout andtheirresultsdocumentedineachoftherequiredform(s).

RequiredActivity 1 Confirmthepatientmeetsallthecriteriain1Determining patienteligibility,underPoliciesapplicabletoallmedication reviewservices. Ifthepatientmeetsalleligibilityrequirements,documentthe patientinformationgatheredinStep1above. Documenttheactivityresultsin Nodocumentationrequired.

Patientsectionof BPMHWorksheet(optional) BPMH ClinicalNeedforServicesectionof BPMH

Documenttheclinicalneed(s)thatarethereason(s)forproviding theservice.

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RequiredActivity 4 Collectanddocumentinformationaboutpatientmedicalissues suchasknownallergiesandreactions.Informationiscollected frommultiplesourcesincludingbutnotlimitedto: PharmaNetprofile localpharmacymedicationprofile interviewwithpatientortheirlegalrepresentative hospitaldischargesummaries 5 Collectanddocumentallpertinentinformationaboutthe patientscurrentandrecentlydiscontinuedmedications (includingprescriptionmedications,nonprescriptionmedications, andnaturalhealthproducts).Collectinformationfrom: PharmaNetprofile localpharmacymedicationprofile interviewwithpatientortheirlegalrepresentative prescriptionmedication,nonprescriptionmedicationornatural healthproductlabels hospitaldischargesummaries otheravailablerecords Determinewhetherthepatientiscurrentlytakingeachmedication andhowtheyaretakingit. Documentanyclinicallyrelevantmedicationsthepatientisno longertaking. 6 Discuss,review,anddocumentthedetailsofeachmedicationthe patientiscurrentlytakingwiththepatientortheirlegal representative,including: whatmedicationthepatientistaking(e.g.,thename,strength, andformofmedication) whythepatientistakingeachmedication(e.g.,whatdisease, conditionorsymptomsthemedicationalleviates/controls) howbesttotakeeachmedication(e.g.,whentotakeit,howto takeit,warnings,etc.) anyspecialinstructions 7 Documentallinformationrelevanttocontinuityofcare(e.g., detailsaboutdecisions,evaluations,plansofaction,andother directionsorobservations). NOTE:IfadrugtherapyproblemisidentifiedduringanMRS,the pharmacistisprofessionallyresponsiblefortakingactionby workingtoresolvetheissueorbyreferringthepatienttoan appropriatehealthcareprofessional.Ifthepharmacisttakesaction toresolvetheissueandcompletesoneormoreDTPforms,aclaim foranMRPCmaybesubmittedinsteadofaclaimforanMRS. ForMRPCrequiredactivitydetails,seeMRPCRequiredActivities.

Documenttheactivityresultsin ClinicalInformationsectionof BPMHWorksheet(optional) Ifapplicable,KnownAllergiesand ReactionssectionoftheBPMH

1

ClinicalInformationandAdditional MedicationssectionsofBPMH Worksheet(optional) MedicationsITake,Current Medicationsand,ifapplicable, ClinicallyRelevantMedicationsThe PatientIsNoLongerTakingsections oftheBPMH

MedicationsITakeandCurrent MedicationssectionoftheBPMH
1

HealthCareProfessionalssectionof theBPMH(includingPrescriber Name,Verified,Action,andNotes segments)

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RequiredActivity 8 Ensureallformsarefullycompleted,includingthenameand RegistrationIDofthepharmacist,andthecontactinformationfor thepharmacy,providingtheservice(toenablehealthcare professionalstorequestthepatientsinformation). Obtainsignatureofpatientortheirlegalrepresentativeinthe PatientAcknowledgementsectionoftheBPMH. Ifsomeoneelseisactingonthepatientsbehalf,obtain documentationofthatpersonsrighttoactasthepatientslegal representative. Retainthesignedoriginalforyourrecords. 10 ProvideacopyofthecompletedandsignedPatientsectionofthe BPMHtothepatientortheirlegalrepresentative. ItisnotnecessarytoprovidetheBPMHHealthCareProfessionals sectiontothepatient.Itisdesignedforusebycliniciansonly. 11 Storealldocumentstogetherforfuturereference.(Fordetails, seePharmaCarePolicyManual,Section10Audit).

Documenttheactivityresultsin Pageheadersof BPMHWorksheet(optional) BPMH

1

PatientAcknowledgementsection ofBPMH,signedanddatedby patientortheirlegalrepresentative Ifapplicable,documentationof anotherpersonsrighttoactasthe patientslegalrepresentative Copyofcompletedandsigned PatientsectionoftheBPMH

1

BPMHWorksheet(ifused) BPMH(original,signedbypatientor theirlegalrepresentative)

1

Ifapplicable,documentationof anotherpersonsrighttoactasthe patientslegalrepresentative 12 Submitthemedicationreviewserviceclaimonthedateofservice delivery,usingtheappropriatePIN. Thisensuresotherpharmaciesknowthatyouhavedeliveredthe servicetothepatientandmakestheclinicalinformationavailable tootherhealthcareprovidersinatimelyfashion. >>SeeSubmittingClaimsfortheappropriatePINanddataentry instructions. 13 Whenyoureceivearequestformedicationreviewinformation fromahealthcareproviderwithinthepatientscircleofcare: FaxacopyoftheBPMHPatientInformationandHealthCare Professionalssectionstotherequestorassoonaspossible. Recordtherequestorsnameandcontactinformation,thedate onwhichtherequestwasmade/fulfilledandthename(s)ofthe formsthatweresharedinyourfiles. FaxedcopyoftheentireBPMH (mandatory) Recordofrequest MRSclaimonPharmaNet

RequiredDocumentation
TosupportyourclaimforanMRSservice,retainthefollowingdocumentationinamanner

accessibleforaudit: completedBPMHoriginal,signedanddatedbypatientortheirlegalrepresentative ifapplicable,documentationofanotherpersonsrighttoactasthepatientslegalrepresentative awrittenrecordofanyrequestsforacopyofapatientsBPMH

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ClaimsforPayment
Foraneligiblepatient,thepharmacycansubmitaclaimtoPharmaCarefora$60MRSfee. TheclaimmustbesubmittedonPharmaNetonthedatethemedicationreviewserviceisprovidedto

thepatient.
SubmittheclaimusingtheappropriatePINandtheCollegeRegistrationIdentification(RegID)ofthe

pharmacistwhoprovidedtheservicetothepatient.
Thepharmacymustenterthe10digitpharmacyphonenumberinthefirst20spacesandinfrontof

anyotherinformationthatappearsintheSIGfieldonthepatientsPharmaNetprofiletofacilitate continuityofcareandsharingoftheBPMHwithinthecircleofcare. >>Fordetails,seeSubmittingclaimsforpayment. >>Forinformationonclaimlimits,seePoliciesApplicabletoAllMedicationReviewServices, 4Claimingmedicationreviewservicesfees.

MedicationReviewPharmacistConsultation(MRPC)

RequiredActivities
ForanMRPCtobeeligibleforPharmaCarereimbursementthefollowingactivitiesmustbecarried

outandtheresultsdocumentedineachoftherequiredform(s).
RequiredActivity 1 EnsurethepatientmeetsthecriteriaforanMRPC.Thepatient must: meetallthepatienteligibilitycriteriadefinedin 1Determiningpatienteligibility,underPoliciesapplicableto allmedicationreviewservices,and havehadaminimumofonedrugtherapyproblem(DTP) identified,resolved,anddocumentedduringthecourseofthe medicationreviewservice. 2 Ifthepatientmeetstheeligibilityrequirements,document patientinformationgatheredinStep1above. Documenttheactivityresultsin Nodocumentationrequired.

Patientsectionof
BPMHWorksheet(optional) BPMH DTPForm ClinicalNeedforServicesectionof BPMH ClinicalInformationsectionofBPMH Worksheet(optional) Ifapplicable,KnownAllergiesand ReactionssectionoftheBPMH
1

3 4

Documenttheclinicalneed(s)thatarethereason(s)forproviding theservice. Collectanddocumentinformationaboutpatientmedicalissues suchasknownallergiesandreactions.Informationiscollected frommultiplesourcesincludingbutnotlimitedto: PharmaNetprofile localpharmacymedicationprofile interviewwithpatientortheirlegalrepresentative hospitaldischargesummaries

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RequiredActivity 5 Collectanddocumentallpertinentinformationaboutthe patientscurrentandrecentlydiscontinuedmedications (includingprescriptionmedications,nonprescriptionmedications andnaturalhealthproducts).Collectinformationfrom: PharmaNetprofile localpharmacymedicationprofile interviewwithpatientortheirlegalrepresentative prescriptionmedication,nonprescriptionmedicationornatural healthproductlabels hospitaldischargesummaries otheravailablerecords Determinewhetherthepatientiscurrentlytakingeachmedication andhowtheyaretakingit. Documentanyclinicallyrelevantmedicationsthepatientisno longertaking. 6 Discuss,review,anddocumentthedetailsofeachmedicationthe patientiscurrentlytakingwiththepatientortheirlegal representativeincluding: whatmedicationsthepatientistaking(e.g.,thename,strength andformofmedication) whythepatientistakingeachmedication(e.g.,whatdisease, conditionorsymptomsthemedicationalleviates/controls) howbesttotakeeachmedication(e.g.,whentotakeit,howto takeit,warnings,etc.) anyspecialinstructions 7 Documentallinformationrelevanttocontinuityofcare (e.g.,detailsaboutdecisions,evaluations,plansofaction,and otherdirectionsorobservations). Documenttheidentificationofandactionstaken/tobetakento resolveaminimumofoneDTP. Workwiththepatientto: identifytheDTP(s), prepareacareplantoresolveeachDTP, implementthecareplan,and makeaplantomonitorandfollowuponresults. DocumentallDTPrelateddecisions,plans,andactionsdecided uponduringtheappointment.Notify(and,ifnecessary, collaboratewith)themostresponsiblephysicianorother prescriberabouttheDTP,careplan,andresultsachieved. 9 Ensureallformsarefullycompleted,includingthenameand RegistrationIDofthepharmacist,andthecontactinformationfor thepharmacy,providingtheservice(toenablehealthcare professionalstorequestthepatientsinformation).

Documenttheactivityresultsin ClinicalInformationandAdditional MedicationssectionsofBPMH Worksheet(optional) MedicationsITake,Current Medicationsand,ifapplicable, ClinicallyRelevantMedicationsThe PatientIsNoLongerTakingsections oftheBPMH

MedicationsITakeandCurrent MedicationssectionsoftheBPMH
1

HealthCareProfessionalssectionof theBPMH(includingPrescriberName, Verified,Action,andNotessegments) HealthCareProfessionalssectionof theBPMH(includingPrescriberName, Verified,Action,andNotessegments) DTPform(s)(oneformforeachDTP) MedicationsITakeSpecial InstructionssectionoftheBPMH

1

Pageheadersof BPMHWorksheet(optional) BPMH

1

DTPform(s)

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RequiredActivity 10 Obtainsignatureofpatientortheirlegalrepresentativeinthe PatientAcknowledgementsectionoftheBPMH. Ifsomeoneelseisactingonthepatientsbehalf,obtain documentationofthatpersonsrighttoactasthepatientslegal representative. Retainthesignedoriginalforyourrecords. 11 ProvideacopyofthecompletedandsignedPatientsectionofthe BPMHtothepatientortheirlegalrepresentative. 12 Storealldocumentstogetherforfuturereference.(Fordetails, seePharmaCarePolicyManual,Section10Audit).

Documenttheactivityresultsin PatientAcknowledgementsectionof BPMH,signedanddatedbypatientor theirlegalrepresentative Ifapplicable,includedocumentation ofanotherpersonsrighttoactasthe patientslegalrepresentative. CopyofcompletedandsignedPatient sectionoftheBPMH

1

BPMHWorksheet(ifused) BPMH(original,signedbypatientor theirlegalrepresentative)

1

DTPform(s) Ifapplicable,includedocumentation ofanotherpersonsrighttoactasthe patientslegalrepresentative. 13 Submitthemedicationreviewserviceclaimonthedateofservice delivery,usingtheappropriatePIN. Thisensuresotherpharmaciesknowthatyouhavedeliveredthe servicetothepatientandmakestheclinicalinformationavailable tootherhealthcareprovidersinatimelyfashion. >>SeeSubmittingClaimsfortheappropriatePINanddataentry instructions. 14 Whenyoureceivearequestformedicationreviewinformation fromahealthcareproviderwithinthepatientscircleofcare: FaxacopyoftheBPMHtotherequestorassoonaspossible Recordtherequestorsnameandcontactinformation,thedate onwhichtherequestwasmade/fulfilled,andthename(s)ofthe formsthatweresharedinyourfiles FaxedcopyoftheBPMH(mandatory) FaxedcopyofDTPform(s)(optional, atpharmacistsdiscretion) Recordofrequest MRPCclaimonPharmaNet

RequiredDocumentation
TosupportyourclaimforanMRPCservice,retainthefollowingdocumentationinamanner

accessibleforaudit: completedBPMHoriginal,signedanddatedbypatientortheirlegalrepresentative aseparateDTPformforeachDTP ifapplicable,documentationofanotherpersonsrighttoactasthepatientslegalrepresentative ifapplicable,awrittenrecordofanyrequestforacopyofapatientsBPMHand/orDTPform(s)

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ClaimsforPayment
Foreligiblepatients,thepharmacycansubmitaclaimtoPharmaCarefora$70MRPCfee. If,duringtheMRPC,aDTPhasbeenresolvedbyanactionthathasaseparatelydefinedPharmaCare

servicefee(e.g.,administrationofinjectionsand/oradaptationsofprescriptions),thepharmacymay submittheclaimsasusual,butwillbereimbursedtoamaximumof$70.
TheclaimmustbesubmittedonPharmaNetonthedatethemedicationreviewserviceisprovidedto

thepatient. Thisensuresotherpharmaciesknowthatyouhavedeliveredtheservicetothepatientandmakesthe clinicalinformationavailabletootherhealthcareprovidersinatimelyfashion.

SubmittheclaimusingtheappropriatePINandtheCollegeRegistrationIdentification(RegID)ofthe

pharmacistwhoprovidedtheservicetothepatient.
Thepharmacymustenterthe10digitpharmacyphonenumberinthefirst20spacesandinfrontof

anyotherinformationthatappearsintheSIGfieldonthepatientsPharmaNetprofiletofacilitate continuityofcareandsharingoftheBPMHand,ifapplicable,DTPForm(s)withinthecircleofcare. >>Fordetails,seeSubmittingclaimsforpayment. >>Forinformationongeneralclaimlimits,seePoliciesApplicabletoAllMedicationReviewServices, 4Claimingmedicationreviewservicesfees.

MedicationReviewFollowUp(MRF)

RequiredActivities
ForanMRFtobeeligibleforPharmaCarereimbursementthefollowingactivitiesmustbecarriedout

andtheirresultsdocumentedineachoftherequiredform(s).
RequiredActivity 1 EnsurethepatientmeetsthecriteriaforanMRF.Thepatient must: meetallthepatienteligibilitycriteriadefinedin1Determining patienteligibility,underPoliciesapplicabletoallmedication reviewservices,and havealreadyreceivedacompleteMRSorMRPCwithinthelast year,and haveaclinicalneedthatrequireseither followupduetoasubsequentmedicationchange(thatis,a changeinmedicationthatisenteredonPharmaNet),or followuptoimplementand/orevaluatethepatient responsetotheactiontakentoresolveaDTP. 2 Ifthepatientmeetsalleligibilityrequirements,documentpatient Patientsectionof informationgatheredinStep1above. BPMHWorksheet(optional) BPMH DTPForm(s)(ifapplicable) Documenttheactivityresultsin Nodocumentationrequired.

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RequiredActivity 3 Documentthereason(s)forprovidingtheMRFservice:thatis, patientsmusthaveaclinicalneedthatrequiresthefollowing: followupduetoasubsequentmedicationchange(thatis,a changeinmedicationthatisenteredonPharmaNet),or followuptoimplementand/orevaluatethepatientresponseto theactiontakentoresolveaDTP 4 Ifappropriate,reviewandupdateinformationaboutpatient medicalissuessuchasknownallergiesandreactions.Information iscollectedfrommultiplesourcesincludingbutnotlimitedto: PharmaNetprofile localpharmacymedicationprofile interviewwithpatientortheirlegalrepresentative hospitaldischargesummaries 5 Iftheserviceisafollowupduetoasubsequentmedication change(i.e.,achangeinmedicationthatisenteredon PharmaNet): speakwiththepatienttoreview,correct,orupdateinformation andimprovethepatientsunderstandingaboutthosechanges including: whatmedicationsthepatientistaking(e.g.,thename, strength,andformofmedication) whythepatientistakingeachmedication(e.g.,whatdisease, conditionorsymptomsthemedicationalleviates/controls) howbesttotakeeachmedication(e.g.,whentotakeit,how totakeit,warnings,etc.) completeanewBPMHPatientsection updatethepatientspreviousBPMHHealthCareProfessionals sectionorgenerateanewone. 6 Iftheserviceisafollowuptoimplementand/orevaluateprogress towardsresolvingthepatientsDTP(s): reviewandevaluatethepatientsprogresswiththeirdrug therapyproblemplanand,ifnecessary,modifytheplantohelp thepatientreachtheirgoals completeanewBPMHPatientsection updatethepatientspreviousBPMHHealthCareProfessionals Sectionorgenerateanewone UpdateeachpreviousDTPformwithnewinformationor generateanewoneforeachDTP. 7 Documentallinformationrelevanttocontinuityofcare(e.g., detailsaboutdecisions,evaluations,plansofaction,andother directionsorobservations).

Documenttheactivityresultsin ClinicalNeedforServicesectionof BPMH

ClinicalInformationsectionofBPMH Worksheet(optional) Ifapplicable,KnownAllergiesand ReactionssectionofanewBPMH

RelevantsectionsoftheBPMH

Relevantsectionsof: anewBPMHPatientsectionand aneworupdatedBPMHHealth CareProfessionalsSection NeworupdatedDTPform(s)(one formforeachDTP)

HealthCareProfessionalssectionof theneworupdatedBPMH(including PrescriberName,Verified,Action,and Notessegments)

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RequiredActivity 8 Ensureallformsarefullycompleted,includingthenameand RegistrationIDofthepharmacist,andthecontactinformationfor thepharmacy,providingtheservice(toenablehealthcare professionalstorequestthepatientsinformation) Obtainsignatureofpatientortheirlegalrepresentativeinthe PatientAcknowledgementsectionoftheBPMH. Ifsomeoneelseisactingonthepatientsbehalf,obtain documentationofthatpersonsrighttoactasthepatientslegal representative. Retainthesignedoriginalforyourrecords. 10 Provideacopyofthenew,completedandsignedPatientsection oftheBPMHtothepatientortheirlegalrepresentative. 11 Storealldocumentstogetherforfuturereference.(Fordetails, seePharmaCarePolicyManual,Section10Audit).

Documenttheactivityresultsin Pageheadersof BPMHWorksheet(optional) BPMH

1

DTPform(s)(ifapplicable) PatientAcknowledgementsectionof BPMH,signedanddatedbypatientor theirlegalrepresentative Ifapplicable,includedocumentation ofanotherpersonsrighttoactasthe patientslegalrepresentative. Copyofnew,completedandsigned PatientsectionoftheBPMH

1

BPMHWorksheet(ifused) BPMH(original,signedbypatientor theirlegalrepresentative)

1

DTPform(s)(ifapplicable) Ifapplicable,includedocumentation ofanotherpersonsrighttoactasthe patientslegalrepresentative. 12 Submitthemedicationreviewserviceclaimonthedateofservice delivery,usingtheappropriatePIN. Thisensuresotherpharmaciesknowthatyouhavedeliveredthe servicetothepatientandmakestheclinicalinformationavailable tootherhealthcareprovidersinatimelyfashion. >>SeeSubmittingClaimsfortheappropriatePINanddataentry instructions. 13 Whenyoureceivearequestformedicationreviewinformation fromahealthcareproviderwithinthepatientscircleofcare: FaxacopyoftheBPMHtotherequestorassoonaspossible Recordtherequestorsnameandcontactinformation,thedate onwhichtherequestwasmade/fulfilled,andthename(s)ofthe formsthatweresharedinyourfiles FaxedcopyoftheBPMH(mandatory) FaxedcopyofDTPform(s)(optional, atpharmacistsdiscretion) Recordofrequest MRFclaimonPharmaNet

RequiredDocumentation
TosupportyourclaimforanMRFservice,retainthefollowingdocumentationinamanner

accessibleforaudit: newBPMHPatientInformationsection,originalsignedbythepatientortheirlegalrepresentative neworupdatedversionoftheBPMHHealthCareProfessionalssection, ifapplicable,aneworupdatedDTPformforeachDTP ifapplicable,documentationofanotherpersonsrighttoactasthepatientslegalrepresentative PharmaceuticalServicesDivision|MinistryofHealth Page24of33

 ifapplicable,awrittenrecordofanyrequestforacopyofapatientsBPMHand/orDTPforms iftheoriginalMRSorMRPCservicewasprovidedatanotherpharmacy,thepharmacyproviding theMRFservicemustobtainacopyofthePharmaCarerequireddocumentationforthepatients mostrecentMRSorMRPC. Ifinformationismissingfromthepreviouspharmacysdocumentation,thecurrentpharmacy shouldensurethatallinformationrequiredforthecurrentMRFisobtained,documentedand retainedintheirrecords. ClaimsforPayment

Foreligiblepatients,thepharmacistcansubmitaclaimtoPharmaCarefora$15MRFfee. EitheranMRSoranMRPCmusthavebeenclaimedforthepatientwithinthepreviousyear. Amaximumof4MRFclaimscanbemadeinthe12monthperiodfollowingtheMRSorMRPC. Forinformationongeneralclaimlimits,seePoliciesApplicabletoAllMedicationReviewServices,

4Claimingmedicationreviewservicesfees.
TheclaimmustbesubmittedonPharmaNetonthedateofthemedicationreviewservice.

Thisensuresotherpharmaciesknowthatyouhavedeliveredtheservicetothepatientandmakesthe clinicalinformationavailabletootherhealthcareprovidersinatimelyfashion.
SubmittheclaimusingtheappropriatePINandtheCollegeRegistrationIdentification(RegID)ofthe

pharmacistwhoprovidedtheservicetothepatient.
Thepharmacymustenterthe10digitpharmacyphonenumberinthefirst20spacesandinfrontof

anyotherinformationthatappearsintheSIGfieldonthepatientsPharmaNetprofiletofacilitate continuityofcareandsharingoftheBPMHand,ifapplicable,DTPForm(s)withinthecircleofcare. >>Fordetails,seeSubmittingclaimsforpayment.

Procedures
SubmittingClaims
ClaimsformedicationreviewservicesmustbesubmittedonPharmaNetonthedateofthe

medicationreview,usingtheappropriatePIN,asshownbelow.
ThePINandthepaymentamountforeachserviceareasfollows:

PIN 99000501 99000502 99000503

Description MedicationReviewStandard(MRS) MedicationReviewPharmacistConsultation(MRPC) MedicationReviewFollowUp(MRF)

PaymentAmount $60.00 $70.00 $15.00

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 Tosubmitaclaimforamedicationreviewservice:

1. IntheDaysSupplyfield,enter1 2. IntheQuantityfield,enter1. 3. IntheDrugCostfield,enter0. EnteringzerointheDrugCostfieldensuresthefeedoesnotinadvertentlyappearonthe patientsreceipt. 4. IntheDIN/PINfield,entertheappropriatePIN. 5. IntheSIGfield,inthefirst20spacesinthefieldandinfrontofanyotherinformationthat appearsinthefield,enterthe10digitphonenumber(includingareacode)ofthepharmacy wheretheservicetookplace.Otherhealthcareprofessionalswillusethisnumbertocontactyou torequestpatientinformation. Ifthepharmacyphonenumberisnotenteredinthefirst20charactersoftheSIGfield,theclaim willnotbereimbursed. 6. InthePrescriberIDfield,entertheCollegeRegistrationIdentification(RegID)ofthepharmacist whoprovidedtheservicetothepatient. Consultyoursoftwarevendortodetermineanyotherrequirementsforpaymentreconciliation.
PharmaNetResponseCodeforMedicationReviewServiceClaims
Claimsformedicationreviewservicesareprocessedforpaymentinmonthlybatchesratherthanin

realtime.Whenaclaimforamedicationreviewserviceissubmitted,PharmaNetreturnsoneof severalrejectionresponses(e.g.,CDpatientnotentitledtodrugclaimed).Theseadjudication messagesfromPharmaNetcanbeignored.

Donotreverseorresubmitclaimsinresponsetoadjudicationmessages.Ifthedatahasbeen

enteredcorrectlyintherequestedfields,theclaimswillbeprocessedforpayment.
ReconcilingPayments
PleasecallthePharmaNetHelpDeskaboutspecificclaims.ThePharmaNetHelpDeskhasaccessto

paymentandclaimdetailsandcanemailthesedetails(withpatientidentifiersremoved).
Audit
AllclaimstoPharmaCarearesubjecttoauditandanyamountassociatedwithadisallowedclaimwill

berecovered. >>ForinformationonPharmaCareauditpolicies,seethePharmaCarePolicyManual,Section10 Audit.

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MedicationReviewServicesForms
BestPossibleMedicationHistory(BPMH) Purpose
ThepurposeoftheBestPossibleMedicationHistory(BPMH)isto createarecordthataneligibleserviceepisodeoccurred,and providepatients,caregivers,andotherhealthcareprofessionalswithaccurate, complete,andcurrentinformationaboutapatientsmedications. TheBPMHincludestwosections:thePatientsectionandtheHealthCareProfessionals section. ThePatientsectionoftheBPMHisacomprehensivelistofallprescriptionmedications, nonprescriptionmedications,andnaturalhealthproductsthepatientiscurrentlytaking onaregularorasneededbasis. Thissectionoftheformisprovidedtothepatientaftertheirmedicationreviewis completed. TheHealthCareProfessionalssectionoftheBPMHprovidesaprofessionalsummaryof informationcollectedduringthereviewsuitableforsharingwithotherhealthcare professionals. Itactsastherecordofcareprovided(i.e.,recordofthepatientscurrentand discontinuedmedications,alongwithchanges,decisions,andrecommendationsmade bythepharmacist). Thissectionoftheformisnotintendedforthepatient.Thissectionmayinclude informationsuitableonlyforclinicians.Keepitonfileavailabletosharewithother healthcareprofessionalsuponrequest.

Whento completeform

ForeveryMRSorMRPCappointmentforwhichaclaimwillbesubmittedto PharmaCare,completeanewBPMHPatientsectionandanewBPMHHealthCare Professionalssection ForeveryMRFappointmentforwhichaclaimwillbesubmittedtoPharmaCare, completeanewBPMHPatientsectionandaneworupdatedBPMHHealthCare Professionalssection.

Formcontents

Allcontent(i.e.,text,fields,andfieldlabels)includedintheBestPossibleMedication Historytemplateismandatoryandmustbeincludedinanypharmacycreatedforms.See Ifyouarecreatingyourownform(s).

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Noteson completingthe form

Allfieldsonallpagesmustbecompletedunlessotherwiseindicated.SeetheBPMH templatefortheformfields. ISITLEGIBLE?TheintentoftheBPMHPatientSectionistogivethepatient(ortheir familyorcaregiver)aclear,writtenrecordofyourdiscussion. Tomakesureyourdirectionsandcommentsareeasyforthepatienttoread,usethe tipsbelow. TIPSFORCLARITY: Makesuretheinformationonthehandwrittenorprintedformislargeenoughfor thosewithvisionproblems. Printratherthanwrite. Usesimplelanguage: DonotuseLatinorotherabbreviationsnotcommonlyusedbypatients Refertoconditionsorsymptomsusingthesamewordsthepatientusesduring theirappointment EnsurethatthepatientortheirlegalrepresentativesignsanddatesthePatient AcknowledgementsectionoftheBPMH. Oneverypageoftheform,includethe: servicedeliverydate nameandRegIDofthepharmacistwhoprovidedtheservice: iftheservicewasdeliveredbyapharmacystudentorintern,providethenameof thepharmacistwhosupervisedthesession iftheappointmentisafollowupandtheserviceisdeliveredbyadifferent pharmacist,addthepharmacistnameandRegIDaftertheoriginalpharmacistsID contactinformationforthepharmacy patientsname,PHN,anddateofbirth Optionalfieldsincludespecialinstructions.Completeifapplicable. Completeallfieldsrelatedtoclinicallyrelevantmedicationsthathavebeenstopped,if theinformationisavailable. Ifthepatientistakingmorethaneightmedications,addadditionalrowstothe MedicationsITakeandCurrentMedicationssectionsasnecessary,orcomplete additionalforms.

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DrugTherapyProblemform(DTPform) Purpose
TheDrugTherapyProblemformisarecordofallinformationassociatedwiththe identification,resolution,followupcare,andcommunicationforaDTPidentifiedduring aMedicationReviewPharmacistConsultationserviceappointment. Thisformmaybesharedwithhealthcareprofessionalswithinthepatientscircleofcare atthepharmacistsdiscretion.

Whentocomplete form

AformmustbecompletedwheneveraDTPhasbeenidentifiedandresolved. AseparateformmustbecompletedforeachDTP. ForeveryMRPCappointmentforwhichaclaimwillbesubmittedtoPharmaCare, completeaDTPforminadditiontotheBPMHPatientsectionandBPMHHealthCare Professionalssection. Ifapplicable,foreveryMRFappointment,whenimplementingand/orevaluating progresstowardsresolvingthepatientsDTP,forwhichaclaimwillbesubmittedto PharmaCare,updateeachpreviousDTPformwithnewinformation(orgenerateanew oneforeachDTP)inadditiontocompletinganewBPMHPatientsectionandanewor updatedBPMHHealthCareProfessionalssection.

Formcontents

Pharmacistsmaydesigntheirownversionoftheform;seeIfyouarecreatingyourown form(s)forrequirements. Allcontent(i.e.,text,fieldsandfieldlabels)includedintheDrugTherapyProblemform templateismandatoryandmustbeincludedinanypharmacycreatedforms.SeeIfyou arecreatingyourownform(s). Allfieldsonallpagesmustbecompletedunlessindicatedotherwise;seetheDTPform templatefortheformfields. Ifaformisillegible,theassociatedclaimwillbesubjecttorecovery. Oneverypageoftheform,includethe: servicedeliverydateifupdatinganexistingformduringafollowupappointment, addthenewservicedeliverydateaftertheinitialservicedate. nameandRegIDofthepharmacistwhoprovidedtheservice: iftheservicewasdeliveredbyapharmacystudentorintern,providethenameof thepharmacistwhosupervisedthesession iftheappointmentisafollowupandtheserviceisdeliveredbyadifferent pharmacist,addthepharmacistsname,andRegIDaftertheinitialpharmacistsID contactinformationforthepharmacy patientsname,PHN,anddateofbirth Optionalfieldsincludenotification.Completeifapplicable.

Noteson completingthe form

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BestPossibleMedicationHistoryWorksheet(BPMHWorksheet) Purpose
TheBestPossibleMedicationHistoryWorksheetisanoptionalformthatpharmacists canusetogather,record,andreviewthepatientsmedicationinformationbeforethe medicationreviewappointment. TheWorksheetcomplieswithallrequirementsforpharmacyprintingofthePharmaNet MedicationReconciliationReport.

Whentocomplete form Formcontents

Thisformmaybeusedasastartingpointforgatheringinformationbeforeamedication reviewserviceappointment. Useofthisformisoptional. ThecontentsofthisformarefoundintheBestPossibleMedicationHistoryWorksheet template. Pharmacistsmaydesigntheirownversionoftheform;seeIfyouarecreatingyourown form(s)forrequirements. N/A

Noteson completingthe form

Ifyouarecreatingyourownform(s)
PharmaCareprovidesformtemplatesthatcontaintheminimumdocumentationrequirementsfor

claimingafeeforamedicationreviewservicefromPharmaCare.
Anypharmacythatchoosestocreatetheirownversionsofthemedicationreviewservicesforms

mustensurethattheseminimumrequirementsaremet;thatis,eachformmustcontainallthetext andfieldsinthePharmaCaretemplates.
Thewordingofthetextandfieldlabelsmustnotbechanged. Claimsformedicationreviewserviceswillbereimbursedonlywhentheformscontainallrequired

text,fields,andfieldlabels.Whentheformsdonotmeettheseminimumrequirements,claimswill besubjecttorecovery.

Tools&Resources
FormTemplates
BestPossibleMedicationHistory(BPMH)Worksheet BestPossibleMedicationHistory(BPMH) DrugTherapyProblemform(DTPform)

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