On August 4, 2017 / News
We appreciate that pharmacies are concerned about the process of submitting Schedule B’s – Notification of Professional Fee Change in respect of the Pharmacy Agreement and the upcoming regulation changes to professional fees. At this time, we can provide the following advice to pharmacies that will be submitting new fee schedules:
- Schedule B’s should only include professional fees and compounding fees relevant to Pharmacare, the Palliative Care Drug Access Program, and the Home Cancer Drug Program. Fee Schedules that include services charged to other programs such as EIA or NIHB will be REJECTED with the request to resubmit. Professional Cognitive Services that pharmacies might currently be charging clients for, but are not covered by Provincial Drug Programs (PDP) should NOT be included on Schedule B.
NOTE THE EXAMPLES BELOW ARE SIMPLY EXAMPLES and not intended to promote or encourage a specific fee structure. We recognize that pharmacies are a business entity and develop fee schedules based on market competition, overhead costs, loss leaders, high volume efficiencies, etc. These are examples of fees we have reviewed, not necessarily ones we would endorse.
Examples of what will NOT be accepted:
“Diabetes Counselling Services $XX/hour”
“In Home Medication Review $XX”
“Dispensing fee for complex clients (or any disease/condition subcategory): U&C + 15%”
“U&C for <age groups, eg. Seniors>: $XX”
Additional examples of what will NOT be accepted can be found on Manitoba Health, Seniors and Active Living’s Information for Health Professionals webpage here: http://www.gov.mb.ca/health/pharmacare/profdocs/faq_audit.pdf
Examples of what WILL be accepted:
“U&C: $XX (all drugs, all the time)”
“Specific service provisions for birth control pill packs/inhalers etc. that are less than the noted U & C“
“U&C based on ingredient drug cost intervals” (e.g. $0-$200: U&C $9.95; $201-$500: U&C $12.95)
- CONCERNS ABOUT AUDIT, RECOVERY, and TIMELINES:
- In the first three to six months following the Effective Date of August 18, 2017, we will be exercising an AUDIT and FEEDBACK process. This means that, we will provide pharmacies with a ‘grace period’ to adjust to the new regulations. During this time, we will be monitoring claims submitted through DPIN and where inconsistencies are identified, pharmacies will receive FEEDBACK. This will serve as an educational tool to assist pharmacies in achieving compliant billings. Subsequent to this 3-6 month ‘grace period’, pharmacies that continue to be non-compliant will be subject to AUDIT and RECOVERY.
- During the 3-6 months post-effective date, we will send general communication to all pharmacies about the types of non-compliance we are observing and reminders on how to appropriately submit claims and fees.
- TIMELINES for approval of Schedule B’s. We are expecting to review and provide approval or rejection letters within approximately 10 business days of receiving your submission. Upon receipt of a Schedule "B", pharmacies can expect to receive “notification of receipt” of the Schedule “B” – Notice of Professional Fee Change. Notification of receipt is not approval. A separate notification which summarizes the professional fee schedule change(s) that have been reviewed will be sent subsequently. Professional fee schedule changes can only be applied to claims upon receipt of the final approval letter and beginning on the specified effective date.
- Any claims submitted that include professional fees not confirmed/accepted by the Department will be subject to audit and recovery. Therefore, we recommend holding on any fee schedule changes until receipt of our approval letter.
- The Frequent Dispensing Authorization Form is still under review. Please refrain from sending in requests for review and approval using the old version. Pharmacies that have submitted the requests using the original version will have to RESUBMIT once the new version is posted.
NOTE: It has become clear to us (from the early adopters that have already submitted the form) that some pharmacies consider ‘senior citizen’ a criteria for frequent dispensing. This is not the case. Frequent dispensing for those drugs on the Frequency of Dispensing List will only be supported in very specific cases and these will be listed on the new form.