Paperless Drug Card Initiative Update
As you may recall from our August 23, 2016 eblast, starting December 1, 2016, social assistance clients with a valid Ontario health card will no longer receive a paper drug eligibility card. While many pharmacies have been transitioning patients to a paperless system over the past months, there may be a number of patients who continue to provide their paper drug cards monthly. In light of this December 1 implementation date, the Ministry of Community and Social Services (MCSS), with guidance from OPA, has put together a number of references and tools to assist pharmacists in the implementation of this system:
We encourage you to review these documents prior to the December 1 implementation date to ensure that you are familiar with the changes. To further assist you in navigating this change, we have highlighted below some key points.
- Social assistance clients will now present their Ontario health card to the pharmacy in lieu of the monthly paper drug card. The pharmacist will use the health card number to adjudicate the claim.
- If a claim is accepted, eligibility has been verified and there is no need to further validate coverage.
- If the claim is rejected, the pharmacist should ensure the correct information has been entered, including the eligibility end date and that only plan codes C or D are being used. Plan codes M, N and Y should be entered as plan code D. If the claim is still rejected, only then should the pharmacist verify patient eligibility with the Social Assistance Verification Line to establish coverage.
- As of December 1, 2016, the Social Assistance Verification Line will be available from 7 a.m. to 7 p.m. and will have a higher call capacity than the current system with the goal of addressing calls in a timely fashion. We recognize that in the event that coverage cannot be verified after hours, and where a patient has an immediate need for the medication, there remains some uncertainty regarding the use of the Good Faith override code. The Ontario Pharmacists Association continues to work with the MCSS and the Ministry of Health and Long-Term Care to get clarity on this matter and we will provide further guidance as it is available.
- For the month of December, pharmacists can accept the paper drug eligibility card issued for November 2016 as verification of eligibility for ALL December claims. As an example, should pharmacists encounter a situation in which they are not able to verify eligibility and the patient has immediate need for a medication, the November paper card can be accepted as proof of coverage and eligibility.
As always, members who have additional questions about the Paperless Drug Card Initiative are encouraged to contact OPA.
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Take-home Naloxone Kit Availability
There has been much attention given by the media recently to opioid overdose and the availability of free Naloxone kits at pharmacies in Ontario. In some cases, there have been reports of difficulty locating a pharmacy that is able to dispense these kits.
The Association would like to encourage members to review OPA’s Take-home Naloxone online module and quick reference page on the Naloxone kit components. An initial Naloxone emergency kit is reimbursed at $70 and replacement Naloxone emergency kits are reimbursed at $45 through the appropriate Health Network System PINs.
For more information, members are encouraged to contact OPA.
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Wholesale Distribution of UIIP Vaccine Supply
As part of the 2016-17 Universal Influenza Immunization Program (UIIP), the Ministry of Health and Long-Term Care implemented a new vaccine distribution pilot which allows pharmacies located outside of Toronto (M postal codes) to place their publicly funded influenza vaccine orders through their primary wholesale distributor. The purpose of this pilot was to assess opportunities to improve influenza vaccine ordering and delivery timeline.
With this year’s UIIP well underway, OPA has received feedback from a number of members participating in the program regarding difficulties with their access to publicly funded influenza vaccine supply. Despite confirmation from Public Health that as of Thursday, November 10, 2016, distributors had received their third shipment of vaccine (for a total of 909,000 doses), we continue to hear from members who are having difficulty accessing allocations of publicly funded influenza vaccine through their various wholesalers. The Association is working closely with the Ministry as well as with the Canadian Association for Pharmacy Distribution Management (CAPDM) to resolve supply issues and we will provide more information as soon as possible. In the meantime, members working in pharmacies that are located outside of Toronto are encouraged to let OPA know if they continue to have trouble accessing flu vaccine supply.
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