BtC Helps You Understand the New Ontario Drug Benefit Paperless Drug Card Initiative.Prior to September 1, 2016 patients brought in monthly cards to prove their drug benefit eligibility (often called “C”or “D”cards). Patients were usually registered under “Ontario Disability Support Program” or “Ontario Works”. Starting September 1, 2016, this monthly card is no longer required. A valid health card is sufficient. A temporary monthly card is also sufficient when an OHIP card is not available. Thanks to Ontario Pharmacists Association, Ministry of Health for answering my emails If you are already familiar with the background info, you should skip down to the table belowImportant Dates Sept 1, 2016 - Earliest date pharmacies can stop asking patients for their monthly ODB cards December, 2016 - No more monthly paper cards will be printed Sept to Dec, 2016 - Monthly cards still printed and mailed, to ease the transition to fully paperless Important Contact Info Help Line, 1-888-284-3928 Email for questions: SASM-Q&[email protected] Email for questions: [email protected] Important Documents:
Here's how I interpreted what to do if a patient does/does not have a drug card, and how to act if there is a successful/unsuccessful adjudication. |
Click Below to Download TABLE.doc | |
File Size: | 32 kb |
File Type: | doc |
Calling the Help Line requires you to complete extra documentation.
Here's how I interpreted the MOH requirements.
**Use at own risk, tool has not been reviewed by Ministry of Health**
Click Below to Download DOCUMENTATION TOOL | |
File Size: | 13 kb |
File Type: | docx |
Additional Documentation required:
If you are calling the Help Line, you need to record additional documentation. The below has been taken verbatim from the draft document provided by MOHLTC but I underlined a few things to emphasize importance.
The Help Line will provide the pharmacy with a confirmation number on completion of the call.
Upon obtaining information related to the eligibility of a client, the caller will then record a note in their vendor software and on the prescription hardcopy detailing the following information:
The information should be logged on the prescription hard copy and in the client’s electronic file and retained on file for the next two years following the last claim date. Please be advised that all elements of documentation listed above are required for postpayment verification purposes. Claims that are submitted with the ML override code without the documented information at the time of claim submission may be subject to recovery.
If you are calling the Help Line, you need to record additional documentation. The below has been taken verbatim from the draft document provided by MOHLTC but I underlined a few things to emphasize importance.
The Help Line will provide the pharmacy with a confirmation number on completion of the call.
Upon obtaining information related to the eligibility of a client, the caller will then record a note in their vendor software and on the prescription hardcopy detailing the following information:
- The first and last name of the person who made the call to help desk
- The date and time of the call
- Patient first name and last name
- Type of Coverage Confirmed (Plan Code)
- Dates of Coverage Confirmed
- Confirmation number from the Help Line to confirm client’s eligibility for ODB
The information should be logged on the prescription hard copy and in the client’s electronic file and retained on file for the next two years following the last claim date. Please be advised that all elements of documentation listed above are required for postpayment verification purposes. Claims that are submitted with the ML override code without the documented information at the time of claim submission may be subject to recovery.
Common Questions:
If anyone else has been in contact with Ministry of Health and has information to share, please do not hesitate to post in comments section below, thanks!
Note 1: According to the flow chart provided by the Ministry of Health it would appear that the Help Line needs to be contacted for *any* rejection. However, MOH has admitted that the flow chart needs to be revised to eliminate this confusion. As of September 1st, 2016, if the client has a (valid) paper drug card, pharmacists do not need to contact Help Line to confirm the client’s social assistance eligibility.
UPDATE: MOH has revised their flow chart here:
https://www.opatoday.com/Media/Default/Eblast/Scenario%20-%20ODB%20Cannot%20be%20Confirmed%20Via%20HNS-1.pdf
Since this is posted under "opinion", I should probably give mine. This has been a long time coming and those monthly drug cards are just one of the many non-clinical frustrations pharmacists and staff experience on a daily basis. However, any new change often causes lots of headaches, so I won't call this initiative a success yet. The documentation is tedious. We can't control how the Ministry implements this initiative on their end...
- Question: If the Help Line is not open (outside of business hours), what are pharmacists expected to do?
Answer from MOH: use current business process for these situations.
Answer from BtC: maybe do something that starts with "a" and ends in "dvance" - Question: I do not know what program the patient is registered to.
Answer from BtC: The HNS does not inform you of the program nor Plan code (C or D). You have two options. You can ask the patient themselves if they know what program their benefits are under (e.g. are your benefits through ODSP? Are you getting benefits through Ontario Works?). The second option is to bill 100 days supply and if there is a cutback to 35 days, then you know the patient should be adjudicated with the “D” code in front of their health card number.
If anyone else has been in contact with Ministry of Health and has information to share, please do not hesitate to post in comments section below, thanks!
Note 1: According to the flow chart provided by the Ministry of Health it would appear that the Help Line needs to be contacted for *any* rejection. However, MOH has admitted that the flow chart needs to be revised to eliminate this confusion. As of September 1st, 2016, if the client has a (valid) paper drug card, pharmacists do not need to contact Help Line to confirm the client’s social assistance eligibility.
UPDATE: MOH has revised their flow chart here:
https://www.opatoday.com/Media/Default/Eblast/Scenario%20-%20ODB%20Cannot%20be%20Confirmed%20Via%20HNS-1.pdf
Since this is posted under "opinion", I should probably give mine. This has been a long time coming and those monthly drug cards are just one of the many non-clinical frustrations pharmacists and staff experience on a daily basis. However, any new change often causes lots of headaches, so I won't call this initiative a success yet. The documentation is tedious. We can't control how the Ministry implements this initiative on their end...
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