Payment Methods for Prescriptions Flashcards
How are pharmacies reimbursed now?
Largely based on provision of pharmacy services.
What is “dispensing”?
The interpretation and evaluation of a prescription, selection and manipulation or compounding of a pharmaceutical product, labelling and supply of the product in an appropriate container according to legal regulatory requirements and the provision of information and instructions by a pharmacist or under the supervision of a pharmacist, to ensure the safe and effective use by the patient.
What is “patient-focused care”?
The merging of several models of health care practice including patient education, self-care and evidence based care into 4 broad areas of intervention: communication with patients, partnership with patients, health promotions and delivery of care.
How are prescriptions paid for in Canada?
A mix of public and private coverage.
What are the two types of public coverage?
Federal Plans: for veterans, first nationa, inuit, military personnel, recent immigrants, inmates, RCMP
Provincial Plants: for low-income seniors, recipients of social assistance, and some provinces do universal soverage.
Which province is modelling universal coverage for its residents?
Quebec
What is Third Party Billing?
The financial coverage for medications or pharmaceutical aids involving a contractual agreement between a third party payer and the pharmacy.
What is a formulary?
A list of medications approved by the insurance company as an eligible benefit.
What is a copay?
The portion of the prescription price that the patient pays (may include a percentage or cost of the prescription above what the plan pays).
What is a deductible?
The amount the patient pays every year before the insurance company starts paying its share of the costs.
What is the out-of-pocket limits?
The most cost-sharing a patient will ever have to pay in a year. It is the total of deductible, copays and coinsurance.
What are types of insurance plans?
Government sponsored: provincially administered by Alberta Blue Cross and Federally sponsored plans
Private Plans: plans offered by employers and adjudicated by insurance carriers like Sunlife
What is Alberta Pharmacy Fee Reibursement?
An agreement between the RxA, Alberta Blue Cross and the Alberta government was implemented. This includes four years of predictable funding, changes to dispensing fees and an updated pharmacy services framework that compensates pharmacists for the services they provide.
What is the Manufacturer List Price?
The price of a drug listed in the ADBL.
What is the base price?
The base price if the price per unit of a drug, a drug product or product. Price established by Alberta Blue Cross… Applied to drugs not listed in the ADBL
What is the one dispensing fee introduced by Pharmacy Free Reimbursement?
12.30
How did pharmacies used to be reimbursed?
By what products they sold and were dispensed - reimbursement was product focused.
What is Alberta Health?
A ministry within the Government of Alberta which sets strategic health care policy and funds health care services.
What organization in Alberta administers front-line health care services?
Alberta Health Services
What is covered by the Alberta Health Care Insurance Plan?
Hospitalization, medically necessary surgery, physician vists, laboratory services, health aspects of long-term care, home care and ambulatory care services. Prescription drug services.
What are options for paying for prescription drugs?
Employer sponsored health benefit plans
Individual health benefit plans
Pay out of pocket
Government sponsored coverage
What are the differences between public and private prescription drug insurers?
Public drug plans have drug benefits informed by a National common drug review undergoing evidence based review. Public plans are funded partially by those using the insurance plans and then taxpayers covering the shortfall.
Who administers Government of Alberta sponsored drug plans?
Alberta Blue Cross: processes claims, provides admin and research support to come on benefits list and administers special authorization process.
What is the Alberta Drug Benefit List?
A mast list of benefits under the plans. It is a list of drug products converted under the plans, criteria and prices… over 4700 DINS. Both brand version and it generic alternatives. It is updated monthly.
