Reimbursement models Flashcards
MedsCheck reimburse
reimbursed through pharmacy software using PINs
-adjudicate through ODBs health network system
who receives MedsCheck coverage
all ON residents meeting eligibility reqs can receive covered service, not just those covered under ODB
universal influenza immunization program (UIIP)
-covers administration of influenza vaccine
+publicly funded
all immunizations other than influenza are not publically funded in ON
true
Smoking cessation reimbursement
regardless of outcome
-reimbursed through pharmacy software using PINs that adjudicate through ODBs health network
+ONLY ODB patients eligible for this
alt: private insurane, out of pocket
Pharmaceutical opinion program (for pharmacist)
example of pharmacist being paid for filling standard of practice (not always the case)
-ID and manage DTP
Pharmaceutical opinion program
reimburse thorugh pharm software using PINs that adjudicate through ODB health network
- ONLY ODB patients eligible
- ID and mngmnt of DTP considered SoP, if patient not ODB recipient, problems still must be adressed
what interventions DO NOT qualify in pharmaceutical opinion program
- contacting prescriber when RPh could otherwise adapted Rx within SoP
- recommend medical device for therapy
- suggest alternatives for drug coverages purposes
- clarigy missing info on Rx or illegible handwriting
- suggest alts due to lack of inventory/drug shortages
- anything w/o recommendation from RPh
Eligibility requirements for medsCheck
Annual
-3+ Rx meds for chronic conditions
At home
-3+ Rx meds and unable attend pharm
Follow-up
- already received annual review
- hospital discharge, planned admission, MD/NP referral, RPh documented decision
LTC
- formerly funded as separate service
- all pharmacy services are reimbursed under capitation model (dollar/bed)
