I understand the pharmacist can bill Pharmacare for certain exception status drugs without a request form or letter from the physician?
Yes, if the prescriber writes appropriate criteria codes on the prescription. By supplying a code, the prescriber verifies that the drug is prescribed for an indication approved under the Pharmacare Programs. The prescriber may provide diagnostic information on the prescription instead of the actual code, but this information must clearly indicate to the pharmacist which code should be used. Any situation that falls outside the criteria identified by the codes requires prior approval and the prescriber must send a form or letter to the Pharmacare office. In selected cases, the pharmacist may provide the criteria code to permit online billing. By doing so, the pharmacist is verifying that the drug is being prescribed for an indication under the Pharmacare Program.
Related Questions
- Why must I complete a Change of Status Request (HRM-3) for extra service, since this form does not reference a box for extra service? In what box should I place the information pertaining to the extra service?
- Once an exception status drug is approved, can the pharmacy bill Pharmacare for the cost of the medication?
- How am I notified of the decisions regarding exception status drugs?
