Why is payment sometimes reduced on the claim a pharmacy submits to TELUS Health Solutions?
Payment can be reduced for a number of reasons. A DIN price can be cut back if the pharmacy submits a DIN price in excess of what the TELUS Health Solutions DIN price file will pay. Dispensing fees can be cut back if the pharmacy submits a dispensing fee in excess of the usual and customary fee. TELUS Health Solutions will pay or if there is a dispensing fee maximum in place for the group. DIN cutbacks can also occur if a drug plan has implemented generic substitution, reference-based pricing and/or maximum-allowable cost pricing. As well, DIN cutbacks can occur if the days supply for a medication exceeds 34 days for acute drugs or 100 days for maintenance drugs.
