volume 3c: business rules - pharmanet - gov.bc.ca · professions act, foippa, pipa and the bylaws...

British Columbia Professional and Software Conformance Standards

Electronic Health Information Exchange

Volume 3C: Business Rules - PharmaNet

Version 3.0 2019-05-24

Security Classification: Low Sensitivity

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Document Details

Author: Ministry of Health Conformance and Integration Services

Date Created: 2011-03-31

Last Updated: 2019-05-24

Version: 3.0

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Table of Contents

1.0 Introduction ............................................................................................................. 4

2.0 General – Business Rules ....................................................................................... 5

2.1 Merged PHNs.......................................................................................................... 6 2.2 PharmaNet Participant Messaging (Fan-Out) .......................................................... 8 2.3 Storing PharmaNet Data ......................................................................................... 9 2.4 PharmaNet Access Discrepancy Reporting ............................................................10 2.5 Patient Protective Word ..........................................................................................14

3.0 Patient Identification – TID .................................................................................... 17

4.0 Patient Name Search – TPN ................................................................................. 20

5.0 Patient Address Update – TPA ............................................................................. 23

6.0 PHN Assignment – TPH ........................................................................................ 24

7.0 Prescriber Identification - TIP ................................................................................ 30

8.0 Patient Medication Profile Request – TRP/TRR/TRS ............................................ 32

9.0 Adjudicate a PharmaCare Claim – TAC/TDU ........................................................ 36

9.1 Refill a Prescription – TAC/TDU .............................................................................44 9.2 Transfer of Refill Authorization – TAC/TDU ............................................................45 9.3 Stocker Transfer – TAC/TDU .................................................................................46 9.4 Refusal to Fill Claim – TAC/TDU ............................................................................47 9.5 Office Use Medications – TAC/TDU .......................................................................50 9.6 Plan B Claims (Long Term Care) – TAC/TDU ........................................................51 9.7 Trial Prescription Claims – TAC/TDU .....................................................................53 9.8 Dispense Processing without the Network – TAC/TDU ..........................................54 9.9 Pharmacy Recovery – TAC/TDU ............................................................................56

10.0 Reversing a Dispense – TAC/TDU ........................................................................ 57

11.0 Drug Use Evaluation - TDU ................................................................................... 59

12.0 Medication Update – TDU/TMU ............................................................................ 61

13.0 Reversing a Medication Update – TMU................................................................. 65

14.0 Patient Protective Word Maintenance – TCP ........................................................ 67

15.0 Drug Monograph Information – TDR ..................................................................... 70

16.0 Adjudication Reconciliation – TDT ........................................................................ 72

17.0 Patient Profile Information Update – TPI ............................................................... 73

18.0 Patient Access to Personal Data – TPM ............................................................... 77

19.0 Get Location Details - TIL ...................................................................................... 79

Conformance Standards Volume 3C: Business Rules - PharmaNet

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1.0 Introduction

The business rules in this volume define the mandatory standards for all software organizations using PharmaNet transaction messages.

PharmaNet is:

• a secure network that links community pharmacies, out-patient pharmacies, in-patient hospital pharmacies, non-pharmaceutical pharmacies, medical device distributors, community health practices, and hospital authorized users throughout the province.

• a provincial repository that stores patient dispense and medication profile information which can only be retrieved in a secure manner by authorized BC health care providers.

• not intended as a substitute for professional knowledge and judgement

• not exhaustive and cannot be relied upon as a complete patient information record

The Pharmaceutical Services Act (PSA) mandates the use of PharmaNet and users are subject to compliance with all applicable legislation, regulations, by-laws and policies.


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2.0 General – Business Rules

Table 1 General – Business Rules

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PNet1.1 Confidentiality

Access to PharmaNet is not permitted unless the confidentiality agreement has been signed by the user.

M M M M M M M M M

PNet1.2 Batch Transactions

Batching transactions must only be used to:

a. dispense to Plan B patients in a Long Term Care facility; and

b. recover from a Network Down situation.

O X X X X X X O X


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2.1 Merged PHNs

Table 2 Merged PHNs – Business Rules

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PNet2.1 Merged PHN Message

If PharmaNet returns a ‘merged PHN’ message, the following steps must be completed:

a. confirm the patient’s identity;

b. verify the patient demographics using the TID transaction against the local patient record;

c. if the information returned through TID appears to be correct, the provider must update the local system with the merged PHN; and

d. if the merge appears to be incorrect, the provider must contact HIBC to request correction.

Notes:

1. There may be some instances where a PHN has been assigned to a patient when one already exists.

2. These PHNs are merged into a single PHN record and PharmaNet will return the new merged PHN message.

M M M M M X X M M


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PNet2.2 Correct Merged PHN

If the demographic information returned from PharmaNet is correct, the user must update the local patient record to reflect the new PHN.

Note: If the PHN on the patient’s BC Services Card is incorrect, advise them to contact HIBC.

M M M M M X X M M

PNet2.3 Incorrect Merged PHN

If the PHN merge appears to be incorrect, HIBC must be contacted to request correction or an un-merge.

M M M M M X X M M


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2.2 PharmaNet Participant Messaging (Fan-Out)

Table 3 PharmaNet Participant Messaging – Business Rules

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PNet3.1 PharmaNet Participant Messaging (Fan-Out)

‘Fan-Out’ messages must be read, and appropriate action taken.

Notes:

1. The PharmaNet Participant Messaging (fan out) is used to broadcast urgent PharmaNet messages (e.g., system disruption/outages, advisory messages, lost/stolen prescription pads).

2. The POS application must deliver the message to each registered PharmaNet user with an active session, or upon login.

3. Fan out messages may be printed and/or stored.

M M M M M M X M M


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2.3 Storing PharmaNet Data

Table 4 Storing PharmaNet Data – Business Rules

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PNet4.1 Acceptable Data to Store

PharmaNet data may be stored in the POS application, but it must be limited to:

a. patient medication profile data retrieved as part of a medication review/BPMH; and

b. drug use evaluation (DUE) results.

Note: For the purpose of medication reviews and BMPH, transaction data files must not be shared with any third-party vendor and must only be used for the purpose of providing clinical care.

M X M X M M X X X

PNet4.2 No Modification of Stored Data

PharmaNet data stored in the POS application must not be modified.

However, annotations may be made.

M X M X M M X M X

PNet4.3 Use of Stored Pharmanet Information

Stored information from PharmaNet must not be used or disclosed for any purpose other than to provide care to the individual whose information is being accessed.

M X M X M M X M X


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2.4 PharmaNet Access Discrepancy Reporting

The purpose of PharmaNet access discrepancy reporting is to identify apparent unauthorized accesses of PharmaNet data that may constitute browsing.

Potential inappropriate accesses to PharmaNet must be identified and investigated and, if deemed inappropriate, reported and escalated as described below.

Table 5 PharmaNet Access Discrepancy Reporting – Business Rules

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PNet5.1 Frequency of Reporting

PharmaNet access discrepancy reporting must be performed by a designated individual a minimum of once per month.

M M M M M M M M M

PNet5.2 Documentation of Discrepancy Process

To the extent possible, the discrepancy reporting must identify potential inappropriate access by identifying accesses where:

a. user’s last name matches to the patient’s current, maiden or other ‘alias’ last name;

b. user’s last name matches with the last name of anyone listed in the patient’s file as a person to notify or family member/next of kin or guarantor;

c. user’s phone number and/or address and/or postal code are the same as the patient’s and/or anyone listed in the patient’s record;

d. patient’s last name matches

M M M M M M M M M


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against an employee’s names (i.e., if employee Joe Smith requests PharmaNet information for Jane Doe and there is a Jason Doe working in the facility, the access gets reported as a potential breach);

e. patient is a public figure or VIP; and/or

f. it is more than five days before or after a clinical encounter with the patient.

PNet5.3 Documenting Inappropriate Accesses

All inappropriate accesses must be investigated.

These may be the result of errors in data entry (i.e., searching ‘Block’ versus ‘Black’), problems related to accurate patient identification, etc.

The outcome of the investigation of an inappropriate access must be documented and maintained along with the PharmaNet access discrepancy reports for a period of two years for review by the audit/inspection team.

M M M M M M M M M


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PNet5.4 Reporting Inappropriate Accesses

All inappropriate accesses that have not been resolved must be reported to the Chief Information Officer (CIO) or administrator depending on the governing body of the facility and relevant profession.

For hospital departments, all inappropriate accesses that have not been resolved must be brought to the attention of the CIO and hospital administration.

M M M M M M M M M

PNet5.5 Retention of Records

Records related to the investigation, reporting, escalation and penalization of PharmaNet privacy breaches must be maintained for a period of two years for review by the audit/inspection team.

M M M M M M M M M

PNet5.6 Confidentiality Breaches

Instances of misuse of information or breaches of confidentiality related to PharmaNet data must be dealt with in accordance with facility policy and escalated to the appropriate regulatory body as necessary.

a. the CPBC will use the Health Professions Act, FOIPPA, PIPA and the Bylaws under the Act, together with the College of Pharmacists Code of Ethics Standard 4, should a pharmacist or staff under their supervision be shown to have breached confidentiality

M M M M M M M M M


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or misused a patient’s confidential data;

b. the CPSBC will use the Health Professions Act and the Bylaws under the Act, together with the Canadian Medical Association Code of Ethics for practitioners, should a physician or staff under their supervision be shown to have breached confidentiality or misused a patient’s confidential data;

c. for nurses, the hospital administration may escalate to the appropriate governing body (NNPBC); and

d. for any authorized clerical staff of a hospital or medical practice bound by the FOIPP Act Part 3 (Protection of Privacy), the Privacy administrator will need to take appropriate action to ensure confidentiality and ensure access to personal information is authorized and complies with the Act.


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2.5 Patient Protective Word

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PNet6.1 Protective Word Patient Consent

If a patient has a protective word assigned to the PharmaNet record, the user must:

a. ask for the patient’s protective word and consent to access the PharmaNet record.

For Pharmacy the user must also:

b. inform the patient that consent will be for both the use and storage of the protective word.

M M M M M M M M M


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PNet6.2 Access without a Protective Word

In order to access PharmaNet protected data without a protective word, HIBC must be contacted to request removal of the protective word.

This method of accessing protected data must only be done if a patient is not able to provide the protective word and it is determined that delay in accessing the PharmaNet data could result in harm to the patient.

Situations where this may be necessary include the patient being:

a. unconscious or semi-conscious;

b. impaired; or

c. incapable of giving consent or refusing to give consent.

In such cases an authorized user (e.g., practitioner or delegated representative authorized by the practitioner) must contact HIBC to have the patient’s protective word removed.

The patient must be informed before being discharged that the protective word was removed and will need to be re-established at a community pharmacy if desired.

M M M M M M M M M


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PNet6.3 Protective Word Storage and Use

Use of a stored protective word must be explicitly verified (e.g., click the field) in the first transaction of a patient session.

Notes:

1. If the stored protective word is required to access PharmaNet, the POS application will automatically populate the protective word field in an encrypted state.

2. The user does not need to verify the use of the protective word in subsequent transactions during the same patient session.

3. Protective words must not be stored on paper.

M X X X X M M X X

PNet6.4 Protective Word Use

PharmaNet protective words must not be shared among users sharing patient information.

M M M M M M M M M


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3.0 Patient Identification – TID

The Patient Identification transaction is used to identify a patient by entering a Personal Health Number (PHN) to return the associated demographic information for verification of the patient.

The following are the business rules specific to identifying a patient.

Table 6 TID (Patient Identification) – Business Rules

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PNet7.1 Confirm Patient Identity

If the patient is not known to the health care provider, the patient’s identity must be confirmed.

M M M M M X X M M

PNet7.2 Correcting Patient Demographics

If a correction to the demographic information in PharmaNet is required, the patient must be informed to contact HIBC.

Note: HIBC can correct or update patient names, date of birth, or gender in PharmaNet.

M M M M M X X M M


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PNet7.3 Review of Identity Documents

The user must review trusted identity documentation to ensure names, birth dates and gender are correctly entered.

Trusted identity documents include:

a. Birth Certificate

b. Canadian Citizenship ID Card

c. Canadian Forces ID Card

d. Canadian Record of Landing

e. Change of Name Document

f. Confirmation of Permanent Residence

g. Driver’s License

h. Marriage Certificate

i. Native Status Card

j. Passport

k. Permanent Resident Card

l. Provincial Health Insurance Cards from other Canadian Provinces

M M M M M X X M M

PNet7.4 Verify Patient’s Demographics

The patient’s demographic information must be verified with the patient to ensure the right patient has been selected.

M M M M M X X M M


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PNet7.5 Verify and Correct Patient Address

The POS will display a comparison of the PharmaNet demographics to the demographics stored in the POS application.

If these records do not match, the incorrect or out of date information must be updated.

M M M M M X X M M


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4.0 Patient Name Search – TPN

The Patient Name Search business interaction is used to locate a patient’s PHN and to ensure multiple PHNs are not assigned to a patient.

If a patient name search is done locally through the POS application and there are no matches found, a search of PharmaNet is required to determine if a PHN exists for the patient. Searches are performed using a patient’s name, date of birth and gender.

Table 7 TPN (Patient Name Search) – Business Rules

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PNet8.1 Search For PHN

The following demographic fields must be entered to search for a patient’s PHN.

a. surname;

b. complete or partial given name;

c. gender; and

d. date of birth or year of birth.

M M M X M X X M X

PNet8.2 Confirm Patient Information

If the information returned from PharmaNet does not match what was provided by the patient the user must ensure the correct person has been selected and determine if the patient’s information has legitimately changed (e.g., the person has moved or changed name).

Note: An incorrect selection has far reaching implications and care must be taken to match the returned demographics to the patient presenting for service.

M M M X M X X M X


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PNet8.3 Merge PHNs

If multiple PHNs are identified for the same patient, HIBC must be contacted to request a PHN merge.

M M M X M X X M X

PNet8.4 Date of Birth

If the results of a PharmaNet query return an incorrect birthdate the patient must be instructed to contact MSP to correct it.

Notes:

1. If PharmaNet returns an “01” as a day of birth it must be verified with the patient.

2. If incorrect, HIBC must be contacted to correct the error.

3. Historically, “01” was used as a default day of birth when the valid day was not collected.

M M M X M X X M X

PNet8.5 Date of Death Error

If a date of death has been incorrectly applied to the patient’s record, HIBC must be contacted to make the correction.

M M M X M X X M X


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PNet8.6 No Candidates Found

If the patient cannot be found in PharmaNet the search criteria must be updated and resubmitted until satisfied that the patient does not exist in PharmaNet.

If a ‘no candidates were found’ warning message is received:

a. update the search criteria; and

b. resubmit the Patient Name Search Transaction.

Note: This warning can occur when not enough search criteria are provided resulting in too much data being generated to be meaningful.

M M M X M X X M X


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5.0 Patient Address Update – TPA

This interaction is used to update a patient’s address information in PharmaNet. The user must review the patient’s address information on both the POS system and PharmaNet to ensure it is accurate and, if necessary, make changes to the address information.

Table 8 TPA (Patient Address Update) – Business Rules

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PNet9.1 Update Address

Review the patient’s address information on both the POS application and PharmaNet to ensure it is accurate and, correct any inaccurate information.

M O M X O X X M X

PNet9.2 Addressing Standards

The patient’s mailing address must be updated in accordance with Canada Post Addressing Standards (see Appendix A).

M O M X O X X M X

PNet9.3 Home Address

Always capture the client’s home address, even if they are visiting the province or temporarily relocated within the province.

M O M X O X X M X

PNet9.4 Postal Code

The postal code must not be left blank.

For out of country addresses or in cases where the postal code is not available, the pharmacy postal code must be entered.

Note: PharmaNet returns an error if the postal code is left blank.

M O M X O X X M X


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6.0 PHN Assignment – TPH

A PHN must not be assigned until the user has searched both the POS application and PharmaNet to ensure a PHN does not exist for a patient.

Assigning a second PHN will result in a split of the patient’s medication profile (medical history, clinical conditions, and adverse reaction) and negatively affect Drug Use Evaluation (DUE) checking and PharmaCare benefits adjudication for the patient.

Table 9 TPH (PHN Assignment) – Business Rules

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PNet10.1 Check for Existing Pharmanet Patient Record

A new patient record must not be entered if one already exists in PharmaNet.

The following steps must be taken before adding a new patient:

a. identify patient; and

b. obtain a patient’s PHN by physical validation of a BC Services Card or the Patient Name Search Business Interaction.

M X M X M X X M X


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PNet10.2 PHN for Every Patient

A Personal Health Number must be assigned to every identified person receiving a health care service in British Columbia.

Notes:

1. The patient does not need to be a resident of the Province to receive a PHN.

2. Availability of PHN is not a confirmation of benefit eligibility.

M X M X M X X M X

PNet10.3 PHN Assignment for Patient with No Matching Record

A PHN must be created for the patient when there is no matching patient record on PharmaNet for the patient.

The New PHN must be given to the patient.

M X M X M X X M X

PNet10.4 PHN Assignment for a Non-Human

A PHN must not be assigned to a non-human (e.g., pets, medical facilities, doctor’s offices).

M X M X M X X M X

PNet10.5 Legal Name

Trusted documents must be reviewed, and the patient’s legal name used when requesting a new PHN.

M X M X M X X M X


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PNet10.6 Full Names

Full names must be recorded:

a. initials must not be recorded as a legal name unless the client’s name is a one-character name (e.g., ‘J’ is the client’s legal first name); and

b. aliases, nicknames and preferred names must not used.

Note: These names may be recorded in a separate field within the POS application.

M X M X M X X M X

PNet10.7 Name Entry

A two-part first name must not be entered as a single name; it must be entered with a dash (-) or space as indicated on their identity documents.

A hyphen, an apostrophe, or a space must be included if it is part of the name.

No other information is to be entered in a name field (e.g., Dr., Jr., Sr., III).

M X M X M X X M X

PNet10.8 Spelling of Names

The patient’s name must be recorded as substantiated by trusted documents.

Note: Misspelling of the client name will cause name mismatches, which may prevent accurate record linkage, and cause client identity and clinical information problems.

M X M X M X X M X


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PNet10.9 PHN For New Born

If a newborn is not listed in PharmaNet, the following steps must be taken:

a. create a PHN

b. provide the PHN to the parent.

If the newborn’s registered name cannot be confirmed the user must record:

c. first name as ‘baby boy’ or ‘baby girl’; and

d. surname as the mother’s surname.

Notes:

1. Baby names should be recorded as found on identify documents or as registered with Vital Statistics.

2. Assigning a PHN to the newborn does not denote eligibility for MSP benefits.

M X M X M X X M X

PNet10.10 Gender Unknown

In the rare instance when a client’s gender is unknown, the gender must be recorded as “Unknown”.

M X M X M X X M X

PNet10.11 Date of Birth – Unknown

Estimated birth dates must not be entered.

For birth dates that cannot be obtained from the patient, 1800/01/01 must be recorded as the default birth date.

M X M X M X X M X


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PNet10.12 Addressing Standards

Addresses must be recorded using the Canada Post Addressing Standards (see Volume 3A – Appendix A).

Information that is not part of a true address must not be recorded in the address lines.

M X M X M X X M X

PNet10.13 Special Characters

Special characters must not be used in an address (see Volume 4C PNet Msg Spec, Implementation Guide, Appendix A – PharmaNet Data Types).

M X M X M X X M X

PNet10.14 Address Validation

An address format that was corrected to meet the Canada Post standards must not be revised.

M X M X M X X M X

PNet10.15 Patient’s Address

Always capture the client’s home address, even if they are visiting the province or temporarily relocated within the province.

Temporary addresses can be stored in the POS application, but must not be sent to PharmaNet.

M X M X M X X M X


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PNet10.16 Residential Care Address

For a person residing in residential care (e.g., extended care facility, mental health facility), the physical address of the residence must be recorded as the client’s home address.

If the last known address is not known, follow the ‘Unknown Address’ rule.

M X M X M X X M X

PNet10.17 Address for Person in Prison

The last known physical address of a person in prison should be recorded.

However, it is acceptable to capture the prison address as the physical address.

M X M X M X X M X

PNet10.18 Foster Family Address

If a child is in foster care, record the foster family address as the physical address.

Other addresses may be entered as temporary addresses in the POS application.

M X M X M X X M X

PNet10.19 Unknown Address

If the client cannot or will not provide a physical address, the following must be recorded:

a. ‘No Fixed Address’ or ‘Unknown Address’ in address line one; and

b. the city, province and postal code of the physical address where service is being performed.

M X M X M X X M X


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7.0 Prescriber Identification - TIP

Situations arise when a provider may need to confirm the identity or contact another provider.

The Prescriber Identification business interaction returns information such as:

• practitioner identifier;

• practitioner identifier reference (e.g., college);

• name;

• address; and

• telephone number.

PharmaNet can only return details associated with the provider as stated within the information sharing agreement between the associated professional college and the Ministry of Health (the “ministry”). These ‘data permissions’ are set within the PharmaNet application.

PharmaNet uses the practitioner identification number and prescriber identification reference code for providers as assigned by the appropriate regulatory body. MSP billing numbers are not used to identify providers anywhere in PharmaNet.


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Table 10 TIP (Prescriber Identification) – Business Rules

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PNet11.1 Search for a Practitioner

To search for a practitioner, use the:

a. College License Number assigned by the appropriate regulatory body; or

b. practitioner’s family name, and optionally, first initial or all characters of the first name and family name.

Notes:

1. If more than 100 practitioner matches are found, and none will be returned, and the following message will be returned ‘106 Selection criteria chosen resulted in too many matches.’

2. MSP billing numbers are not used to identify prescribers in PharmaNet.

M O M O M X X M X


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8.0 Patient Medication Profile Request – TRP/TRR/TRS

The patient medication profile contains dispensed medication history over the previous 14 months and all recorded clinical conditions, adverse reactions and associated comments.

PharmaNet is a real-time system and updates occur continually so it is recommended that the most up-to-date patient medication profile information be reviewed when making decisions.

Note: Dispense information for products designated as non-pharmaceuticals (e.g., prosthesis and other devices) are only returned to the pharmacy that filled the original prescription.

Table 11 TRP/TRR/TRS (Patient Medication Profile Request) – Business Rules

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PNet12.1 PharmaNet Profile Corrections

Any patient profile errors, orphan records, or changes to adverse reaction/clinical condition text fields must be reported to the Ministry’s PharmaNet Data Quality Services Team at:

• 1-844-660-3200; or

• [email protected].

Note: Personnel patient information should not be transmitted by email.

M M M M M M M M M

mailto:[email protected]


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PNet12.2 Medication Error Over 120 Days

HIBC must be notified of any medication profile errors that are older than 120 days.

Notes:

1. A provider can submit reversals and corrections to dispenses in PharmaNet within 120 days.

2. Beyond 120 days, the provider can contact HIBC to request a change window of up to 180 days for correction of the medication error.

3. For changes older than 180 days, contact the Ministry’s PharmaNet Data Quality Services Team at:

• 1-844-660-3200; or

• [email protected].

M X M X M X X M M

PNet12.3 Patient Profile Access

Accessing and storing a patient’s PharmaNet profile must only be for direct patient care or technical support as per the Pharmaceutical Service Act, Information Management Regulation, and under the following guidelines:

a. it is not more than five days before or after a clinical encounter with the patient;

b. each reported access must contain all the fields in the PharmaNet Access Log; and

c. only authorized users are permitted to view the report.

M M M M M M M M M

mailto:[email protected]


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PNet12.4 Medication Profile Review

Practitioners should review the most up-to-date patient medication profile information prior to providing care.

Note:

This information will provide:

• up to 14 months of PharmaNet patient data;

• a list of the patient’s dispenses; and

• adverse drug reactions and conditions that have been recorded in PharmaNet.

M M M M M M M M M

PNet12.5 Medication Profile Request

A patient may request their local medication profile (i.e., dispense records) for up to 14 months from the pharmacy.

PharmaNet patient medication profile records beyond 14 months can be requested directly from the PharmaNet Profiles Department at:

• 1-855-952-1432

M M M X X X X M M


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PNet12.6 Conditions for Display, Print, or Distribution

The patient medication profile may be displayed, printed or distributed by a practitioner working in a hospital, designated mental health facility, emergency department, medical practice, or pharmacy or by an authorized member who is working under the supervision of a medical practitioner, only on the following conditions:

a. the purpose of displaying, printing and/or distributing the medication profile is to enhance the therapeutic care or treatment of the patient;

b. the medication profile is only used for review by a medical practitioner or pharmacist in a facility as noted above;

c. the printed or distributed copy of the medication profile must either be maintained on the patient’s medical chart or record, or it must be appropriately destroyed; and

d. if the patient medication profile is printed or distributed, only one of the following two report formats may be used (see Volume 4C – Application Enforced Rules for more details on display and print standards:

i. Medication Profile Report; and

ii. Medication Reconciliation Report.

M M M M M M M X X


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9.0 Adjudicate a PharmaCare Claim – TAC/TDU

Claim adjudication (TAC transaction) represents the financial portion of a dispense. With every claim there is also a clinical portion which is represented by the Drug Use Evaluation interaction (TDU transaction). If a pharmacist submits and reverses a dispense claim to PharmaNet, both the Adjudicate PharmaCare Claim and clinical DUE interaction information is sent.

The dispense prescription interaction is used to adjudicate the patient’s claim, perform DUE checking against the dispensed medications and update the patient medication profile with dispense information.

This section describes the steps of dispensing an original prescription, refilling a prescription, refusing to fill a prescription or adapting a prescription.

Original Prescription - An ‘original’ prescription is any prescription as defined in the Pharmacy Operations and Drug Scheduling Act (PODSA) and its bylaws and under the Regulations to the Food and Drugs Act. It is either presented by a patient or patient’s agent at the pharmacy or called in to the pharmacy by a practitioner.

Refill Prescription - A refill prescription differs from an original prescription only in the pre-existence of an original dispense for that prescription.

Adapted Prescription - An ‘adapted’ prescription must have an original prescription and must be current, authentic, and appropriate for the patient. A pharmacist may dispense a drug contrary to the terms of a prescription (adapt a prescription) if the action is intended to optimize the therapeutic outcome of treatment and meets the protocols to adapt a prescription as defined by the College of Pharmacists of BC Professional Practice Policy 58 (PPP-58).


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The following are the rules related to Adjudicate a PharmaCare Claim:

Table 12 Adjudicate a PharmaCare Claim – Business Rules

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PNet13.1 Responsible Pharmacist

The pharmacist is professionally responsible for the decision to dispense an original prescription, refill a prescription, or adapt a prescription.

M X X X X X X X X

PNet13.2 Adjudicate Claim to Zero

To have a claim adjudicate to zero, the intervention code of ‘DE’ must be entered or send drug cost ‘0’ and professional/dispensing fee ‘0’.

M X X X X X X M M

PNet13.3 Patient Pay Transaction Code

Transaction code ‘01’ must be used to identify that the claim for the dispense is to be paid to the provider and the patient pays any difference.

The transaction code ‘04’ must be used to identify that the provider collects the full amount for the dispense from the patient.

M X X X X X X M M

PNet13.4 Pay-Patient Claim (Payee)

The payees PHN must be entered in the Client ID # field (when the payee is different from the patient).

Note: Usually the PHN for the payee and the patient are the same.

M X X X X X X M M


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PNet13.5 Pay-Patient Claim (Child)

The parent’s PHN must be entered in the Client ID field and the child’s PHN entered in the Provincial Health Care ID field for cheques to be made payable to the parent.

Note: The PHN entered in the Client ID field must be a member of the same Ministry MSP family coverage as the child’s PHN.

M X X X X X X M M

PNet13.6 Adapted Prescription

Fees are paid only for prescription adaptation as defined by the College of Pharmacists of BC Professional Practice Policy 58 (PPP-58) if:

a. renewing a prescription;

b. changing the dose, formulation or regimen of a prescription; and

c. making a therapeutic drug substitution within the same therapeutic class.

M X X X X X X X X


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PNet13.7 Medication Reviews

Claims for medication reviews must be submitted to PharmaNet on the date the medication review service is provided to the patient and must specify the:

a. appropriate PIN for the level of service performed (standard, consult, or follow-up);

b. College Registration Identification of the pharmacist who provided the service to the patient; and

c. 10-digit pharmacy phone number in the first 20 spaces and in front of any other information that appears in the SIG field.

M X X X X X X X X

PNet13.8 Medication Review Fees

Pharmacists must not request additional fees from any patient or third-party payer in relation to medication reviews for which a fee has been claimed from PharmaCare.

M X X X X X X X X


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PNet13.9 Adapted Prescription Claim

A claim for an adapted prescription must have the:

a. PRACT ID Ref field entered as P1 (for College of Pharmacists of BC);

b. PRACT ID field entered with Pharmacist College ID;

c. ADAPTED at the beginning of the sig ("directions") field; and

d. appropriate intervention code (see list below):

Code Description

NI dosage change

NJ formulation change

NK directions for use modified

NL renewal of prescription

NM therapeutic substitution

Note: It is important that the word ‘Adapted’ appears at the beginning of the SIG field to ensure other health care practitioners recognize this is not the original prescription.

M X X X X X X X X


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PNet13.10 Emergency Prescription Claim

A claim for an emergency prescription must have the:

a. PRACT ID Ref field entered as P1 (for College of Pharmacists of BC);

b. PRACT ID field entered with Pharmacist’s College ID; and

c. appropriate intervention code (see list below):

Code Description

NN emergency supply of medication

NO emergency contraceptive

Note: These claims are not eligible for a clinical services fee.

M X X X X X X X X

PNet13.11 Dispenses for Animals

Dispenses for animals (written by veterinarians) must be recorded in the POS application and transmitted to PharmaNet.

M X X X X X X X X

PNet13.12 Dispenses for Animals – Owner’s PHN

Dispenses for animals must be processed under the owner’s PHN.

Note: This does not affect the owner’s patient medication profile and DUE results if prescribed by a veterinarian.

M X X X X X X X X


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PNet13.13 Review Days Supply

The days supply must be reviewed when changing the quantity on a refill and edited if necessary.

M X X X X X X M M

PNet13.14 Error Detected in Dispense

The dispense must be reversed and a new dispense transmitted if a dispense error is identified in the following:

a. DIN,

b. drug name,

c. strength,

d. quantity,

e. practitioner ID, or

f. instructions for use.

The dispense must be reversed in PharmaNet, applicable third-party carriers and the POS applications.

M X X X X X X M M

PNet13.15 Retransmission

A TAC/TDU transmission that failed due to no response from PharmaNet must be retransmitted.

M X X X X X X M M


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PNet13.16 Suspected Medication Duplication

If it is suspected that medication duplication in the patient profile is a result of multi-doctoring, the pharmacist must reverse the dispense(s) in PharmaNet.

Code Description

CM Suspected multi-pharmacy / multi-doctor

CO Potential overuse / abuse

Note: The pharmacist may submit a “refusal to fill claim”.

M X X X X X X M M

PNet13.17 Dispensed at Another Location

A prescription dispensed at another location must be transferred to the current pharmacy prior to it being refilled.

M X X X X X X M M


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9.1 Refill a Prescription – TAC/TDU

Table 13 Refill a Prescription – Business Rules

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PNet14.1 Refill Review

If the quantity on a refill is changed, the pharmacist must review and edit the days supply if necessary.

M X X X X X X M M

PNet14.2 Refill Quantity

It is permissible to change the quantity for a prescription refill, provided the POS software can retain a record of the quantity dispensed on each previous fill.

M X X X X X X M M

PNet14.3 Refill Changes

Changes made to the quantity for a refill must:

a. not change the historical record of the prescription; and

b. display to the pharmacist the details of the most recent dispensing event.

M X X X X X X M M

PNet14.4 Part Fills

Part fills refer to an original prescription divided to allow multiple dispensing.

The original prescription number must be recorded when processing subsequent part fills.

M X X X X X X M M


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9.2 Transfer of Refill Authorization – TAC/TDU

At a patient’s request, a pharmacist will transfer the refill authority for a prescription(s) to another pharmacy.

The following are the rules related to Transfer of Refill Authorization:

Table 14 Transfer of Refill Authorization – Business Rules

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PNet15.1 Refill Transfer

The transfer of refill authorization must be done by direct communication between pharmacists or registered pharmacy technicians following CPBC policies.

This is a local system function and must not result in any transmissions to PharmaNet.

M X X X X X X X X

PNet15.2 Transfer of Refill Authorization

The transfer of refill authorizations to another pharmacy must be recorded on the local system in compliance with current CPBC bylaws.

M X X X X X X X X

PNet15.3 Remaining Refill Authorizations

All refill authorizations remaining on the prescription must be transferred on previously filled prescriptions.

M X X X X X X X X

PNet15.4 New Refill Authorizations

New, previously un-dispensed prescriptions may be transferred.

M X X X X X X X X


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PNet15.5 Transfer of Narcotic and Controlled Drugs

Transfer of narcotic and controlled drugs is not permitted.

M X X X X X X X X

9.3 Stocker Transfer – TAC/TDU

Table 15 Stock Transfer – Business Rules

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PNet16.1 Stock Transfer

The transfer of drug inventory to an LTC facility for future use is a local system function and must:

a. not result in any transmissions to PharmaNet at the time of transfer.

M X X X X X X X X

PNet16.2 Stock Transfer Dispenses

Medications from a stock transfer must:

a. be transmitted to PharmaNet once the medication is dispensed to a patient.

M X X X X X X X X


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9.4 Refusal to Fill Claim – TAC/TDU

Pharmacists may choose to not dispense a prescription for reasons such as a drug-to-drug interaction or suspicion of multi-doctoring. In some instances, the pharmacist may be entitled to claim a Special Service Fee.

In order to process a ‘refusal to fill’, an original claim must have been sent using the Dispense Prescription Business Interaction, reversed using the Reversing a Dispense Business Interaction and submitted again with a special services fee code. Special Service Fees are paid on a ‘refusal to fill’ prescription only if there has been a previous successful PharmaCare claim (with PharmaCare adjudication results greater than $0) and a subsequent reversal of that claim.

The following are the rules related to Refusal to fill a Claim:

Table 16 Refusal to Fill Claim – Business Rules

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PNet17.1 Special Services Fee

To claim a Special Services Fee, the original dispense claim must be dispensed and reversed before a special service fee claim can be claimed.

If a pharmacist refuses to fill a prescription for suspected poly-pharmacy/multi-doctoring and processes a special services fee, the prescription can be returned to the patient marked with the notation “refused to fill” with the date.

M X X X X X X X X


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PNet17.2 Reason to Refuse to Fill

Justification for a ‘refusal to fill’ a prescription must be done using Canadian Pharmacy Association (CPhA) ‘Refusal to Fill’ (intervention) codes.

Note: A Special Service Fee would be paid in the following situations:

a. prior adverse reaction;

b. potential overuse / abuse;

c. therapeutic duplication;

d. falsified / altered prescription;

e. sub-therapeutic dose;

f. treatment failure;

g. suspected polypharmacy / multi-doctoring;

h. consulted prescriber – changed dosage;

i. consulted prescriber – changed instructions for use;

j. significant drug interaction (drug-to-drug); and

k. dangerously high dose.

M X X X X X X X X


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PNet17.3 Reversal and Special Fee Claim

The reversal and special service fee claim must be done on the same day.

To claim a special service fee the pharmacist must:

a. submit the original prescription;

b. reverse the prescription using a designated intervention code on the same day as the prescription fill; and

c. submit the claim with:

i. special services fee code (consult your vendor for information if necessary);

ii. intervention/exception codes; and

iii. double the dispense fee for the special services fee in the ZCD segment.

M X X X X X X X X


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9.5 Office Use Medications – TAC/TDU

Prescriptions written by practitioners for Office use medications are transmitted to PharmaNet using the pharmacy’s uniquely assigned O-Med PHN. O-Med PHNs are assigned by HIBC.

The following are the rules related to Office Use Medications:

Table 17 Office Use Medications – Business Rules

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PNet18.1 Use of O-Med PHN

A pharmacy’s uniquely assigned O-Med PHN must:

a. be used for all sales of medications to practitioners (e.g., physicians, dentists, veterinarians);

b. be transmitted to PharmaNet with the corresponding protective word if it exists;

c. not be shared with other pharmacies; and

d. not be used for sale of drug inventories, medical supplies, or non-pharmaceuticals between pharmacies (Note: This is a local function only).

M X X X X X X X X


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9.6 Plan B Claims (Long Term Care) – TAC/TDU

Pharmacies dispense Long Term Care (LTC) resident’s medications in compliance packaging. The reimbursement for this service is provided under PharmaCare Plan B agreements. A physical invoice must be submitted to PharmaCare for the number of occupied beds eligible for reimbursement of claims.

It is acceptable for an LTC facility to batch the dispenses.

The following are the rules related to Plan B Claims (Long Term Care):

Table 18 Plan B Claims (Long Term Care) – Business Rules

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PNet19.1 Advanced Batching of Dispenses

It is permissible for LTC facilities to fill prescriptions in advance of one month's worth of medications by batching the transactions.

M X X X X X X X X

PNet19.2 Change A Dispense

An incorrect dispense submitted during the batch process must be reversed; and if necessary a new dispense transmitted.

M X X X X X X X X

PNet19.3 Special Service Fee

Plan B Special Service Code dispensing fees must be a zero.

Note: Special Service Fees are not paid for long-term care patients.

M X X X X X X X X


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PNet19.4 Batch Dispenses for Plan B

Batch dispenses for Plan B do not require a Patient medication profile review prior to each submission of a dispense.

If Plan B dispenses are batched by the POS application, all DUE messages must be reviewed to determine if a stand-alone Patient medication profile transaction is required to verify DUE warnings.

M X X X X X X X X

PNet19.5 Batch Review

On completion of a batch process, the transaction sets must be reviewed, and a decision must be made on further action for each dispense.

M X X X X X X X X

PNet19.6 LTC Group Number

A valid LTC Group Number must be submitted with every Plan B claim.

Note: A valid LTC Group Number identifies the LTC facility the pharmacy is contracted for dispensing under Plan B.

M X X X X X X X X

PNet19.7 MX And MY Intervention Codes

The MX and MY intervention codes must only be used for Plan B claims.

Note: Correct use of MX and MY intervention codes are subject to Ministry Audit.

M X X X X X X X X


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9.7 Trial Prescription Claims – TAC/TDU

The PharmaCare Trial Prescription Program is in place to reduce the cost of drugs for patients who must discontinue the drug use and replace it with a different medication. The objective is to supply the patient with a portion of the prescription on a trial basis. Then, if they must discontinue its use, the entire prescription quantity is not dispensed and wasted.

The pharmacist will receive dispensing fees for both the trial portion of the prescription and the completion of the prescription.

The following are the rules related to Trial Prescription Claims:

Table 19 Trial Prescription Claims – Business Rules

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PNet20.1 Trial Drug Claims (VAC And NIHB)

Trial drug claims must not be submitted for federally insured patients such as:

a. Canadian Armed Forces (CAF);

b. Non-Insured Health Benefits (NIHB);

c. Royal Canadian Mounted Police (RCMP); or

d. Veterans Affairs Canada (VAC).

M X X X X X X M M


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9.8 Dispense Processing without the Network – TAC/TDU

If the POS system is unable to connect to PharmaNet, the user will have the following options available to them:

• Dispense paper prescriptions and treat patients as cash customers. Batch the Record and Dispense Prescription transactions and send them as pay cardholder; or

• Dispense paper prescriptions and apply judgment on how to treat each patient (e.g., if the Provider knows that the patient is Plan C, then charge accordingly and send the transactions as pay provider); or

• If no paper prescription is available, contact the prescriber for a verbal or faxed prescription; or

• Dispense an emergency supply

The POS application nor PharmaNet allow processing of a dispense without a PHN. If PharmaNet is unavailable, the provider cannot search for an existing PHN or assign a new one.

The following are the rules related to processing without network availability:

Table 20 Dispense Processing without the Network – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet21.1 PHN Not Known

If PharmaNet is not available and the patient’s PHN is unknown, the PHN 9999999999998 must be entered.

Notes:

1. A dispense will not be processed without a PHN.

2. Entering 9999999999998 allows the POS application to complete the transaction.

M X X X X X X M M


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet21.2 Search/Assign PHN

Once PharmaNet is available, a search must be done to find the correct PHN or assign a new PHN, prior to submitting the PharmaCare claim.

Note: Once PharmaNet is available, batched transactions will be submitted and rejected for unknown PHN’s.

M X X X X X X M M

PNet21.3 Review of DUE Messages

After the network access is restored and transactions are sent, all PharmaNet returned DUE messages must be reviewed.

Note: The Provider may request a stand-alone profile request (TRP, TRR, or TRS) to verify the DUE messages.

M X X X X X X M M


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9.9 Pharmacy Recovery – TAC/TDU

All prescriptions recorded and dispenses processed during a network outage must be submitted to PharmaNet. This can be accomplished by either sending a batch of transactions to PharmaNet or retransmitting specific transactions.

The following are the rules related to pharmacy recovery:

Table 21 Pharmacy Recovery – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet22.1 Required Submission

All dispenses processed during a network outage must be submitted to PharmaNet within 24 hours of reconnecting to the network.

M X X X X X X M M

PNet22.2 Batch Processing

Dispenses processed in a network down situation may be batched and handled without direct operator intervention (e.g., the POS system may do this as an automated process).

M X X X X X X M M

PNet22.3 Review of DUE Messages

The DUE messages must not be discarded until reviewed.

Note: The Provider may request a stand-alone profile request (TRP, TRR, or TRS) to verify specific DUE messages.

M X X X X X X M M


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10.0 Reversing a Dispense – TAC/TDU

Reversing a dispense will automatically cause a billing correction. There are a variety of legitimate reasons for reversing a dispense. An intervention code indicating the reason for the reversal must be entered as part of the claim.

The following are the rules related to Reversing a Dispense:

Table 22 Reversing a Dispense – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet23.1 Reverse Dispensed Medications

Dispensed medications that are not picked up by the patient within 30 days must be reversed and returned to stock.

M X X X X X X M M

PNet23.2 Billing Adjustments

Reversals to adjust billings must be done as per CPBC and Pharmacare policies.

M X X X X X X M M

PNet23.3 Backdating

Dispenses may be backdated only when correcting a patient medication profile.

Note: Dispenses must not be backdated to change adjudication results.

M X X X X X X M M


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# Rule

Ph

arm

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In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet23.4 Correct a Patient Medication Profile

To correct a patient medication profile, dispenses must be reversed and resubmitted with the correct information.

The same date as the original dispenses must be used; not the date the correction was made.

Reversals and corrections to dispenses can be done in PharmaNet within 120 days.

Note:

1. In order to correct a claim greater than 120 days, contact HIBC to request a change window.

2. Backdating a dispense is only permitted to correct a patient’s medication history (data integrity) and cannot be used to change adjudication results.

M X X X X X X M M

PNet23.5 Valid CPhA Intervention Code

A valid CPhA intervention / exception code must be used to reverse a claim.

M X X X X X X M M


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11.0 Drug Use Evaluation - TDU

The PharmaNet Drug Use Evaluation (DUE) interaction includes three sub-types:

• TDU Inquiry where a Drug Use Evaluation is returned with no associated claim. The TDU inquiry function allows a Provider to inquire without updating a patient’s medication profile. This functionality is useful when researching ‘what if’ scenarios related to administering medications to a patient.

• TDU Update where a Drug Use Evaluation is returned with an associated claim. The TDU Update function allows a Provider to update a patient’s medication profile and utilization history when a prescription is dispensed.

• TDU Reversal where a Drug Use Evaluation is not returned, and the associated claim is reversed. The TDU Reversal function allows a Provider to reverse a patient’s medication history information.

The absence of a warning about a drug or drug combination is not an indication that the drug or drug combination is safe, appropriate or effective in any given patient. Health care professionals should confirm information obtained from PharmaNet, and ensure no additional relevant information exists, before making patient care decisions.

Table 23 TDU (Drug Use Evaluation) – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet24.1 Review DUE Warnings

All DUE warnings must be reviewed and acknowledged.

M M M X M M X X X


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet24.2 Non-Prescription Medications

The patient’s use of non-prescription medications may be transmitted to PharmaNet at the discretion of the provider for purposes of DUE checking and completing patient record information.

If this information is transmitted, it must contain $0 in the cost and fee fields or include the intervention code ‘DE’.

In such cases the Prescriber ID is the Pharmacist ID.

M X M X M M X X X


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12.0 Medication Update – TDU/TMU

The rules in this section apply to both TDU and TMU transactions.

The TDU and TMU Update transactions allow providers to update the patient’s medication profile.

The TMU Medication Update is a standalone PharmaNet transaction used to update a patient’s medication history without sending an accompanying claim.

TMU (update and reversal) transactions have identical functionality to TDU (update and reversal) transactions.

A TDU update can only be reversed by a TDU reversal and a TMU update can only be reversed by a TMU reversal.

Table 24 TDU/TMU (Medication Update) – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet25.1 Practitioner ID

The user’s Practitioner ID must be entered in the Prescriber ID and Practitioner ID fields for submission to PharmaNet.

M X M X M M X M M

PNet25.2 Directions for Use

Special characters or abbreviations must not be entered in the directions for use field.

Note: SIG codes entered will be transmitted to PharmaNet as full text; information downloaded from PharmaNet will display the directions for use in full text.

M X M X M M X M M


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet25.3 Review Medication Profile

The patient’s medication profile must be reviewed by the provider prior to dispensing or updating a medication; and appropriate action must be taken for:

a. drug-to-drug interactions;

b. unintended dosage changes;

c. medication duplication;

d. inappropriate drug therapy;

e. contraindicated medications;

f. unusual dosages;

g. any other observations which may adversely affect the patient; and

h. those individuals suspected to be ‘drug seeking’.

M X M X M M X X X

PNet25.4 Update Medication Profile

Updating a medication profile may occur if an emergency room provider dispenses or administers medication(s) that are included in the patient’s chart.

The Prescriber ID and Practitioner ID submitted to PharmaNet must both correspond to the CPSBC ID of the responsible physician.

X X M X M M X X X


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet25.5 Local Medication Record

The local medication record must contain the following:

a. PHN of the patient;

b. name, initials and address of the patient;

c. prescription dispensing date;

d. prescription number (as assigned by the local software);

e. quantity of the drug dispensed;

f. intended duration of therapy, specified in days;

g. directions to the patient (without SIG or shorthand codes);

h. identification of prescribing or authorizing practitioner; and

i. identification of the physician who requested the PharmaNet medication profile.

M X M X M M X M M


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet25.6 Quantity Submitted to PharmaNet

PharmaNet can only interpret one decimal point for quantity.

The user must be able to enter the actual quantity dispensed as at least a two-decimal quantity (e.g., ‘1.75’).

For example, if a quantity of ‘1.75’ is entered locally, the POS application will round-up (e.g., from ‘1.75’ to ‘1.8’) prior to sending to PharmaNet.

M X M X M M X M M


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13.0 Reversing a Medication Update – TMU

This interaction is used to correct an error in a dispensed medication or reverse a medication update if PharmaNet identified a drug interaction, contraindication or other problem with the entered medication. If there is a correction or a question regarding the accuracy of other medications in a patient’s medication profile, contact the dispensing pharmacy.

Reversing a dispensed medication will flag a dispensed medication entry on the patient’s medication profile as ‘reversed.’ An intervention code indicating the reason for the reversal must be entered as part of the reversal process. If the intervention code of ‘RE’ (Data Entry Error) is used, the reversed medication update and corresponding medication profile entry will no longer be returned by PharmaNet on subsequent profile request transactions.

The following are the rules related to Reversing a Medication Update:

Table 25 Reversing a Medication Update – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet26.1 Reversals

Reversals must be done as per CPBC and PharmaCare policies.

Notes:

1. Reversals to dispenses can be done in PharmaNet within 120 days.

2. For reversals greater than 120 days, contact HIBC to request a change window.

M X M X M M X X X


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet26.2 Corrections

To correct the medication profile, the dispense must be:

a. reversed;

b. correctly dispensed using the original dispense date*; and

c. transmitted to PharmaNet.

* Do not use the date of the correction.

Notes:

1. Corrections to dispenses can be done in PharmaNet within 120 days.

2. For corrections greater than 120 days, contact HIBC to request a change window.

M X M X M X X X X

PNet26.3 Valid Intervention Code

A valid CPhA intervention / exception code must be entered when reversing a medication update.

M X M X M X X X X


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14.0 Patient Protective Word Maintenance – TCP

A patient has the option of attaching a protective word to their record. Protective words protect a patient’s privacy by allowing them to control who has access to their information. The protective word limits access to those practitioners that the patient has provided the protective word.

Table 26 Patient Protective Word Maintenance – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

HA

P

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet27.1 Protective Word Option

The option to create a patient protective word must be available to all patients.

M X X X X X X X X

PNet27.2 Protective Word Over-Ride

Patients must be informed that, if they are unable (e.g., unconscious) to provide the protective word, a hospital or emergency room care provider may have it removed to enable safe and effective treatment.

M X X X X X X X X


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

HA

P

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet27.3 Protective Word Storage

A patient protective word:

a. can only be stored if the POS application supports protective word storage; and

b. must not be stored in free text.

Patient consent is required for:

c. storing the protective word in the POS application; and

d. sharing the protective word between users at the POS.

Notes:

1. POS applications have the option of supporting protective word storage.

2. Supporting protective word storage means the protective word will be stored with proper encryption and assigned appropriate use.

3. Protective words protect a patient’s privacy by allowing them to control who has access to their information.

O X X X X X X X X

PNet27.4 Protective Word 24 Hour Change Cycle

The patient’s protective word cannot be changed more than once in a 24 hour period.

Note: HIBC is also unable to change the patient’s protective word more than once in a 24 hour period.

M X X X X X X X X


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

HA

P

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet27.5 Protective Word Change Request

Pharmacists can change the patient’s protective word upon request.

M X X X X X X X X

PNet27.6 Protective Word Reset

If a patient forgets the protective word, the user must:

a. review the patient’s identification to confirm identity; and

b. contact HIBC to have the patient protective word reset.

M X X X X X X X X


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15.0 Drug Monograph Information – TDR

PharmaNet provides on-line access to patient counselling information through PharmaNet drug monographs which provide drug information (e.g., ingredients, possible side effects, and contraindicated drugs) which can be used as an aid in counselling patients about the proper use and side-effects of medications.

There are two types of monographs available in PharmaNet:

Type Details

Patient Education Monograph This includes the:

• Education Long monograph which provides detailed information for the patient on precautions, drug interactions, and storage of the medication which is presented in a way that can be understood by a layperson and be printed to provide to the patient.

Counselling Message Monograph This includes the:

• Counselling Professional monograph (for the pharmacist) which provides a ‘technical’ and sometimes detailed explanation regarding proper use, side effects, and other information; and the

• Counselling Patient monograph (for the patient) which provides the equivalent information to the Counselling Professional, but the messages are meant to be understood by laypersons.


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The following are the rules related to Drug Monograph Information:

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet28.1 Drug Monographs

The following types of monographs may be requested from PharmaNet by submitting a single DIN or a pair of DINs:

a. Patient Education Long

b. Counselling Message Professional

c. Counselling Message Patient

M O O X O X X X X


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16.0 Adjudication Reconciliation – TDT

A PharmaNet reconciliation report can be used to reconcile PharmaCare claims and reversals that have been processed. There are four different transactions available for this purpose:

• Daily Totals – provides total number of claims, same day reversals, and prior day reversals for a particular adjudication date.

• Claims Details – provides a list of claims processed for a particular day as well as the amount paid by PharmaCare for each claim.

• Same Day Reversal Details – provides a list of claims that were reversed on the same day for a particular day, as well as the dollar amount for each reversed claim.

• Prior Day Reversal Details – provides a list of reversed claims from a previous day for a particular day, as well as the dollar amount of each reversed claim.

Table 27 Adjudication Reconciliation – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet29.1 Adjudication Reconciliation

The pharmacist must:

a. reconcile all processed PharmaCare claims and reversals; and

b. request reconciliation reports prior to 45 days from the adjudication dates.

M X X X X X X M M


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17.0 Patient Profile Information Update – TPI

This transaction is used to update a patient’s profile by:

• adding clinical condition information;

• adding adverse drug information;

• discontinuing a dispense; and

• adding comments to a dispensed medication.

Note: Discontinuing a dispense, adding comments to a dispensed medication, or adding comments to an adverse reaction can only be done by the POS application that created the initial dispense or adverse reaction record.

Table 28 TPI (Patient Profile Information Update) – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet30.1 Patient Profile Update

The Patient Profile may be updated to:

a. add a clinical condition;

b. add an adverse drug reaction;

c. flag a dispense as having been discontinued; and

d. add comments to a dispensed medication.

M M M X M O X O X


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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet30.2 Update Clinical Condition Information

Providers may choose to send a patient’s clinical conditions to PharmaNet to update the patient’s profile.

a. The following information must be entered when updating patient clinical information:

i. condition;

ii. chronic indicator;

iii. reported by; and

iv. date reported.

b. Updates may include:

i. comment text;

ii. practitioner ID reference;

iii. practitioner ID; and

iv. date entered.

Note: An existing clinical condition can only be removed by submitting a HLTH 5550 Request to Inactivate Adverse Reaction/Clinical Condition on PharmaNet Profile form to the Ministry.

M M M X M O X O X

https://www2.gov.bc.ca/assets/gov/health/forms/5550fil.pdf





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# Rule

Ph

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In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet30.3 Update Adverse Drug Reaction

If a pharmacist enters an adverse drug reaction for a patient, a comment must be included, and the update will be sent to PharmaNet.

The following information must be included when adding or changing a comment for an adverse reaction:

a. DIN (Drug Identification Number);

b. comment text;

c. practitioner ID reference;

d. practitioner ID; and

e. date entered.

Comments must only be added by a user at the POS that submitted the adverse reaction.

Notes:

1. An existing adverse reaction can only be removed by submitting a HLTH 5550 Request to Inactivate Adverse Reaction/Clinical Condition on PharmaNet Profile form to the Ministry.

2. Adding adverse reaction details will overwrite previously recorded information.

M M M X M O X X X





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# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet30.4 Discontinuing A Dispense

The purpose of discontinuing a prescription is to document instances where a patient has stopped or discontinued the use of medication previously dispensed.

Examples of reasons to discontinue a prescription include an adverse drug reaction, a change of medication, or a change of dosage.

Notes:

1. A medication may only be discontinued by the pharmacy that originally dispensed it.

2. The date discontinued will be used by PharmaNet drug interaction checking to determine if the medication is still active in the patient.

3. No billing correction occurs when a prescription is discontinued.

4. Instead, the expiry date of the prescription is changed so that the prescription will not be included in the DUE checking performed.

5. If a dispense is discontinued, no further changes can be made to the dispense record in PharmaNet.

M M M X M X X O X


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18.0 Patient Access to Personal Data – TPM

A patient may request a print out of their confidential and personal data from the POS system and/or PharmaNet.

The PharmaNet patient record contains:

• patient demographics;

• medication profile information;

• clinical condition information;

• adverse drug reactions;

• patient dispensed veterinarian records; and

• a log of all accesses to the patient’s medication profile where no medication was dispensed.

The Ministry of Health co-ordinates the patient’s requests for the PharmaNet patient record and subsequent mailing of the patient record.

Table 29 Patient Access to Personal Data – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet31.1 Form of Identification Used

The form of identification used to identify the patient must be kept on file.

Acceptable forms of identification are described in the Identify Patient Business Interaction.

M X O X X X X M X

PNet31.2 Requesting a Pharmanet Patient Record

If requesting a PharmaNet patient record, the patient’s address and PHN must be validated in PharmaNet.

If necessary, the patient’s address must be updated prior to submitting a Patient Access to Personal Data Transaction.

M X O X X X X M X


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# Rule

Ph

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In P

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nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

wer

NP

S

MD

D

PNet31.3 Patient Request for Printed Records

Printed copies of PharmaNet Patient profile must not be given directly to the patient.

A printout will be mailed to the patient.

M X O X X X X M M


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19.0 Get Location Details - TIL

This interaction allows the user to retrieve the name, address, and telephone number for a specified POS location identifier or Pharmacy ID from PharmaNet.

This interaction is useful for contacting the dispensing pharmacy to:

• correct an error in the patient medication profile;

• discuss a dispense; or

• discuss an adaptation.

Note: Use of this functionality is logged in PharmaNet and may be subject to audit.

Table 30 TIL (Get Location Details) – Business Rules

# Rule

Ph

arm

acy

In P

atie

nt

CO

MP

AP

H

AP

EDA

P

HA

-BP

MH

HA

Vie

we

r

NP

S

MD

D

PNet32.1 Valid Reason Code

A valid reason code must be selected before accessing this information.

X X X X X O O X X