Pharmacy Services Agreement 2010 Guide for Guild members

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confidential – for guild members onlyPayment for Services and Pharmaceuticals, claiming procedure and payment terms(Part H)This part of the Service Agreement template describes the rules surrounding payment for services, claiming procedures andthe claiming of penalty interest when either party does not meet their payment obligations. Part H should be read inconjunction with Schedule H1, the Pharmaceutical Schedule and the Procedures Manual.H1: Payment for Services andPharmaceuticalsH1.4: Claim certificationH2.1: Reliance on Informationfrom PrescribersYou may claim, and be paid, for any subsidised Pharmaceutical dispensed pursuant to theAgreement. Note that the Pharmaceutical Schedule states that for the purposes of thisAgreement HP1, HP3, and HP4 pharmaceuticals are only subsidised when dispensed from apharmacy that has been contracted to provide Complex Medicine services, Special Foodsservices, or Clozapine Services, respectively. Part P lists which services you are contractedto provide.Ordinarily, you may only claim against a Prescription Item once it has been collected.However, if a Prescription Item becomes an “Uncollected Prescription Item” you may claimagainst it. More details of this can be found in the Procedures Manual.Note that repeats can only be claimed for following a specific and express request by aService User, their caregiver, or their prescriber that has been initiated by them after theoriginal item has been dispensed.In addition, you cannot claim for an uncollected item if you have previously prepared anidentical item for that Service User that remained uncollected.All claim submissions must be signed and dated by you, or approved by you and signed onyour behalf. Online claims may be digitally signed.For the purposes of this Agreement, particularly with regards to submitting claims, you mayrely on the information you receive from a Prescriber as being accurate, unless you havereason to believe otherwise.H3: Claiming generally With online claiming there are four claim periods per month. Without online claiming thereare two. Note this should be regarded as the maximum number of times you can claim permonth; you do not have to claim in every period if you do not think the more promptpayment is worth the extra administrative work required to generate claims more often.H4.1: Eligible personsH4.3 Determining andcollecting co-payments,pharmacy charges, andproduct premiumsFor online claiming the four due dates per month are: the 7 th , the 15 th , the 23 rd , and the lastday of that month.Otherwise, the two due dates are the 15 th and the last day of the month.Any claims that are submitted after the due date fall into the following claim period.The dates you receive payment relate to the due dates and are typically 20 days after thedue date. See clause H12.For any and all Services you provide under this Agreement you may only charge ServiceUsers the charges that are permissible under the Agreement.However, this does not preclude you from providing services that are related to theServices of the Agreement, yet outside the Agreement, and charging as you deemappropriate. Two examples of this are accepting a credit card payment for Services,or storing dispensed Pharmaceuticals on behalf of the Service User.You are responsible for determining and collecting the correct charges.The Ministry of Health website is the best place for up-to-date information on co-payments.See http://www.moh.govt.nz/eligibility. See also clause H4.4 below for more information.Your dispensary software should automatically calculate product premiums. See clause H4.5below for more information.You are free to determine the level of any Pharmacy Charges you might levy, providing theyare reasonable and permissible. See clause H4.6 below for more information.PAGE 22
confidential – for – for guild guild members only onlyH4.4 Co-payments For prescriptions that are valued at less than the co-payment, pharmacies continue to havediscretion regarding the charge to the service user, up to the value of the co-payment.The Ministry of Health website is the best place for up-to-date information on co-payments.See http://www.moh.govt.nz/eligibility. Note the exclusions to co-payments listed in clauseH4.4 (b): Service Users under six, Hokianga Ward Medical trust prescriptions, antituberculoticsand antileprotics, or Class B Controlled Drugs (other than methylphenidate hydrochloride ordexamphetamine sulphate).When a Service User with a special food prescription asks for their product to be dispensedas a combination of flavours, each dispensing only carries one co-payment. Please note thisonly applies if the product is listed in the Oral Supplement/Complete Diet section or theGluten Free Foods section of the Pharmaceutical Schedule.You may charge less than the maximum permissible co-payments if you choose. This doesnot affect the payment you receive from your DHB for the Services; effectively you paythe difference between the maximum co-payment and the actual co-payment from yourown pocket.Whenever a Service User does not pay a co-payment that item does not count towards thePSC scheme.H4.5: Product premiumsH4.6: Pharmacy chargesH4.8: Receipts forPharmaceuticalsH6.3: No unnecessarydispensingNote the extra requirements if the total cost of a three month supply of an item with repeatsdispensed all-at-once (stat) is less than the co-payment.If the price of a pharmaceutical is more than the subsidy, you may charge the Service User aProduct Premium. You are free to determine the level of the premium.Your dispensary software should automatically calculate product premiums according to asimple formula, but these premiums can be overwritten if you choose.The Guild produces and updates a Product Premium Guide. Please contact the Guild if youwould like to learn more about the Guide.Members should read this section carefully to ensure they fully understand their rights andresponsibilities when setting their charging policies.The Guild produces a guide and template regarding pharmacy charges, which can bedownloaded from our website.In general, you are free to determine the level of any Pharmacy Charges you might levy,providing they are reasonable and permissible.The anticipatory, or flat-fee, charge is expressly forbidden. Ad hoc intervention chargesremain permissible.Also note that you may charge for other services you provide to the Service Users that are inexcess of the requirements of the PSA or the Pharmaceutical Schedule. An example of thismight be accepting a credit card payment as a co-payment.You should inform Service Users of applicable Pharmacy Charges before you begin work andexplain how he or she may avoid or reduce the pharmacy charge. A sign, such as the oneincluded in the Guild-produced template, is sufficient.You must provide a receipt to Service Users for any subsidised item dispensed. The receiptmust include the name of the Pharmaceutical, the cost to the Service User and the cost tothe Government.Pharmacies must not boost their revenue artificially by dispensing prescriptions unnecessarilyor more frequently than the Pharmaceutical Schedule or Procedures Manual allows.PAGE 23
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Pharmacy Services Agreement 2010 Guide for Guild members

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