BC: Submitting Claims for Drugs Used for Medical Assistance in Dying

Effective immediately, British Columbia pharmacies can now submit a claim for reimbursement when dispensing certain drugs used for medical assistance in dying (MAID). All MAID medications will be 100% covered by PharmaCare, regardless of a patient’s PharmaCare plan. See the following links for more information:

• BC PharmaCare Newsletter Edition 16-005

• List of PharmaCare covered products

When billing, you must use the PINs outlined in the chart below.

PIN	Description	Maximum Reimbursement Amount
88000000	Clinical Service Fee:Primary & Secondary IV Drug Regimen	$100
88000001	Clinical Service Fee: Primary Oral Drug Regimen and Secondary IV Regimen	$60
88000002	Compound: PB+CHLORHYD+MS ORAL CPD SUSP (MAID)	$1.075/mL (compound fee is included)

To Submit a Claim to PharmaCare:

MAID prescriptions are for two regimens that must be dispensed in tamper-proof kits:

• A primary regimen, which may be oral or intravenous
• A secondary regiment, which is always intravenous

For Oral Drug Regimen (with secondary Intravenous Regimen)

1. Create a Compound for the Primary Oral Drug
   1. Create a new compound drug file.
   2. Select the Alternatives tab.
   3. Select the Add button at the top of the screen.
   4. Add the following rule:

   

   5. Select the Save button.
2. Submit a Claim for the Compound
   1. Create a new prescription with the following details:
      • Patient: Patient receiving MAID
      • Drug: Drug created in Step 1
      • Doctor: Prescriber
      • Qty Auth: In accordance to prescription
      • Qty: In accordance to prescription
      • SIG: PB+CHLORHYD+MS ORAL CPD SUSP (MAID)
      • Days Supl: In accordance to prescription
   2. Ensure a valid PharmaCare bill code exists in the Bill field (e.g. PC, P1, P2, etc.). 
   3. Select the Third Party tab.
   4. Select the Add button.
   5. Select the DQ intervention code from the dropdown list.
   6. Select the Fill button.

3. Submit a Claim for the Clinical Services Fee
   1. Create a new prescription with the following details:
      • Patient: Same patient in Step 1
      • Drug: 88000001
      • Doctor: Dispensing pharmacist
      • Qty Auth: 1
      • Qty: 1
      • SIG: MEDCP
      • Days Supl: 1
   2.  Select the Fill button.

   Note: Only one Clinical Services Fee can be claimed for a MAID prescription.

For Intravenous Drug Regimen

As both the primary and secondary kits for the IV drug regimen are identical, PharmaCare can provide only one dispensing fee for each medication. To address this, PharmaCare covers a higher Clinical Services Fee for dispensing two intravenous regimens.

Note: Enter only one claim for each medication, for a total of four claims. If the same components of both the primary and secondary kits are entered in separate claims, PharmaNet will reject the identical claims.

1. Submit a Claim for Each DIN
   1. Create a new prescription with the following details:
      • Patient: Patient receiving MAID
      • Drug: DIN from the list of PharmaCare covered products
      • Doctor: Prescriber
      • Qty Auth: In accordance to prescription
      • Qty: In accordance to prescription
      • SIG: MEDCP
      • Days Supl: In accordance to prescription
   2. Ensure a valid PharmaCare bill code exists in the Bill field (e.g. PC, P1, P2, etc.).
   3. Select the Third Party tab.
   4. Select the Add button.
   5. Select the DQ intervention code from the dropdown list.
   6. Select the Fill button.
   7. Repeat Steps a-f for all DINs your pharmacy is dispensing.
2. Submit a Claim for the Clinical Services Fee
   1. Create a new prescription with the following details:
      • Patient: Same patient in Step 1
      • Drug: 88000000
      • Doctor: Dispensing pharmacist
      • Qty Auth: 1
      • Qty: 1
      • SIG: MEDCP
      • Days Supl: 1
   2. Select the Fill button.