NIHB Refusal to Dispense (British Columbia)

NIHBs Refusal to Dispense program allows pharmacists to claim reimbursement on the dispensing fee portion of a claim that is rejected with one of the following DUR response codes and the pharmacist decides that it is in patient’s best interest that the prescription not be dispensed:

  • ME Drug/Drug Interaction Potential
  • MW Duplicate Drug
  • MY Duplicate Drug Other Pharmacy

To receive reimbursement of the fee, the rejected claim must be resubmitted with the identical claim details, along with the CPhA intervention code UL - Rx not filled, Pharmacist Decision. The fee will be eligible for payment based on the current NIHB pricing rule for the submitted drug; no amount beyond the fee will be paid.

As when overriding any rejection with an intervention code, be sure to document the nature of the intervention on the prescription, file copy or in the Patient folder.

The prescription will be flagged as Fee for Service to indicate the medication has not been provided to the patient; the Fee for Service checkbox is selected in the patient’s Profile. The Audit History indicates *Fee For Service* for the prescription. Inventory does not decrement when Fee for Service claims are filled, as no stock is dispensed with the prescription. Gross Profit reports reflect the prescription as 100% profit.

To process a Refusal to Dispense prescription

  1. Process the prescription as you would normally. When NIHB rejects the prescription with ME, MW or MY, press Skip TP to skip the NIHB claim. You must finish the prescription and then cancel it. Cancel the prescription as you would normally, using Correct Rx Refuse.
  2. Refill the prescription. When the prescription opens in Rx Detail, ensure IA is included in the prescription’s billing code (e.g. PC/IA/CA).
  3. Press the magnifying glass in the Cost box.
  4. Requested Cost and Fee opens. Select Fee for Service in the lower left corner of the window.
  5. Press the OK button.
  6. The screen returns to the main tab in Rx Detail, with a new value in the Qty field. Change the Qty field back to its previous value (N the Refusal to Dispense prescription be filled with the same Qty as the rejected prescription).
  7. Press the Third Party tab.
  8. For the Pharmacare claim, enter 66123227 in the Alternative DIN field (this is the Pharmacare pseudoDIN for non-medical, non-benefit).
  9. Press the Next button until the IA claim is displayed on the screen.
  10. Press the Add button to add an intervention code.
  11. A blank row is added to the For Claim box. Enter UL in the Code column.
  12. Continue to fill the prescription as usual. A file copy prints, indicating *Fee For Service* - a complete label set does not print, as no medication has been provided to the patient.