Submitting a $5 Veterans Affairs Fee

Veterans Affairs Canada (VAC) occasionally allows you to submit an additional $5.00 special services fee. This generally occurs when VAC returns a rejection such as Call Adjudicator. By calling the VAC help desk (1-800-561-4377), you may be authorized to submit a claim for the additional $5.00.

Either of the following situations may occur:

  • VAC approves the drug.
  • VAC does not approve the drug, but will reimburse for the $5 Fee.

When the Drug is Approved by Veteran’s Affairs Canada

The additional $5.00 must be entered as a Special Services Fee before the prescription is filled.

  1. Open the prescription in Rx Detail.
  2. Press the Third Party tab.
  3. If the VO claim is not displayed, press the Next button until the VO claim appears.
  4. Select 2 - Pharmacist Intervention from the Special Services dropdown list.
  5. Enter 5.00 in the Special Srv Fee field.
  6. Continue to fill the prescription as usual.

When the Drug is NOT Approved by Veteran’s Affairs Canada

VAC may still pay a $5.00 fee for the pharmacist intervention. Submit a new prescription to VAC for the $5.00 using a freeform drug and the pseudoDIN provided by Veterans Affairs. It is recommended that you cross-reference this prescription with the original and document that it is for a $5.00 VAC fee. A freeform drug must be added to the Drug file before this type of claim can be submitted; only add this drug once (KGCL corporate banners should add the new drug through the Add Drug Utility - do not follow the steps below).

To add the VAC SPECIAL AUTHORIZATION Freeform Drug to the Drug File, do the following:

  1. Press the Drug button.
  2. In Drug Search , search for VAC SPECIAL in the Trade Name or Generic Name fields.
  3. Since no records will be found, press the New button.
  4. Enter VAC SPECIAL AUTHORIZATION in the Generic Name field.
  5. Enter VAC SPECIAL AUTHORIZATION in the Trade Name field
  6. In the Schedule dropdown list, select Schedule IV.
  7. Press the Alternatives tab at the top of the screen.
  8. Press the Add button beside the Alternatives box in the middle of the window.
  9. A row is added to the Alternatives box. Select *All* from the Third Party dropdown list.
  10. In the PIN field, enter 998062 (this is the VAC pseudoDIN for the $5 fee).
  11. Press the Inventory tab.
  12. Press the Add button located in Packs Available.
  13. The Add New Pack Size window appears. Enter 1 in the Pack Size field.
  14. Deselect the Monitor flag if it is ON.
  15. Enter 0.0001 in the Acq Cost (ut) field.
  16. Press the OK button in the Add New Pack Size window.
  17. Press the Save button in the Drug Folder.

Then submit the claim by doing the following:

  1. If you choose to fill the prescription for the patient, fill it as a Cash prescription. Once the prescription has been dispensed as Cash, submit a NEW prescription for the $5.00 intervention.
  2. Create a New prescription for the patient using the VAC SPECIAL AUTHORIZATION freeform drug. Enter 1 in the QA, Qty and DS fields. In the SIG field, cross-reference the prescription to the original and indicate that the claim is for VAC special authorization (ex. VAC SPECIAL AUTH CLAIM FOR RX#500001). The prescription’s billing code should be VO/CA.
  3. In main tab of Rx Detail, press the Cost magnifying glass to open the Requested Cost & Fee window.
  4. Enter 0 in the Cost Before Markup field.
  5. Enter 0 in the Prof. Fee field.
  6. Press the OK button to save changes and return to main tab of Rx Detail.
  7. Press the Third Party tab.
  8. Select 2 - Pharmacist Intervention from the Special Services dropdown list.
  9. Enter 5.00 in the Special Srv Fee field.
  10. Press the Fill or Queue button to fill the prescription.