ODB Capitation Rules

According to ODB legislation, a dispensing fee can be charged on two fills per 28 days. Therefore, PharmaClik Rx will automatically charge the fee on the first two (2) fills in a 28-day period - the Capitation flag will be OFF in Rx Detail because the fee is not capped.

When the prescription is filled for the third time, and all subsequent fills, in the 28-days period, the Capitation flag will be turned ON and the fee will not be charged. This is done automatically and does not require intervention by the pharmacy team.

Note: Exemptions that apply to ODB, and PharmaClik Rx will set the Capitation flag accordingly and display a prompt.

The ODB fee capitation will only be applied to the billing code DB.

Trillium prescriptions (billing code TR) will continue to be billed with the U&C Dispensing Fee, allowing the full fee to be collected during the deductible period. Once the Trillium patient reaches his or her deductible, the prescriptions will continue to be billed with the TR fee. Continue the usual practice of waiving any fee cut-backs from the Claim Summary for the TR prescriptions