UPDATE: Transitional Issues

On Wednesday, June 16 Coalition members met with Helen Stevenson and Pamela MacDonald of the MOHLTC to discuss transitional issues arising from the new regulations.

Following are the highlights of that discussion:

• The Ministry currently has no plan for a washout period for existing inventory, but are providing a 10-day notice period of price change. We asked the Ministry to consider the financial penalty to pharmacies of this decision, and reconsider a 30-day period for washout — including markup. The Ministry agreed to provide an update by end of next week.

• Transition fees will be paid automatically and manually as a separate line item in the normal OPDP payment record, based upon scripts filled. Methadone, LTC or equivalent, and pre-Trillium claims are not eligible.

• Variable Dispensing Fees — Pharmacies eligible to receive more than the $8/script dispensing fee will be notified by the MOHLTC as soon as this week. The Ministry has completed its analysis of eligibility. If we are in disagreement with their analysis we can appeal the decision on the fee. The Ministry indicated that stores will receive these letters ONLY if they are eligible to receive more than $8/script. All other stores will just automatically receive the $8 fee if submitted on July 1st.

• Professional Services Funding beyond the $75 Million to be covered by transition fees, $25 Million will focus on, but not necessarily be exclusively for, rural pharmacy services. An ad hoc committee will be formed in July/August to put together a plan for payment for services. Coalition Representatives will participate on this committee.

• MedsCheck Accessibility, there will be consideration made for MedsCheck ‘at home’ in rural locations to be eligible for some kind of mileage/time fee because of distance. Program will be expanded to include diabetic patients not otherwise covered and will be at the pharmacists professional discretion. There will be consideration for payment for additional counseling at the same time (diet, exercise, foot care). It appears that MedsCheck (Home, LTC and Diabetes) may be priced differently than the $60 fee. A complete Q&A document from the Ministry on these services is to be sent out next week. Follow up MedsChecks remain at $25.

•Generic Pricing (including exceptions) will be announced in the upcoming formulary notice of changes, expected 10 days before implementation. All Generic vendors have been asked to submit their exception lists (non 25% pricing) to the MOHLTC this week.

Other Issues:

• Appeal Process — When opening a new pharmacy, the dispensing fee is automatically set at $8. MOHLTC will assess the category of the new pharmacy and re-set the fee. This could take a few days. Retroactive payment would be made available. Likewise when a store category changes (a pharmacy closes in the town, etc.), the Ministry will only re-set the categories annually. Once again, retroactive payment will be allowed in this case.

• Methadone scripts under capitation are not included with any fee increase at this time. These will be dealt with this fall. Suboxone would be included in this as well.

• MOHLTC indicated that they have intentions to meet with pharmacy on LTC in the upcoming months. For now the higher fee with no transition fee applies.