Health Care Professionals

MedsCheck

Frequently Asked Questions: MedsCheck General Information

General

Eligibility

Conducting the Service

Record Keeping and Documentation

Claim Payment


General

What is the definition of ‘chronic prescription medication’ under the MedsCheck program?

Chronic prescription medication refers to prescription medications that are used to treat conditions on a long-term ongoing basis. For example, medication for hypertension would be eligible, whereas an antibiotic for a respiratory tract infection would not be eligible.

A prescription medication is a Schedule 1 drug according to the National Drug Schedules as per the National Association of Pharmacy Regulatory Authorities.

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A patient is taking a combination drug for a chronic condition, does that count as one or two drugs under the MedsCheck program?

The number of medications is based on the number of drug identification numbers (DIN). For example, a single-tablet that is a combination of two or more active medication ingredients will have one DIN and will be considered one drug under the MedsCheck program.

Please note that two different strengths of the same medication count as ONE medication, even if they have different DINs.

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Is the program voluntary?

Yes. The MedsCheck program is voluntary and requires the patient’s signed acknowledgment of the services each year. This process builds patient awareness and a better understanding of the MedsCheck services offered at community pharmacies.

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What does the pharmacist provide to the patient after the MedsCheck service?

The patient is provided with a MedsCheck Personal Medication Record after the consultation and after the pharmacist has resolved any drug therapy issues. This may be immediately after the consultation if there are no issues or when the pharmacist arranges for the record to be provided. The completed MedsCheck record is signed and dated by the pharmacist and is also shared with the patient’s primary care provider.

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What are the MedsCheck programs that are available to Ontarians?

There are five main MedsCheck services available for Ontarians each with their own criteria. Pharmacists should refer to the individual programs for added information.

  1. MedsCheck Annual: The original program for Ontarians who are taking three or more prescription medications for one or more chronic conditions.
  2. MedsCheck Follow-up: The MedsCheck Follow-up review program was developed for patients taking a minimum of three chronic prescription medications, who have already had an annual review (with the exception of the MedsCheck LTC) and require the service more than once during the year due complexities in their drug therapy. The criteria for this program includes a prescriber’s referral, admission or discharge from the hospital as well as a pharmacist’s decision based on significant changes in a patient’s medication regimen.
  3. MedsCheck for Diabetes program is intended for Ontarians who are diagnosed with either type 1 or 2 diabetes whether or not they are taking prescription medications to help manage their diabetes.
  4. MedsCheck at Home is for patients who are taking a minimum of three chronic prescription medications and not able to physically attend the community pharmacy for the review. This service also includes a medicine cabinet cleanup in which the pharmacist may take unused medications back to the pharmacy for proper disposal. With patient permission, the service takes place at the location of the patient’s private home or the home of a relative. (Residents of retirement home or groups homes are not eligible for the MedsCheck at Home service.)
  5. MedsCheck for Long-Term Care (LTC) is for residents living in a licensed LTC home who are taking a minimum of three prescription medications for chronic conditions and thereby eligible for quarterly reviews including an in-depth annual review in collaboration with the health team at the LTC home.
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Why is the Ontario Government incorporating further enhancements to the MedsCheck program?

At the request of the Executive Officer, the Ontario Pharmacy Council initiated a review of the MedsCheck program in 2013 to improve overall quality, consistency, health-system collaboration as well as program recognition by the public and those receiving the service.

Based on their advice, the ministry worked with the Ontario Pharmacists` Association (OPA) to develop and implement program enhancements - to help improve quality and ensure standards are met; ensure patient needs are being met; and foster health-team collaboration.

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What are the MedsCheck program enhancements that are effective on October 1, 2016?

Program enhancements include:

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Are pharmacists required to complete the MedsCheck Personal Medication Record form according to the updated standard, or is it optional?

Pharmacists will be required to use the ministry’s standard MedsCheck Personal Medication Record or an adapted version of the form if developed by their pharmacy software vendor as long as the adapted form exactly replicates the ministry form. Please note that pharmacists are required to implement all of the program enhancements (forms, templates, procedures) by October 1, 2016.

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Where can I find information on the MedsCheck program?

Details of the MedsCheckprogram can be accessed on the ministry website at: health.gov.on.ca/en/pro/programs/drugs/medscheck/medscheck_original.aspx

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Where do I get tools, forms, and/or other resources?

Examples of forms, tools and templates can be downloaded from the ministry website by accessing the following link:  health.gov.on.ca/en/pro/programs/drugs/medscheck/resources.aspx

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Can the pharmacy develop its own MedsCheck Personal Medication Record (patient form)?

Yes, the pharmacy may choose to develop its own form however, it must exactly replicate the ministry’s form. Pharmacies may have the ability to integrate the information from the ministry form to their pharmacy computer systems. In so doing, the appearance of the output must duplicate / align with the ministry form.

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Is the patient required to sign the MedsCheck Personal Medication Record along with the pharmacist?

No. Effective October 1, 2016, only the pharmacist signs and dates the MedsCheck Record. The patient is no longer required to sign the MedsCheck Record. Instead, the ministry expects pharmacies to implement the MedsCheck Patient Acknowledgment of Professional Pharmacy Services form and process. This annual process outlines the MedsCheck services funded by the Ontario government, that they occur at the pharmacy (unless the program specifies otherwise) where there is sufficient privacy and that the MedsCheck patient personal medication record will be shared with the patient’s primary prescriber.

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Who do I contact for more information on MedsCheck?

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Eligibility

Are Trillium patients eligible for MedsCheck?

Yes, provided they meet the respective MedsCheck program criteria and agree to the service.

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Are non-ODB patients eligible for the MedsCheck and is there an age limit?

All Ontarians are eligible for the MedsCheck service provided they meet the respective program criteria and agree to the service. There is no age restriction for the MedsCheck program.

For additional information regarding Ontario’s public drug programs, please visit the following webpage: health.gov.on.ca/en/public/programs/drugs/faq.aspx

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When a MedsCheck service is restricted as annual, is the one year based on a calendar year or per patient?

The annual medication review whether it is a MedsCheck Annual, a MedsCheck for Diabetes annual or a MedsCheck at Home annual service is based on the date that the recipient had their previous MedsCheck service one year prior; it is not based on a calendar year.

NOTE: Patients are eligible for ONE “annual” medication review per year. If it is identified that a patient requires another medication review during the year, pharmacists may consider whether the patient meets the criteria for the MedsCheck Follow-up program.

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How do I determine whether a patient has already had a MedsCheck conducted at another pharmacy?

Prior to initiating a MedsCheck review, it is important to ask the patient whether or not they have participated in this service at another pharmacy. This includes whether the patient has completed / signed the annual “MedsCheck Patient Acknowledgement of Professional Pharmacy Services” form at another pharmacy. If the patient wishes to continue with a MedsCheck at your pharmacy, you must ensure that the patient completes another annual “MedsCheck Patient Acknowledgement of Professional Pharmacy Services” at your pharmacy.

If the patient has had a MedsCheck Annual review from another pharmacy within the past year, they are not eligible to receive another “annual” review (i.e., MedsCheck for Diabetes annual or MedsCheck at Home annual). However, patients may be eligible for a MedsCheck Follow-up within the annual timeframe under specific criteria.

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How does the patient prepare for their MedsCheck?

To help prepare for a more meaningful interview, pharmacists may ask the patient to complete a short questionnaire or screening tool. The MedsCheck patient brochure can be used to help engage the patient as it outlines specific questions.

On the day of the appointment, pharmacy staff should remind the patient to bring:

Encourage their caregiver to come along, if appropriate. For patients who are not able to attend the pharmacy, the pharmacist may conduct the MedsCheck with the caregiver provided there is patient consent and documentation that the MedsCheck was conducted with the patient’s caregiver.

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How will the ministry address instances of patients receiving more than one ‘annual’ MedsCheck?

MedsCheck claims are subject to audit and may be recovered if appropriate. Patients meeting program criteria may receive one annual medication review per year (i.e., MedsCheck Annual, MedsCheck for Diabetes Annual, or MedsCheck at Home Annual). Ministry inspectors continue to monitor the claims and will follow up with pharmacies if there are concerns about how the claims were submitted.

Patients may be eligible for a MedsCheck Follow-up when there is a need to conduct another medication review during the year.

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Conducting the Service

As a licensed pharmacist, do I need to register or sign-up to provide and be paid for conducting a MedsCheck?

MedsCheck services that are billed to the Ontario government are paid to the accredited pharmacy that holds the Ontario Drug Benefit (ODB) Health Network System (HNS) account with the ministry. As long as the pharmacist is practicing in a community pharmacy that is registered as a provider with the ODB program, you may provide and claim for a MedsCheck service through the ODB HNS and indicate your pharmacist identification in the prescriber field.  The ministry does not provide or arrange for HNS accounts to individual pharmacists.

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As a pharmacist am I required to provide the MedsCheck service? What if I do not wish to participate?

Pharmacists are encouraged to offer professional pharmacy services to their patients; however, it is not mandatory that they provide MedsCheck services.

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Can a MedsCheck be conducted with a caregiver?

Yes. The MedsCheck may be conducted with a caregiver; however, every attempt must be made for the patient to also be present for the review. If the patient cannot be present, they must give consent to the pharmacist to conduct the MedsCheck with the caregiver and the pharmacist must ensure that the patient acknowledgment of services documentation includes the caregiver’s signature.

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Can a MedsCheck medication reviews be conducted over the phone or through internet video conferencing?

No, at this time, none of the MedsChecks can be provided over the phone or through video conferencing. However, the MedsCheck may be initiated over the phone to make and confirm appointments with the patient. The intent of the current MedsCheck program is for the pharmacist to review the medication history directly with the patient at a face-to-face, in-person meeting at the pharmacy location.

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Where does the pharmacist conduct the MedsCheck?

Depending on the MedsCheck service the pharmacist is expected to have the consultation as follows:

Note: Residents of Retirement and group homes who are not able to attend the pharmacy for services are not eligible for a MedsCheck LTC or a MedsCheck at Home; however, they may be eligible for MedsCheck Annual / Follow-up or MedsCheck for Diabetes if they meet the criteria and agree to the service (including having a pharmacist from their pharmacy visit them in the said home).

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Can a MedsCheck be conducted outside of the pharmacy?

Apart from the MedsCheck at Home service that is conducted outside the pharmacy in the patient’s private home and the MedsCheck LTC that is conducted in the LTC Home, there may be some instances when a pharmacist is asked to conduct a MedsCheck in the patient’s residence; for example in a Retirement Home. In these instances, the name and address of the location of the MedsCheck service, if different from the pharmacy address, must be noted on the MedsCheck Record as well as on the pharmacist’s worksheet. In addition, the patient must agree to any arrangements being made for the home visit.

It should be noted that MedsCheck services are not intended for clinical facilities to partner with a community pharmacy in order to bill for MedsChecks conducted in a clinical facility.

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Can the pharmacist conduct the MedsCheck in an out-patient hospital clinic?

No. The principles of the MedsCheck program are such that the community pharmacist conducts the medication review with their patients at the community pharmacy. The MedsCheck program does not include a pharmacist - whether an in-patient staff pharmacist or a contracted community pharmacist - to conduct the MedsCheck at the hospital out-patient clinic. Hospital clinics may use a recent MedsCheck that was conducted in the community pharmacy or a printed patient medication profile (not considered a MedsCheck) to assist them in conducting the medication reconciliation in the hospital environment.

Note: Hospital Emergency Departments have access to the Ontario Drug Benefit (ODB) Drug Profile Viewer that indicates ODB drug claims as well as Professional Pharmacy Services claims (i.e., MedsCheck) including the contact information of the pharmacy that provided the services (submitted the claims).

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Which pharmacist should provide the MedsCheck service for a patient?

Although patients may have several pharmacies that have billed ODB for a medication on their behalf (i.e. their regular pharmacy, a pharmacy near a walk-in clinic, a pharmacy near a doctor’s office, etc.), the pharmacist conducting the MedsCheck or Pharmaceutical Opinion (POP) should be a pharmacist that regularly dispenses most of the medications for the patient’s chronic condition(s).  If a patient chooses to attain MedsCheck or POP services at a pharmacy other than a regular pharmacy of theirs, or if they do not have a regular pharmacy, documentation must demonstrate that the pharmacist billing the MedsCheck discussed this issue with the patient, the reasons why the MedsCheck was conducted at a pharmacy other than a regular pharmacy, and how the pharmacist ensured an accurate patient record was attained.

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Can an intern/student under the supervision of a pharmacist conduct a MedsCheck service?

Yes, an intern or a registered pharmacy student may conduct aMedsCheckas long as the intern or student is under the supervision of a licensed pharmacist. The level of supervision is at the discretion of the pharmacist who must have the level of knowledge and training to conduct the expanded service themselves.

The supervising pharmacist is expected to co-sign any MedsCheck medication record when the service was conducted by the intern or registered pharmacy student – thus indicating the supervisory role and fulfilling the MedsCheck requirement; this pharmacist would also submit the billing information through the Health Network System. It is highly recommended that the intern or registered student identify who they are to the patient so that the patient is clear as to their role.
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Can a pharmacy technician conduct a MedsCheck?

No, a pharmacy technician may not conduct a MedsCheck service. The pharmacy technician may play an administrative support role in scheduling patients and assisting the pharmacist in compiling materials in preparation of the MedsCheck and other support roles as needed.

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How long should a MedsCheck take?

Time required to conduct the MedsCheck will vary from patient to patient; it is estimated that the interview portion for the medication review will take approximately 20-30 minutes on average of the patient’s time.

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I’ve just conducted a MedsCheck and it took longer than 30 minutes. Can I bill for the extra time?

No, the Government of Ontario is compensating a flat rate for the MedsCheck services.

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Which MedsCheck / professional pharmacy service(s) do I use to bill when monitoring specific drugs for example warfarin INR levels?

There is no funded professional pharmacy service that accommodates drug monitoring; the MedsCheck program is not considered a “monitoring” service as in “monitoring INR (international normalized ratio) levels”. Pharmacists should not be billing drug monitoring as a MedsCheck or as a Pharmaceutical Opinion (POP) as this specific service does not meet program criteria of either the MedsCheck or the POP. During a MedsCheck pharmacists are reviewing all drugs and combinations of drugs towards optimizing a patient’s drug therapy and improving quality of life.

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What are some examples of improper MedsCheck billings?

There are many examples of improper billing; some of these include:

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Where is the most appropriate place in the pharmacy to conduct the MedsCheck with a patient?

Patients should be comfortable during the MedsCheck session and receive the pharmacist’s undivided attention. A sufficient level of patient privacy and safety must be established by the pharmacist.

 If the patient agrees, a private counseling room can be used for the MedsCheck consultation. Some pharmacists may be able to accommodate a patient’s privacy in a seating area of the pharmacy. It is not appropriate to conduct a MedsCheck any place where other clients are within hearing or where there is a likelihood of being interrupted.

Pharmacists must be cognizant of the Standards of Practice and the Code of Ethics of the profession in ensuring confidentiality of patient information. This includes patient privacy while conducting the MedsCheck service.
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Can I conduct the MedsCheck at the dispensing counter?

The MedsCheck may be conducted at the dispensing counter only if the pharmacy dispensing counter provides for acoustical privacy in which the pharmacist may engage the patient in a dialogue about their medications. It is not appropriate to conduct a MedsCheck any place where other clients are within hearing or where there is a likelihood of being interrupted.

As per the Ontario College of Pharmacists’ Standards of Practice and the Code of Ethics, a pharmacist must ensure confidentiality of patient information. This would include patient privacy regarding the MedsCheck program.

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Record Keeping and Documentation

What is the benefit of completing a MedsCheck medication review form?

The MedsCheck medication review form represents a detailed medication history based on the accuracy and completeness at the time of the appointment. It is also part of the patient’s pharmacy health record and along with pharmacist’s professional notes and other records is a program requirement for auditing purposes. Patients are encouraged to carry their MedsCheck medication review with them when visiting their physician, other health care providers or if they go to the hospital.

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Am I required to keep a copy of a patient’s MedsCheck medication review form in the pharmacy?

Yes. All documentation forms and pharmacy records submitted through the ODB Health Network System PIN mechanism are subject to audit and must be maintained in a readily retrievable format for a minimum of 2 years for the purposes of audit under the ODB program; and for a minimum of 10 years as part of the patient health record as per O. Reg. 58/11 of the Drug and Pharmacies Regulation Act.

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How long does the documentation need to be kept at the pharmacy?

Retention of MedsCheck documents and associated records pertaining to the patient record must be kept on site in a readily retrievable format at the pharmacy for a minimum period of ten years or as indicated in O. Reg. 58/11 of the Drug and Pharmacies Regulation Act.

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How much documentation is required for MedsCheck?

All patient interactions must be documented, either in paper form or on computer. Refer to the Ontario College of Pharmacists’ Standards of Practice and Documentation Guidelines for Pharmacists for documentation standards.

Depending on the MedsCheck program that is being conducted, documentation will vary. Pharmacists should refer to the MedsCheck program details for more information. It is important that professional notes, the MedsCheck Personal Medication history, any check-lists and other related materials are cross-referenced where appropriate to the ODB claims transaction number.

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Do I have to send the patient’s MedsCheck documentation to the patient’s doctor?

Yes. It is mandatory that the MedsCheck medication review be sent by fax to the primary provider using the ministry’s standardized fax/letter for this purpose. Pharmacists must aim to resolve all potential drug therapy problems that were identified during the MedsCheck review. Pharmacists must indicate on the fax cover page whether the MedsCheck is for information purposes only or whether it requires action.

Patients need to be part of the discussion and provide an annual acknowledgement of MedsCheck services that includes sharing their health information with their primary prescriber and other health professionals within the circle of care.

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What is the time period that pharmacists have to submit the MedCheck claim? Can it be submitted 1 or 2 days after the patient encounter?

Claims submissions for any MedsCheck occur on the day the MedsCheck service is conducted and ideally after the patient receives a medication review list that is signed and dated by the pharmacist. When pharmacists follow-up with drug therapy problems, the MedsCheck claim ought to be submitted on the date of service; however, the completed form would be shared with the patient and the primary prescriber as soon as possible afterward.

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Regarding patient confidentiality, can we share the MedCheck medication review form by fax or email to others? Who can we share the MedsCheck forms with? Are we allowed to disclose this information without the need for patient written consent?

Effective October 1, 2016 the ministry implemented the MedsCheck Patient Acknowledgment of Professional Pharmacy Services. This annual process outlines the MedsCheck services that are funded by the Ontario government, that they occur at the pharmacy where there is sufficient privacy and that the MedsCheck patient personal medication record will be shared with the patients primary prescriber. Apart from this process, pharmacy staff should refer to the Personal Health Information and Protection Act, 2004 (PHIPA) for more information.

PHIPA allows a pharmacist to disclose personal health information it has received from a patient, the patient’s substitute decision maker, or another health information custodian, without the express consent of the patient, when the purpose of the disclosure is to provide or facilitate the provision of health care to that patient. A pharmacist may assume it has a patient’s implied consent to the disclosure of the patient’s MedsCheck medication record to another pharmacist or health information custodian. However, if the pharmacist is aware that the patient has expressly withheld or objected to such a disclosure, the pharmacist cannot disclose the information.

According to PHIPA, a health information custodian is a listed individual or organization under PHIPA that, as a result of his or its power or duties, has custody or control of personal health information. Health care practitioners (doctors, nurses, pharmacists), hospitals, pharmacies, laboratories, nursing homes and other organizations are included among others.

Please refer to the www.ipc.on.ca for more information on PHIPA.
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When do we need to give the MedsCheck medication review information to another health care provider or another person?

Effective October 1, 2016 pharmacists must share the MedsCheck patient personal medication record with the patient’s primary prescriber. Specific MedsCheck program criteria warrants sharing the patient medication review with other health care providers as in the case of the MedsCheck LTC and when a physician has made a referral. Pharmacists may also be asked to share the MedsCheck with a hospital, to a diabetes education centre or to a community care access centre if the circumstances surrounding the MedsCheck call for sharing the information. If a patient expressly objects to sharing the information, the pharmacist will include the request as part of the documentation.

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Does the consent form need to be completed for each interaction with the same patient? For example, if a patient signs the consent form to receive the Annual MedsCheck, do they still need to sign it for each subsequent Follow-up MedsCheck?

No. Patient consent should be obtained on an annual basis as part of the MedsCheck Patient Acknowledgment of Professional Pharmacy Services form and process. Pharmacists should confirm that an up-to-date consent form is on file before conducting any subsequent interactions within the year.

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The new MedsCheck Guidebook (Version 3.0) states that, “…when sharing the MedsCheck information with the primary prescriber, a record of the successfully transmitted fax must be kept on file at the pharmacy.” What is needed to meet this requirement?

When sharing information with the primary prescriber, pharmacists must complete the Health Care Provider Notification of MedsCheck Service form and include documentation of a successful transmission. An example of documentation would include a printed successful fax transmission record to be kept on file at the pharmacy.

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Claim Payment

What is the billing process for completing the MedsCheck medication review form?

The pharmacist bills for the MedsCheck service through the Ontario Drug Benefit (ODB) Health Network System (HNS) using a product identifier number (PIN) upon completion of the MedsCheck medication review visit with the patient; billing is done on the date of the visit. However, pharmacists must also follow-up on potential drug therapy problems (DTP) resulting from the review therefore sharing the MedsCheck with the patient and the physician after the visit when DTP have been resolved. Payment is to the community pharmacy.

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Is there a total maximum that will be paid to a pharmacy for the MedsCheck program?

No, at this time, the ministry has not set a maximum number of services or maximum amount allocated to a pharmacy for the MedsCheck program.

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Is the fee for MedsCheck to be considered part of the $100.00 deductible that some ODB recipients are required to pay?

No. Since there is no patient payment associated with the MedsCheck program there is no out of pocket expense that can be applied to the deductible payment. In addition, the Health Network System (HNS) will not apply the MedsCheck fee payment to the recipient’s deductible calculation.

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For More Information

To learn more about MedsCheck talk to your Pharmacist or contact ServiceOntario, INFOline 1-866-255-6701 or TTY 1-800-387-5559