New professional services performed by pharmacists
Since June 20, 2015, pharmacists are providing new professional services to the public. Note that previously these services were performed by physicians and are now covered under the Basic Prescription Drug Insurance Plan (BPDIP). Four of them are billable.
|Billable Services||Non Billable Services|
|1. Assess need and prescribe medication when no diagnosis is required||5. Adjust a prescription|
|2. Assess need and prescribe medication for minor conditions when the diagnosis is known||6. Substitute one therapeutic medication for another in the event of supply disruption|
|3. Assess need and extend a prescription||7. Administer a medication to demonstrate proper use|
|4. Dosage adjustment to achieve therapeutic targets||8. Prescribe and interpret lab tests|
Details of the 4 services
- Service 1
- Service 2
- Service 3
- Service 4
Assess need and prescribe medication when no diagnosis is required
Your pharmacist may prescribe medication when no physician's diagnosis is required in the following cases.
Note that this service is reimbursed, whether or not a medication is prescribed. The pharmacist may not prescribe medication, depending on the assessment of your condition. The applicable fee for this service is $16.*
- Traveller's diarrhea (treatment)
- Malaria prophylaxis
- Perinatal vitamin supplementation
- Nausea and vomiting related to pregnancy
- Smoking cessation (excluding the prescription of varenicline or bupropion)
- Hormonal contraception following a prescription of emergency oral contraceptive, for an initial period not exceeding three months; the prescription may be extended for a maximum of three months
- Antibiotic prophylaxis in patients with prosthetic heart valves
- Cytoprotective prophylaxis in patients at risk
- Prophylaxis of acute mountain sickness (excluding the prescription of dexamethasone or sildenafil)
Assess need and prescribe medication for minor conditions when the diagnosis is known
Your pharmacist may now prescribe medications for the following minor health problems. However, the attending physician must have already diagnosed the problem and prescribed medication. This service must meet certain conditions such as being performed within a maximum period of four years after the last diagnosis by a physician.
Note that this service is reimbursed, whether or not medication is prescribed. The pharmacist may not prescribe medication, depending on the assessment of your condition. The applicable fee for this service is $16.*
- Allergic rhinitis
- Herpes labialis
- Minor acne (without nodules or pustules)
- Yeast vaginitis
- Diaper rash
- Atopic dermatitis (eczema) requiring the use of a weak or moderate strength of corticosteroids
- Allergic conjunctivitis
- Thrush following the use of a corticosteroid inhaler
- Mouth ulcers
- Primary dysmenorrhea
- Urinary infections in women
Assess need and extend a prescription
Your pharmacist may now extend a physician's prescription to avoid treatment being interrupted. However, extension is limited to the maximum valid period of the physician's prescription, without exceeding one year.
Note that this service is reimbursed only if the extension is for treatment lasting more than 30 days. If treatment is 30 days or less, the service is not reimbursed. The pharmacist may not prescribe medication, depending on the assessment of your condition. The applicable fee for this service is $12.50.
Dosage adjustment to achieve therapeutic targets
Dosage adjustments include three categories of therapeutic areas:
|Category||Therapeutic area||Initial visit||Follow-up|
|1||High blood pressure, dyslipidemia, hypothyroidism, non-insulin-dependent diabetes, migraines (prophylactic treatment)||$15.50||
$40 per year (two payments of $20, minimum of two visits)
$50 per year (three payments of $16.67, minimum of three visits)
|1 et 2||Two therapeutic areas or more||$19.50||
Follow-up fees + 50% on follow-up fees for other conditions
$16 per month
La Capitale will reimburse the four new billable services according to the coinsurance percentage specified in your group insurance contract and booklet, in the Health Insurance section, under Prescription Drugs.
New services paid by the insured since June 20, 2015 that were not reimbursed by the Insurer
La Capitale will also reimburse claims filed since June 20, 2015, for the new services according to the coinsurance percentage specified in the contract. If participants have saved supporting documents for these services, they can forward them by mail or by using the online Claim form for prescription drug, medical and paramedical expenses. If claims have already been sent to La Capitale, we will process them as soon as possible, without having to resubmit a new claim.
Automated prescription payment service in-store is available since December 1, 2015, upon presentation of a La Capitale insurance certificate. If the contract does not include direct reimbursement, claims will be processed according to the terms of your contract.
Example of calculation
Here is an example* of how to calculate the amount paid by the insured when the group insurance contract has coinsurance of 80%.
|Cost of professional service (e.g. assess need and prescribe a medication when no diagnosis is required)||$16|
|Percentage paid by the insurer (coinsurance)||80 %|
|Amount paid by the insurer||12,80 $|
|Amount paid by the insured||3,20 $|
*This example does not take into account the applicable deductible. It will be deducted from the amount paid as required.