Prescription Drugs

5-7 Prescription Drugs


PURPOSE



1. To provide for the recurring and emergency prescription drug needs of clients.



PRINCIPLE



2. Applicants must have timely access to prescription drugs.



3. Having drugs delivered through retail pharmacies will allow the pharmacists to provide clients with necessary education about their medications.



4. There will be no cost to clients to have eligible prescriptions filled at their retail pharmacy.



POLICY



5. Drugs required by an applicant, and prescribed by a medical doctor or dentist, are to be obtained from the retail pharmacy of the client’s choice.



a. Certain non-prescription items may be available from the retail pharmacy but only if prescribed by a physician or dentist. E.g., aspirin, Tylenol, vitamins, laxatives.



b. Certain items, although prescribed by a Physician, are considered medical supplies and should be purchased at a retail pharmacy. eg. aero chambers, needles, syringes, bandages.



6. CSAs are not to be issued for drug purchases and applicants are not to be reimbursed for drug purchases.



7. Personal Health Cards shall be used as identification for each individual in the family unit in receipt of Social Assistance to facilitate obtaining prescription drugs at retail pharmacies.



8. Once persons are approved as eligible for Social Assistance, they are eligible for the Social Assistance Drug Program.



PROCEDURE



9. The worker will complete a Social Assistance Assessment form (ISM) and determine eligibility for Social Assistance.



10. Variations to this procedure include:



(a) If the client has a Personal Health Number (PHN) but has forgotten to bring their card(s) to the appointment, the worker can leave the space for the PHN blank on the PhIP Input Record form and ask the processing person to look up the number(s) on the Common Client Index. Processing will then add these numbers to the form and process in the usual way.



(b) If the client doesn’t have a PHN, the worker will help the client complete an application for medicare or for a temporary ID depending on clients circumstances. (A client must be a resident of PEI for three months to be eligible for medicare.) If a client is not planning to remain in PEI for at least three months, they should just complete the Application Form for Temporary Non-eligible Residents.



The worker will call the Medicare office and relay the information from the form over the phone. HINT*....It may take medicare office about 15 minutes to produce a PHN so workers may want to complete this process early in the intake process. (The worker should mail the completed form to the Medicare office along with a copy of the clients birth certificate or a copy of their health card from their previous province.)



Staff at the Medicare office will enter this information into their system and create a Personal Health Number. A Personal Health Card will not be produced until the client has eligibility for Medicare.



11. The processing staff person will produce a Temporary Drug ID Card for each family member who doesn’t have a Personal Health Card. This temporary card is to be used for identification for the Social Assistance Drug Program only and is to be used until the client is eligible for and receives his/her Personal Health Card. (If a client has lost his/her Personal Health Card, a temporary ID card can be issued until he/she is able to get a new one.)



12. If workers or processing staff see that file information on the Common Client Index is wrong, they can complete with the client, the Personal Health Card Update Request form in order to help keep the Common Client Index up to date and consistent with eligibility information on our system. This form should then be mailed to the Medicare office in Montague.



13. Retail pharmacies will be advised to direct their calls to the Help Desk. Provincial Pharmacy staff may need to call the Department from time to time to verify eligibility of clients if they don’t appear on the system, ie, have not yet been entered into the PhIP system but are in fact eligible.



14. If a pharmacist has entered a claim for a person who is not eligible, payment will not be made to the pharmacist. It will be the pharmacist’s responsibility to collect the money from the individual who was not eligible to receive drugs.