1. Does methadone oral liquid need to be listed on the Frequent Dispensing Documentation Form?
No, methadone oral liquid is not subject to the policy because it is not a solid oral dosage form.
2. Does the drug strength need to be included on the Frequent Dispensing Documentation Form?
Yes.
3. Does a new Frequent Dispensing Documentation Form need to be completed if the drug strength changes?
Yes.
4. Can drugs be added to an existing Frequent Dispensing Documentation Form after it is completed and signed?
No, a new Frequent Dispensing Documentation Form is required.
5. What is a licensed adult residential facility?
Adult residential facility is the term used for all licensed facilities such as Special Care Homes, Memory Care Homes (dementia care), Generalist Care Homes and Community Residences. Drug administration is managed for residents by the staff of the facility.
6. Are half-way houses considered correctional facilities?
No.
7. Are pharmacies eligible for a dispensing fee for clonidine if it is dispensed for less than a 7 days’ supply?
No, to be eligible for payment of dispensing fees in a 1 to 6 days’ supply, drugs must be in one of the following categories: narcotic, controlled drug, benzodiazepine or other targeted substance, anticonvulsant, antidepressant, antimanic, antipsychotic or hypnotic.
8. Are pharmacies eligible for weekly dispensing fees if the patient is taking a designated high-cost drug, and does not meet criteria for weekly dispensing but there are concerns about the patient losing the drug?
No, the patient must meet criteria for more frequent dispensing, or pharmacies may submit zero or partial fees (i.e. ¼ of the fee).
9. A continuous drug was provided to the patient from the nursing home’s “stat box/ward stock.” Are pharmacies eligible for payment of a dispensing fee for that dose(s) in addition to the regular monthly supply?
No, pharmacies are eligible for one dispensing fee for a continuous drug in a 28-day period unless there is a new drug start or change in dosage.
10. Can CPhA intervention codes (e.g. MN, NI, MX) be submitted with claims to avoid being audited?
No, all claims are subject to audit.
For patients who met the criteria for payment of a dispensing fee when a drug is dispensed in a 7 to 27 days’ supply (questions 11 to 14):
11. If a patient is prescribed drugs with a high potential for dependence, misuse or abuse along with drugs that do not have a high potential for dependence, misuse or abuse, are both types of drugs eligible for payment of weekly dispensing fees?
Pharmacies are eligible for payment of weekly dispensing fees for all the patient’s drugs if a patient:
- fails to comply with a drug regimen dispensed in a 28-day compliance package due to cognitive impairment, mental disability, psychiatric illness or physical disability; or
- has no fixed address and is susceptible to theft or loss of belongings.
12. The prescription indicates the drug is to be dispensed in the same days’ supply as the patient’s opioid agonist therapy (OAT) (i.e., “dispense daily and with carries”). If the patient receives one witnessed dose and 6 carry doses, a 7 days’ supply of their other drug will be dispensed to match. Can the Frequent Dispensing Documentation Form for 1 to 6 days’ supply be filled out in case the witness/carry schedule of OAT is reduced?
No, since the patient is receiving a 7 days’ supply, they do not meet the criteria for dispensing in a 1 to 6 days’ supply.
13. If there is less than a 7 days’ supply remaining on the prescription, are pharmacies eligible for two dispensing fees for that drug for that week (one for the remaining quantity of the current prescription, and one for the remainder of the week from the new prescription)?
No, pharmacies are eligible for one dispensing fee for that week and must submit a zero or partial dispensing fee.
14. There are often holidays that require changing from a 7 days’ supply to an 8 days’ supply followed by a 6 days’ day supply. Are pharmacies eligible for a dispensing fee for each claim and is a Frequent Dispensing Documentation Form for 1 to 6 days’ supply form required in addition to the Frequent Dispensing Documentation Form for 7 to 27 days’ supply form?
Pharmacies may submit claims earlier than required or change the days’ supply to accommodate statutory holidays, patient vacations or other scheduling issues. However, over a 28-day period, pharmacies are only eligible for four dispensing fees. A Frequent Dispensing Documentation Form for 1 to 6 days’ supply form is not required in these cases.