The following exceptions are not permitted for drugs dispensed to patients living in nursing homes, special care homes or adult residential facilities whose drugs are managed for them, regardless if weekly dispensing has been prescribed or requested.
1. Drugs requiring frequent monitoring of laboratory values:
Drugs that require frequent laboratory tests for therapeutic drug monitoring are eligible for a dispensing fee once every 7 days or more (e.g. lithium, clozapine). The pharmacist must complete an authorization form for each patient.
2. Patient’s drug therapy cannot be managed when dispensed as a 28-day supply:
For a pharmacy to be eligible for more than one dispensing fee every 28 days, the “Frequent Dispensing Authorization Form for Less Than 28 Day Supply” must be completed yearly. The pharmacist must complete an authorization form for each patient. One or more of the following reasons must apply:
- Risk of dependence to, or misuse/abuse or diversion of, the drug. This only includes drugs with a high potential for dependence or misuse.
- Documented failure to comply with a drug regimen dispensed in a 28-day compliance package due to cognitive impairment, mental disability, psychiatric illness or physical disability.
- Individuals with no fixed address who are susceptible to theft or loss of belongings.
3. Daily Dispensing:
For a pharmacy to be eligible for one dispensing fee every day, the “Frequent Dispensing Authorization Form for Daily Dispensing”, must be completed monthly. The pharmacist must complete an authorization form for each patient. Daily dispensing of a drug is for exceptional patients and one or more of the following reasons must apply:
- The patient is at risk of intentional overdose.
- The patient requires daily monitoring until methadone treatment becomes available (please provide date of application).
- Buprenorphine / naloxone (Suboxone™) for opioid dependence during initiation of treatment when daily dispensing is required.
- The patient is taking methadone for opioid dependence and has a documented risk of dependence to, or misuse of, a drug that cannot be addressed with weekly dispensing. This only applies to drugs with a high potential for dependence or misuse.
- The patient has severe cognitive impairment, severe mental disability, severe psychiatric illness or severe physical disability that cannot be addressed with weekly dispensing.
Under the Controlled Drugs and Substances Act, pharmacists are not permitted to alter existing prescriptions or prescribe narcotics, controlled drugs, benzodiazepines and targeted substances.