Thank you to Dr Verhulst of the Patterns of Practice Committee for alerting us to MSP’s interpretation of overservicing a patient and how we might risk being found at fault in an audit [BCMJ 2017;59:40].
Thank you to Dr Verhulst of the Patterns of Practice Committee for alerting us to MSP’s interpretation of overservicing a patient and how we might risk being found at fault in an audit [BCMJ 2017;59:40]. If I receive a request from my patient or a pharmacist for Special Authority from Pharmacare, would MSP deem it to be overservicing if I call my patient in to see me just for this and I bill a regular office visit? This service would include, of course, reviewing the patient’s condition, looking up the Special Authority criteria, discussing with the patient the need for the drug versus alternatives and their costs, filling in the Special Authority form, sending it to Pharmacare, documenting all this, receiving the response from Pharmacare, documenting that, and recalling the patient if coverage is declined.
I note that we now have over 20 different Pharmacare Special Authority forms and 273 drugs that require them. This does not include the low-cost alternative and reference drug program medications.
A while back the Society of General Practitioners of BC asked the Medical Services Commission (MSC) to approve a fee to pay doctors for submitting Special Authority forms. The MSC refused, stating that a Special Authority form is “part of a visit.” Surely this means that it is an MSC-insured service and, therefore, a legitimate reason for an office visit?
Now we are getting third-party insurance companies demanding that Pharmacare Special Authority be applied for and refused before they will cover certain drugs. Since this is a third-party request that would not otherwise be medically necessary, would we be permitted to charge the patient privately for this service?
I am sure many of my colleagues would appreciate your advice on this. Thanks very much.
—Eugene Leduc, MD
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