Publicly Funded Paxlovid

This topic is intended for Independent pharmacies only and is not applicable to Rexall pharmacies.

Select the appropriate tab to learn about publicly funded Paxlovid in your province.

British Columbia pharmacies are eligible to provide Paxlovid for eligible patients at no cost.

Paxlovid DINs and PINs

Table 1. Paxlovid DINs and PINs.

DIN/PIN Drug Name Fee
2524031 PAXLOVID 300&100mg $10
2527804 PAXLOVID 150&100mg $10

Submitting a Paxlovid Claim

Use the dropdowns below to learn more about submitting claims for each type of service.

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug = applicable DIN from Table 1

      DIN 2527804 is used for patients with moderate renal impairment.

    • Qty Auth = 30 for DIN 2524031, 20 for DIN 2527804

    • Qty = 30 for DIN 2524031, 20 for DIN 2527804

    • SIG

    • DS = 5

  3. Select Process. The prescription opens in Rx Detail.

  4. Confirm the dispensing fee is not more than $10.

  5. Select the Third Party tab. Confirm the TP Qty is 1.

  6. Select Fill.

If during your clinical assessment, you decide to not fill the prescription, you can submit a refusal to fill fee.

  1. Fill a Paxlovid prescription.

  2. Refuse the prescription.

  3. Refill the prescription.

  4. In the Rx Detail Third Party tab, dropdown the Special Services field and select Refuse to Fill Prescription.

  5. In the Special Service Fee field, enter up to double your pharmacy's dispensing fee.

  6. Enter the appropriate intervention code. See Special Services Fees for a list of intervention codes that can be used.

  7. Select Fill.

Alberta pharmacies are eligible to provide Paxlovid for eligible patients at no cost.

Paxlovid DIN

Table 1. Paxlovid DIN.

DIN/PIN Drug Name Fee
2524031 PAXLOVID 300&100mg Up to $22.15

Setting Up the Patient Folder

Claims for Paxlovid should be billed using the patient's PHN. If the patient is from out-of-province, a pseudo-PHN should be used. Select the dropdowns below for more information.

To bill a publicly funded fee for service claim for a resident of Alberta who has a valid PHN, the following Third Party information must be added to the patient’s Third Party tab:

  • Bill Code = AV (Alberta Blue Cross - Alberta Public Health Activities Program)

  • Cardholder = The first 5 characters of the patient's last name (entering the patient's complete last name is also acceptable)

  • Relationship = Card Holder

  • Carrier ID = 16

  • Group ID = 0023464000

  • Client ID = patient's PHN

To bill a publicly funded fee for service claim for a resident of Alberta without a PHN or for an out-of-province patient, the following Third Party information must be added to the patient’s Third Party tab:

  • Bill Code = AV (Alberta Blue Cross - Alberta Public Health Activities Program)

  • Cardholder = The first 5 characters of the patient's last name (entering the patient's complete last name is also acceptable)

  • Relationship = Card Holder

  • Carrier ID = 16

  • Group ID = 0023464000

  • Client ID = CV00000000 (this is a pseudo-PHN)

When the patient is first created, enter the pseudo-PHN CV00000000 in the PHN field located in the Main tab of the Patient Folder. This will auto-populate the Client ID.

Submitting a Claim for a Paxlovid Dispense

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug = 2524031

    • Qty Auth = 30 (20 if renal impairment)

    • Qty = 30 (20 if renal impairment)

    • DS = 5

  3. Select Process. The prescription opens in Rx Detail.

  4. Enter AV/CA in the Bill field if it's not defaulted.

  5. Confirm the dispensing fee is not greater than $22.15. The cost and markup should be $0.

  6. Select Fill.

Saskatchewan pharmacies are eligible to provide Paxlovid at no cost to eligible patients.

  • Patient eligibility is outlined on the Government of Saskatchewan website.

  • A pharmacist may prescribe Paxlovid under the Minor Ailment Program.

Paxlovid DIN and PINs

Table 1. Paxlovid DIN and PINs.

DIN/PIN Drug Name Cost
2524031 PAXLOVID 300&100mg $20
951375 SK MINOR AILMENT: COVID-19 (PAXLOVID) $18
951376 SK PATIENT ASSESS: PAXLOVID INELGBLY/REFRL (PHRMCST PRSCRB)
951377 SK PATIENT ASSESS: PAXLOVID INELGBLY/REFRL (OTHER PRSCRB)

A Custom Class has been added to the Drug Folders to submit the appropriate cost to the province. A TP Rule has been added to the Paxlovid Drug Folder to convert a quantity of 30 to 1 when submitting to the Saskatchewan Drug Plan.

Setting Up the Patient Folder

Claims must be submitted using the patient's HSN. If the patient is not a resident of Saskatchewan or has no HSN, you must contact the Drug Plan and Extended Benefits Branch (DPEBB) for further instruction.

Saskatchewan Residents with a HSN

The patient's HSN should be entered in the Client ID field for the Saskatchewan Drug Plan. The Claim Type should be set to Adjudicate.

Submitting a Paxlovid Claim

There are four types of claims that can be submitted for Paxlovid. Use the dropdowns below for more information.

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug = 2524031

    • Qty Auth = 30

    • Qty = 30

    • DS = 5

  3. Select Process. The prescription opens in Rx Detail.

  4. The Patient EHR Access Reason window opens if the patient's EHR Profile has not been viewed yet. Select a reason for accessing the patient's EHR Profile and enter any additional comments if needed. Select OK.

    Review the patient's EHR Profile and select OK once done.

  5. Confirm the cost is $20. The markup and fee should be $0.

  6. Select the Third Party tab. Confirm the TP Qty is 1.

  7. Select Fill.

  8. If there are any Detected Issues, the Detected Issues Maintenance window opens. Review the window and add any appropriate Issue Management codes as needed.

  9. Select OK.

If Paxlovid was prescribed under the Minor Ailment Program, a Minor Ailment Fee can be submitted after the Paxlovid claim has been submitted.

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug = 951375

    • Qty Auth = 1

    • Qty = 1

    • DS = 1

  3. Select Process. The prescription opens in Rx Detail.

  4. The Patient EHR Access Reason window opens if the patient's EHR Profile has not been viewed yet. Select a reason for accessing the patient's EHR Profile and enter any additional comments if needed. Select OK.

    Review the patient's EHR Profile and select OK once done.

  5. Confirm the cost is $18. The markup and fee should be $0.

  6. Select Fill.

  7. If there are any Detected Issues, the Detected Issues Maintenance window opens. Review the window and add any appropriate Issue Management codes as needed.

  8. Select OK.

If the patient was deemed ineligible for Paxlovid or requiring referral to the SHA Specialized Early COVID Therapeutics Team following a pharmacist's assessment, a claim can be submitted for an Ineligibility/Referral Assessment Fee.

A maximum of 4 claims can be submitted in a 365 day period.

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug = 951376

    • Qty Auth = 1

    • Qty = 1

    • DS = 1

  3. Select Process. The prescription opens in Rx Detail.

  4. The Patient EHR Access Reason window opens if the patient's EHR Profile has not been viewed yet. Select a reason for accessing the patient's EHR Profile and enter any additional comments if needed. Select OK.

    Review the patient's EHR Profile and select OK once done.

  5. Confirm the cost is $18. The markup and fee should be $0.

  6. Select Fill.

  7. If there are any Detected Issues, the Detected Issues Maintenance window opens. Review the window and add any appropriate Issue Management codes as needed.

  8. Select OK.

If a patient has a Paxlovid prescription but the patient was deemed ineligible for Paxlovid or requiring referral to the SHA Specialized Early COVID Therapeutics Team following a pharmacist's assessment, a claim can be submitted for an Ineligibility/Referral Assessment Fee.

A maximum of 4 claims can be submitted in a 365 day period.

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug = 951377

    • Qty Auth = 1

    • Qty = 1

    • DS = 1

  3. Select Process. The prescription opens in Rx Detail.

  4. The Patient EHR Access Reason window opens if the patient's EHR Profile has not been viewed yet. Select a reason for accessing the patient's EHR Profile and enter any additional comments if needed. Select OK.

    Review the patient's EHR Profile and select OK once done.

  5. Confirm the cost is $18. The markup and fee should be $0.

  6. Select Fill.

  7. If there are any Detected Issues, the Detected Issues Maintenance window opens. Review the window and add any appropriate Issue Management codes as needed.

  8. Select OK.

Manitoba pharmacies are eligible to provide Paxlovid at no cost to eligible patients.

  • Patient eligibility is outlined on Government of Manitoba website.

  • If the patient does not have a PHIN, you must fax the paper form to DPIN. This must be done within 28 days of the dispense date.

  • If the claim needs to be reversed, do so within 28 days of the dispense date.

  • Claims should be submitted on the day of the dispense but may be accepted for up to 7 days after.

Paxlovid DIN

Table 1. Paxlovid DIN and PINs.

DIN/PIN Drug Name Fee
2524031 PAXLOVID 300&100mg The lesser of $15 or the pharmacy's dispensing fee
2527804 PAXLOVID 150&100mg

Submitting a Paxlovid Claim

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug

    • Qty Auth = 30 (20 if renal impairment)

    • Qty = 30 (20 if renal impairment)

    • DS = 5

  3. Select Process. The prescription opens in Rx Detail.

  4. Confirm the cost and markup are $0. The fee should be the lesser of $15 or your pharmacy's dispensing fee.

  5. Select Fill.

    It is expected to get a "D1 - DIN not a benefit message" from Manitoba Health. Claims are not paid at the time of submission. Payment will occur monthly and be indicated as positive adjustments on your pharmacy statements.

Ontario pharmacies may submit a claim to Ontario Drug Benefit (ODB) for the following Paxlovid related services:

  • Assessing a patient for Paxlovid therapy and issuing a prescription where appropriate.

  • Identifying a drug therapy problem related to a Paxlovid dispense and consulting with the prescriber who issued the prescription.

  • Dispensing Paxlovid pursuant to a prescription.

For more information, see the Executive Officer Notice and FAQ (dated May 17, 2024).

Paxlovid DINs and PINs

Each type of Paxlovid related service has been assigned an ODB PIN for billing purposes. Each ODB PIN has been assigned a Drug Folder in Propel Rx.

Drug Folders for Paxlovid Assessment and Prescribing

If you accessed a patient for Paxlovid therapy, submit a claim using the appropriate PIN from Table 1. The strength, or lack thereof, in the Drug Folder indicates whether the consultation was provided in-person or virtually and if it resulted in a prescription or not.

Only 1 assessment and prescribing PIN for Paxlovid and/or oseltamivir can be submitted per patient per day. If a prescription is issued, 1 claim can only be submitted for the duration of the infection(s). Check the provincial Clinical Viewers to see if a claim was already submitted for the patient.

Table 1. ODB PINs for Paxlovid assessment and prescribing services.

PIN Trade Name Location? Rx Issued? Fee
9858233 ASSESS & PRSCRBE: PAXLOVID In-person Yes $19
9858235 ASSESS & PRSCRBE: PAXLOVID Virtual Yes
9858323 ASSESS & PRSCRBE: PAXLOVID & OSELTAMIVIR In-person Yes
9858324 ASSESS & PRSCRBE: PAXLOVID & OSELTAMIVIR Virtual Yes
9858325 ASSESS & PRSCRBE: PAXLOVID / OSELTAMIVIR In-person No
9858326 ASSESS & PRSCRBE: PAXLOVID / OSELTAMIVIR Virtual No

Drug Folders for Dispensing Paxlovid

If you dispense a Paxlovid prescription, submit a claim using the appropriate DIN from Table 2.

Table 2. DINs for dispensing Paxlovid.

Propel Rx DIN Trade Name Strength
2524031 PAXLOVID 300&100MG
2527804 PAXLOVID 150&100MG

Drug Folders for Paxlovid Pharmaceutical Opinions

As of May 27, 2024, Paxlovid specific Pharmaceutical Opinions PINs were deactivated. The submission of Pharmaceutical Opinions for Paxlovid prescriptions will follow the same process as other drugs. For more information, see Opinions.

Setting Up the Patient Folder

Claims for Paxlovid can be submitted for three types of patients. Select the dropdowns to learn more about the billing information required for each type of patient.

To bill a publicly funded fee for service claim for an ODB-eligible patient, the following Third Party information must be added to the patient’s Third Party tab:

  • Bill Code = DB (Drug Benefit)

  • Cardholder = The first 5 characters of the patient's last name (entering the patient's complete last name is also acceptable)

  • Relationship = Card Holder

  • Client ID = patient's health card number

When billing the claim, the following intervention code is required in the Rx Detail > Third Party tab:

  • PS - Professional Care Service

To bill a publicly funded fee for service claim for a non-ODB recipient with a valid Ontario health card number, the following Third Party information must be added to the patient’s Third Party tab:

  • Bill Code = ON (Drug Benefit - Non-ODB Recipient)

  • Cardholder = The first 5 characters of the patient's last name (entering the patient's complete last name is also acceptable)

  • Relationship = Card Holder

  • Carrier ID = S

  • Client ID = patient's health card number

As with all claims submitted to ODB, the patient’s gender and birth date must be recorded in the Patient Folder.

When billing the claim, the following intervention codes are required in the Rx Detail > Third Party tab:

  • PS - Professional Care Service

  • ML - Good Faith Standard Coverage

To bill a publicly funded fee for service claim for a patient without an Ontario health card number, the following Third Party information must be added to the patient’s Third Party tab:

  • Bill Code = ON (Drug Benefit - Non-ODB Recipient)

  • Cardholder = The first 5 characters of the patient's last name (entering the patient's complete last name is also acceptable)

  • Relationship = Card Holder

  • Carrier ID = S

  • Client ID = 7999999993 (this is a proxy patient ID)

As with all claims submitted to ODB, the patient’s gender and birth date must be recorded in the Patient Folder.

When billing the claim, the following intervention codes are required in the Rx Detail > Third Party tab:

  • PS - Professional Care Service

  • PB - Name Entered is Consistent With Card

Submitting a Paxlovid Claim

Use the dropdowns below for more information on how to submit the different types of Paxlovid related claims.

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Prescriber

    • Drug = applicable DIN from Table 1

    • Qty Auth = 1

    • Qty = 1

    • SIG

    • DS

  3. Select Process. The prescription opens in Rx Detail.

  4. Confirm the cost and markup are $0. The fee should be $19.

  5. Select the Third Party tab.

  6. Ensure the following intervention codes are entered:

    • ODB program recipient: PS 

    • Non-ODB program recipient: PS and ML

    • No Ontario Health number: PS and PB

  7. Select Fill.

  1. From the Workbench or patient's Profile, select Intake.

  2. Enter the following information:

    • Drug = applicable DIN from Table 2

    • Qty Auth = 30 (20 if DIN 2527804)

    • Qty = 30 (20 if DIN 2527804)

    • DS = 5

  3. Select Process. The prescription opens in Rx Detail.

  4. Select the Extended tab. Enter the applicable LU code in the MR Code field (673, 674, or 675).

  5. Select the Third Party tab. Confirm the TP Qty is 1 for Ontario Drug Benefit.

  6. Select Fill.

 

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