Acquisition Cost Prompt

The Acquisition Cost Prompt can be leveraged to minimize financial losses when billing Prescriptions to provincial and private Third Parties. The prompt identifies instances where Prescriptions are priced lower than the cost to acquire the drug and then provides you with the opportunity to bill the Acquisition Cost instead if desired.

The Acquisition Cost Prompt can be leveraged to minimize financial losses when billing Prescriptions Ontario Drug Benefit (DB, TR). The prompt identifies instances where Prescriptions are priced lower than the cost to acquire the drug and then provides you with the opportunity to bill the Acquisition Cost instead if desired.

Conditions for the Acquisition Cost Prompt

For the Acquisition Cost Prompt to appear, all of the following conditions must be met:

  • The Prescription's Cost Method is set to ELI (Eligibility Price). The Cost Method is set in the Pricing module for the Third Party plan driving the Prescription's price (ELI/SUP/ACQ or ELI/ACQ/SUP).

  • The Prescription's Cost Method is set to ELI (Eligibility Price).

  • The Eligibility Price and Acquisition Costs are populated in the Drug Folder.

  • The Acquisition Cost exceeds the Eligibility Price by a certain percentage threshold. This threshold is set in the backend for each Third Party.

    For Ontario Drug Benefit, the threshold is 8%.

  • The Acquisition Cost exceeds the Eligibility Price by 8%.

  • The Acquisition Cost Prompt preference is NOT set to "Never Prompt."

  • The Acquisition Cost exceeds the Eligibility Price by $0.01 or more.

Setting the Acquisition Cost Prompt Preference

To set the Acquisition Cost Prompt preference:

  1. Select More (...) > Pharmacy > Rx Detail.

  2. For the Acquisition Cost Prompt, choose one of the following options:

    • Always Prompt - when the prompt conditions are met, the prompt will appear for New, ReAuth, and Refill Prescriptions, including Rebills.

    • Prompt on New Rx or 'No' Response - when the prompt conditions are met, the prompt will appear if there is no history of a response recorded for the Prescription chain. If a response was previously recorded in the Prescription chain, it will be automatically applied and the prompt will not appear.

      • New Prescription chains.

      • Existing Prescription chains that were previously billed with the Supplier Price or Acquisition Cost but are now being billed with the Eligibility Price (i.e., primary Third Party plan was updated).

      • Existing Prescription chains that were previously billed for quantities that were too low to meet the dollar or percentage threshold for the prompt.

      • Existing Prescription chains that were previously billed for an Acquisition Cost that did not surpass the Eligibility Price until now.

    • Never Prompt - the prompt will never appear.

  3. Select Save.

Using the Acquisition Cost Prompt During Prescription Processing

If a Prescription is eligible for the Acquisition Cost Prompt, the prompt will appear in Rx Detail after interactions, if any, are displayed. After responding to the prompt, if there is a change in quantity or days supply or the Prescription is Rebilled, the prompt will reappear again for you to re-evaluate and confirm the response.

The Acquisition Cost Prompt will stop a Prescription from background processing. The Prescription will remain in an Incomplete status until the Acquisition Cost Prompt is addressed.

The options available in the Acquisition Cost Prompt will vary depending on the Third Party plan driving the Prescription's price.

Ontario Drug Benefit (DB, TR) All Other Third Party Plans

  • Add Markup - only available when billing Ontario Drug Benefit (ODB) plans. If this checkbox is ON, a markup is added based on the Acquisition Cost. If this checkbox is OFF, the markup defaults to $0. By default, this checkbox is OFF.

  • Add MI Intervention Code - only available when billing to ODB plans. If this checkbox is ON, the MI intervention code is inserted for the ODB claim. If this checkbox is OFF, a MI intervention code is not auto-inserted. By default, this checkbox is ON.

  • Yes - the Prescription is billed using the Acquisition Cost.

  • No - the Prescription is billed using the Eligibility Price.

After responding to the prompt, it is possible to switch between the Eligibility Price and Acquisition Cost by adding or removing the MI intervention code.

  • If Yes was selected to the prompt, you can switch to using the Eligibility Price by manually removing the MI intervention code, if it was auto-inserted. The markup will be recalculated to reflect the Eligibility Price.

  • If No was selected to the prompt, you can switch to using the Acquisition Cost by manually adding the MI intervention code to the Third Party plan driving the Prescription price. However, the markup will not be recalculated automatically (i.e., still reflect the Eligibility Price). To change the markup, perform a price override in the Requested Cost window.

  • If No was selected to the prompt, you can switch to using the Acquisition Cost by manually adding the MI intervention code to the ODB claim. However, the markup will not be recalculated automatically (i.e., still reflect the Eligibility Price). To change the markup, perform a price override in the Requested Cost window.

Special Considerations for Mixture Prescriptions

The Acquisition Cost Prompt can appear for mixture Prescriptions but there are a few differences that exist compared to the prompting for regular Prescriptions.

  • If a Fixed Cost is entered in the Mixture Folder for the Third Party plan driving the Prescription's price, the Acquisition Cost Prompt will not appear.

  • If Yes is selected to the prompt, the Acquisition Cost is only used for the ingredients listed that meet the conditions for the prompt. All other ingredients will use the Eligibility Price. The markup will be set to $0.