Minor Ailments

Last Updated: November 14, 2024

On January 1, 2023, the scope of practice for Ontario pharmacists expanded to include the provision of Minor Ailment services. The assessment and prescribing for 13 Minor Ailments were announced as part of this scope. If the service is provided to an eligible patient, a fee can be claimed from Ontario Drug Benefit (ODB). The claim must be submitted electronically, and appropriate documentation must be recorded for the consultation. For more information on funding for Minor Ailment services, refer to the Executive Officer Notice and FAQ.

In Ontario, a subscription-based integrated solution is available for Minor Ailments. For more information, click here. If you do not have this feature activated, see the steps below on how to bill for Minor Ailment services in Propel Rx.

This topic contains the following sections:

• Billing a Minor Ailment Service Claim to ODB

• Frequently Asked Questions

• Helpful Resources

Billing a Minor Ailment Service Claim to ODB

Third Party Information

Minor ailment services can be provided by pharmacists to patients with a valid Ontario health number. Depending on whether the patient has ODB coverage, the Third Party information required for submitting the claim varies. Refer to Table 1 for required Third Party information.

Table 1. Third party information for submitting Minor Ailment claims.

Patient	Bill Code	Client ID	Intervention Codes*
ODB - eligible	DB	Ontario Health Card number	PS
Non-ODB	ON (Carrier ID = S)	Ontario Health Card number	PS and ML

*Intervention codes auto-populate in Rx Detail when a prescription is filled for a Minor Ailment service.

Minor Ailment PINs

Unique PINs have been issued for each Minor Ailment. As Minor Ailment services can be provided in person or virtually as well as result in a prescription being issued or not, each Minor Ailment has 4 PINs that can be used for billing. These PINs have been created as Drug Folders in Propel Rx. Select the dropdown below or refer to Executive Officer Notice for the list of Minor Ailment PINs.

All Minor Ailment Drug Folders have a trade and generic name beginning with "ASSESS & PRSCRBE" followed by the Minor Ailment name. Use the name to search for the Drug Folder.

Minor Ailment Service Prescription

To claim the fee for a Minor Ailment service, a prescription must be billed to ODB on the same day the service is provided. As maximum claim limits have been set for each Minor Ailment, you should confirm the number of consultations that the patient has already received for the applicable Minor Ailment before submitting a claim.

A provincial clinical viewer (ClinicalConnect or connectingOntario) can be used to view the professional service history for the patient. This allows you to confirm if the patient already received the maximum number of Minor Ailment services. For more information on clinical viewers, click here.

To fill a Minor Ailment service prescription:

1. Select Intake from the Workbench or Patient Profile.

2. Enter the following information:

   • Patient if not already entered

   • Prescriber = pharmacist providing or supervising the Minor Ailment service

   • Drug = Minor Ailment PIN

   • Qty Auth = 1

     If the Minor Ailment service was provided remotely by a pharmacist working in a rural pharmacy, enter 2 as the Qty Auth and Qty.

   • Qty = 1

   • SIG

     You can use the SIG Code "MedCP" to quickly auto-populate the phrase "Consultation provided by" in the SIG.

   • DS = 1

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

4. Confirm the Bill field includes Drug Benefit and Cash.

5. Confirm the cost and markup are $0.00.

6. Confirm the fee is as follows:

   • $15 if the consultation was conducted virtually

   • $19 if the consultation was conducted in person

7. Select the Third Party tab.

8. Confirm the intervention codes are entered as follows:

   • PS if the patient is an ODB recipient

   • PS and ML if the patient is not an ODB recipient

   

9. If a referral to a health care professional is required, dropdown the Special Services field and select 4 - Referral by Pharmacist.

10. Select Fill. If your store has Digital Workflow, the Minor Ailment service prescription will skip Packaging and Dialogue as the Drug Folder is flagged as PFS.

    Troubleshooting Rejection Messages

    Table 3. Response codes that can be returned when billing a Minor Ailment service.

    Response Code	Meaning	Actions Required
    LO - Benefit Maximum Exceeded	The maximum number of claims have been submitted for the Minor Ailment service in the last 365 days.	Cancel the Minor Ailment service claim. Refer the patient as needed to another health care provider.
    60 - Prescriber License Code Error	The wrong Prescriber Type was transmitted in the claim.	Confirm the pharmacist is entered as the prescriber in the claim. Confirm the Prescriber Type in the Prescriber Folder is set to Ontario College of Pharmacists.
    68 - Professional Fee Error	The Minor Ailment service fee cannot be billed by primary pharmacy service providers for patients in LTC homes.	Zero the fee and resubmit the claim. If you are a secondary pharmacy service provider and the Minor Ailment service is being provided for emergency purposes, enter the LT - LTCH Dispensing Fee Payment for Emergency Rx intervention code to override the response.

Frequently Asked Questions

Helpful Resources

If your store belongs to a banner group, we recommend reaching out to your member account executive for guidance on Minor Ailments.

• Executive Officer Notice and FAQ

• Clinical Viewers for Community Pharmacies

• OCP Minor Ailments

On June 1, 2023, the scope of practice for British Columbia pharmacists expanded to include the provision of Minor Ailment and contraception services (MACS). If the MACS is provided to an eligible patient, $20 can be claimed from PharmaCare. The claim must be submitted electronically, and appropriate documentation must be recorded for the consultation. For more information on funding for MACS, refer to the PharmaCare Policy Manual.

Minor ailments functionality is an area of consideration for our Propel Rx platform. We are currently exploring vendor integration options to support out customers in the future. Until Propel Rx has a fully integrated solution available, Propel Rx will support related fee for service claim submissions.

This topic contains the following sections:

• Locating the MACS Drug Folders

• Verifying the Custom Classes for the MACS Drug Folders

• Submitting the Claims

• Minor Ailments

Locating the MACS Drug Folders

A Drug Folder has been created for each MACS PIN. To locate them, you can search using one or more of the following attributes:

• PIN - refer to the PharmaCare Policy Manual section 8.14 for the list of PINs.

• Trade or Generic Name - all Drug Folders contain "ASSESS & PRSCRBE" in the trade and generic name followed by a brief description of the MACS.

  If you can't locate the Drug Folder by name, try using a wildcard (%) in the search. Place the wildcard after "assess & prscrbe" and then enter a description of the service. A wildcard replaces one or more characters in a name, allowing you to retrieve more records.

  For example, to search for the GERD Drug Folder, enter "assess & prscrbe%gerd" in the Trade or Generic Name search fields.

• Strength - the strength when specified corresponds to the outcome of a MACS.

  • No strength = schedule 1 drug prescribed

  • NO RX = non-Rx/non-pharmacological recommendation

  • OTHER HCP = schedule 1 drug prescribed, and patient was referred to another healthcare professional

  • NO RX;HCP = non-Rx/non-pharmacological recommendation, and patient was referred to another healthcare professional

  • Virtual = virtual service

Verifying the Custom Classes for the MACS Drug Folders

A Custom Class has been entered in each MACS Drug Folder to submit a zero-dollar claim to PharmaCare. If you notice the cost, markup, and/or dispensing fee are not auto-populating correctly in Rx Detail, follow the steps below to add the Custom Class to the Drug Folder and/or set up the Pricing Strategy.

1. Open the Drug Folder.

2. Select the Alternative tab.

3. In the Custom Class section, confirm there is no existing row for Pharmacare. If the Custom Class already exists, skip to step 7.

4. Select Add.

5. Enter the following information:

   • Third Party Plan = Pharmacare

   • Custom Class = Professional Care Service

6. Select Save.

7. Select More > Pricing.

8. On the pricing tree to the left, expand the Pharmacare row. Confirm there is no existing sub-row underneath Pharmacare for the Custom Class.

9. Select the Pharmacare row.

10. Select Add. The Create New Strategy window opens.

11. Dropdown the Custom Class field and select Professional Care Service.

12. Select OK.

13. Under the Strategies tab, enter the following in the Fixed Rules section:

    • Fee = $0

    • Markup% = 0.0%

14. Select Save.

Submitting the Claims

Submitting the MACS Claim

To claim the $20 for a MACS, a prescription must be billed to PharmaCare on the same day the service is provided. A minimum of 3 days must elapse between claims for the same Minor Ailment for the same patient.

A medication review claim will not be paid if it's submitted on the same day as a MACS claim.

To process a MACS claim:

1. Select Intake from the Workbench or Patient Profile.

2. Enter the following information:

   • Patient

   • Prescriber = pharmacist

   • Drug = PIN

   • Qty Auth = 1

   • Qty = 1

   • SIG = must include the 10-digit pharmacy phone number at the beginning

   • DS = 1

3. Select Process. Rx Detail opens.

4. In the Price section, confirm the following:

   • Cost = $0

   • Markup = $0

   • Fee = $0

5. Select Fill

If your store has Digital Workflow, the MACS prescription will skip Packaging and Dialogue as the Drug Folder is flagged as PFS.

Submitting a Prescription Claim as a Result of a MACS

If a prescription is issued as a result of a MACS, process the prescription as per usual process with the following exceptions:

• In the Prescriber field, enter the pharmacist.

• Before submitting the claim, add a PS intervention code in the Rx Detail Third Party tab for PharmaCare.

Helpful Resources

Sample MACS Form (gov.bc.ca)

MACS Quick Reference Guide

PharmaCare Policy Manual Section 8.14 Minor Ailments and Contraception Service

College of Pharmacists of British Columbia - Pharmacist Prescribing for Minor Ailments and Contraception (PPMAC)