PharmaNet data set

Description

The PharmaNet system is an online, real-time system that captures all prescriptions for drugs and medical supplies dispensed from community pharmacies in BC as well as prescriptions dispensed from hospital outpatient pharmacies for patient use at home.   In addition, physicians may record medications provided to patients during an office, clinic or emergency department visit.  The recording of medications by physicians is not mandatory at this time; therefore this data is not complete.

PharmaNet supports drug dispensing, drug monitoring and claims processing. The PharmaNet system contains data related to both medications dispensed and PharmaCare claims.

Inclusions

• All prescription medications and supplies dispensed by community pharmacies in BC
• Prescriptions dispensed from hospital outpatient pharmacies for patient use at home
• Medications provided to patients during a physician office, clinic or emergency department visit (not mandatory at this time)
• Patient demographic data: Personal Health Number, name, address and date of birth, reported drug allergies
• Drug information and drug interaction evaluations
• PharmaCare and patient paid prescription claim information for drugs, dispensing fees, special services fees

Exclusions

• Medications administered to patients when admitted to hospital
• Drugs dispensed to hospital in-patients
• Antiretroviral medications dispensed from the Centre of Excellence in HIV/Aids at St. Paul’s Hospital
• Medications purchased without a prescription by the patient (e.g. Over the counter medications, herbal products, vitamins)
• Information regarding third party coverage; as a result it is not apparent if the patient paid amount was paid by the patient or a third party insurer.
• Third party paid amounts

Data changes over time

The PharmaNet system began on September 1, 1995. Before this time PharmaCare, the province’s public drug insurance program, provided drug claim information. However, PharmaCare only captured the portion of the population eligible for the PharmaCare program and as a result, it is not possible to access comprehensive prescription data for the province prior to 1996.

Quality/accuracy of information/field coding source

PharmaNet data is entered by pharmacists reflecting live transactions.

Important additional information

• Although the PharmaNet data is not part of the Population Data BC internal holdings at this time, it can be linked to data held by Population Data BC.
• Practitioner IDs in the PharmaCare data files held by Population Data BC (ie MSP, DAD) are not currently linkable to the practitioner IDs in the PharmaNet data files.

References

• More information on the PharmaCare program and the Fair PharmaCare plan is available on the BC Ministry of Health website at: http://www.health.gov.bc.ca/pharmacare/index.html#.

Fields available

Field Name	Description
DINPIN	The Drug Identification Number / Product Identification Number assigned by Health Canada, also referred to as Canadian Drug Identity Code (CDIC), is used to uniquely identify a particular drug by chemical, dosage, form and manufacturer
Canadian Brand Name	Name the product is marketed by in Canada
Chemical / Generic Name	Represents the chemical composition of a drug
GCN Sequence Number	Proprietary random number assigned by Health Canada that represents the generic formulation of drug
Drug Strength	Alpha numeric description of drug potency and units e.g., 75%, 70U
Drug Form Units	The drug measurement units for performing drug encounter and price calculations; e.g., ml, grams, each.
Dosage Form Code	Code identifying the form by which a drug is formulated; e.g., aerosol, foam, capsule, tablet, liquid.
Dosage Form Description	Describes the form by which a drug is formulated.
AHFSCode	American Hospital Formulary code assigned and maintained by Health Canada to group drugs by therapeutic categories
PharmaCare TheraClass	PharmaCare therapeutic class based on AHFS code, is assigned and maintained by PharmaCare to group drugs by therapeutic categories

 

Medication Review

Field Name	Description
Medication Review Records	Pharmacists provided details about all drugs a patient is currently taking, possible adverse affects, recommendations, etc. Medication reviews are a service provided by pharmacists. Pharmacists can then claim these and be reimbursed for this extra service.

 

Medication Dispensing Information

Field Name	Description
Date of Service	Date treatment, product or service was provided to the patient.
Quantity Dispensed	Quantity of medication dispensed
Days Supply	Estimate of number of days treatment contained in the dispense
Directions for Use	Directions regarding on the drug should be taken in terms a patient should understand. 80 character free format text field.

 

Claims or Cost Information

Field Name	Description
Date of Service	Date treatment, product or service was provided to the patient.
Account Code1 and Description	Account type under which claim adjudicated, represents type of PharmaCare plan e.g., long term care, income assistance, cystic fibrosis, mental health, Fair PharmaCare.
Quantity	The actual number of units dispensed as submitted by the Pharmacist.
Quantity Accepted	Pro-rated quantity based on days supply accepted for payment by PharmaCare
Days Supply	Estimated number of days of treatment contained in the prescription as submitted by pharmacist
Days Supply Accepted	Pro-rated days supply based on the ‘allowed’ days supply.  The ‘accepted’ days supply may be reduced from the submitted days supply based on: exceeding one of the following; patient’s special authority days supply, amount allowed for the plan or amount allowed for the DINPIN.
Days Supply	Estimated number of days of treatment contained in the prescription as submitted by pharmacist
Days Supply Accepted	Pro-rated days supply based on the ‘allowed’ days supply.  The ‘accepted’ days supply may be reduced from the submitted days supply based on: exceeding one of the following; patient’s special authority days supply, amount allowed for the plan or amount allowed for the DINPIN.
Drug Cost Claimed	Ingredient cost claimed / submitted by the pharmacist
Drug Cost Accepted	Product cost that Pharmacare used to adjudicate the claim. If the product was in a Reference Based Price Category, or part of a Low Cost Alternative group of drugs, and the price charged for the drug was greater than the base-line cost established by Pharmacare, before adjudicating the claim the product cost is set to the appropriate base-line cost. Special Authorities may be given to have Pharmacare pay the entire price of the higher drug.
Drug Cost Paid	The amount of the submitted drug cost paid by PharmaCare.
Professional Fee	Dispensing fee cost claimed / submitted by the pharmacist for technical and professional services.
Professional Fee Accepted	Professional fee cost Pharmacare used to adjudicate the claim. If the Professional fee charged exceeded the maximum allowed for the BENEFITGRP or PHARMACY, before adjudicating the claim the professional fee is adjusted is set to the appropriate maximum allowed.
Professional Fee Paid	The amount of the dispensing fee cost amount paid by PharmaCare for technical and professional services.
Special Services Fee	The amount claimed by pharmacist for special service e.g., consulted prescriber, action Rx issue
Special Services Fee Paid	The amount paid by PharmaCare to the pharmacy for the special service e.g., consulted prescriber, action Rx issue
Copay to Collect	The amount the pharmacy collected from the patient for a claim. Note: PharmaNet does not track amounts paid by third party insurers, the copay to collect amount may be passed on to a third party.
Total Amount Paid	Total amount paid by PharmaCare to the pharmacy for drug cost and professional fee after adjusting for maximum price rules and subtraction of the copay to collect amount.
Special Authority Flag	Y/N  Indicates whether or not a special authority was in effect at the time of the claim.
Special Authority Type	Represents the type of special authority in effect at the time of the claim e.g., B = non-benefit, L = low cost alternative (LCA) and R = reference drug program (RDP)
Accumulated Expenditure Amount	Total dollar amount spent by, or on behalf of the family since the start of the benefit year. The value includes expenditures up to but not including this claim. This amount is the cumulative total of the Accepted Amount but does not include the current claim.
Claim Status	Current status of the claim, reversal, or adjustment
Intervention Type Code	Identifies intervention codes for special services performed. Up to two Special Service Intervention codes are allowed per claim

 

1. Different accounts target specific sub-sets of the population. Fair PharmaCare plan level data is not provided for privacy reasons due to the potential for determining family income.