PharmaCare

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Date range: January 1, 1986 onwards

Data source: BC Ministry of Health

This checklist is historical and provided only for reference. Please refer to https://my.popdata.bc.ca/dar/ for the current application and checklists.


Description

PharmaCare is BC's public drug insurance program that assists BC residents in paying for eligible prescription drugs and designated medical supplies.

Inclusions

  • Only data on prescription drugs paid for under the PharmaCare program are included in the PharmaCare data; these are a subset of the prescriptions issued in BC.

Exclusions

  • Prescription drug use below the deductible level does not appear in the PharmaCare data.
  • Drugs given to hospital inpatients are not included in the PharmaCare data.

Data Changes Over Time

  • Until May 1, 2003, the PharmaCare program consisted of seven separate coverage plans, some targeting specific subsets of the population, such as seniors, long-term care residents or social services clients, and one catastrophic plan for everyone not otherwise covered. These plans offered relatively comprehensive coverage for some groups such as senior citizens, and fixed-deductible catastrophic coverage for others.
  • On May 1, 2003 the Fair PharmaCare plan was introduced, combining two of the former major plans, the universal catastrophic plan and the seniors' plan, into one new plan with deductibles based on family net income. These coverage changes under the PharmaCare program mean that after May 1, 2003, the data captured by PharmaCare have changed.Prescription drug use below the deductible levels does not appear in the PharmaCare data, but drug use over the deductible does appear. Thus, after May 2003, a smaller proportion of the population has comprehensive data in the PharmaCare system. For example, one can no longer easily study drug use by seniors, as only a subset of their drug prescriptions appear in the data - those obtained after they have reached their family deductible for the year.
  • Fair PharmaCare is based on family rather than individual net income. This means that one high drug use family member may pull a family across the financial threshold, so that even a first prescription for other family members may be recorded in the data.

Important Additional Information

  • PharmaNet (as opposed to PharmaCare) is a province-wide network that links all BC pharmacies to a central set of data systems. It supports drug dispensing, drug monitoring and claims processing. The PharmaNet system contains data related to both medications dispensed and PharmaCare claims. All prescription medications dispensed by community pharmacies in BC are recorded in the PharmaNet system. Although the PharmaNet data is not part of the Population Data BC holdings at this time, it can be linked to data held by Population Data BC (see references below).
  • Practitioner IDs in the PharmaCare data files held by Population Data BC are not currently linkable to the practitioner IDs in the PharmaNet data files.

References

Fields Available

Field Name

Description

Plan type

Different plans or plan types target specific sub-sets of the population. Please note: the plan types available changed after the introduction of Fair PharmaCare on May 1, 2003. See description of Plan Types prior to May 2003. See description of Plan Types after May 2003.

Drug number

The Drug Identification Number / Product Identification Number, also referred to as Canadian Drug Identity Code (CDIC), is used to uniquely identify a particular drug as to its chemical, dosage, form and manufacturer.

Practitioner number A number applied to a practitioner and granted by the Medical Services Commission in accordance with the Medical Services Act and Regulations.
Phamacy number A unique identifier assigned by the Canadian Pharmaceutical Association.

Date of service

Date prescription is dispensed at the pharmacy counter.

Days' supply accepted

An estimate of the number of days of treatment contained in the prescription that was accepted for payment.

Days' supply dispensed

An estimate of the number of days of treatment contained in the prescription that was dispensed.

Quantity accepted Prorated number of doses accepted by the PharmaCare adjudication process and based on the accepted days supply
Quantity dispensed The actual number of units dispensed by the Pharmacist.

Ingredient cost accepted

Dollar amount that PharmaCare accepted for the ingredient(s) or treatment supplied for the prescription.

Ingredient cost claimed

Dollar cost of ingredient(s) or treatment supplied that the pharmacy charged the people getting the prescription filled.

Ingredient cost paid

Dollar amount that PharmaCare paid for the ingredient(s) or treatment supplied for the prescription.

Professional fee accepted

Specifies the fee for dispensing a prescription recognized by PharmaCare.

Professional fee claimed

Dollar amount charged to the recipient, for the services the pharmacist provided in filling the prescription. Typically these are dispensing fees, but could include other pharmacist services.

Professional fee paid

Dollar amount PharmaCare paid for the services the pharmacist provided in filling the prescription.

Product selection

A code that indicates the reason for no substitution or a reason for the selection of the product dispensed.

Special authority

Indicates that a special authority was in effect for the claim. This single field has been replaced with three ypes of special authorities, but historical information still needs a catch-all field

Special authority low cost Alternative

Indicates if a Low Cost Alternative special authority applied, i.e., the accepted drug price was not reduced to the amount of the generic baseline drugs.

Special authority non benefit

Indicates if a Non-Benefit special authority applied, i.e., the product was treated as being eligible for coverage by the PharmaCare program.

Special authority reference drug program

Indicates if a Reference Drug Price special authority applied, i.e., the accepted drug price was not reduced to the amount of therapeutically equivalent drugs.

Subsidy indicator

Denotes whether an individual/family qualifies for MSP Premium Assistance.

Accumulated expense amount The total dollar amount recognized by PharmaCare that has been paid by the patient since the start of the calendar year prior to the current claim.
Total copayment Total copayment

Total amount paid

Total amount paid by PharmaCare. Combination of the ingredient and professional fee paid amounts.

Special services fee claimed

Amount claimed by pharmacist for special service (e.g., consulted prescriber, action Rx issue).

Special services fee paid Amount paid by PharmaCare to the pharmacy for the special service (e.g., consulted prescriber, action Rx issue)
Special Services fee accepted Specifies the fee for special services (e.g., consulted prescriber, action Rx issue) recognized by PharmaCare

** Data field which could potentially identify an individual, and which therefore is only released only to researchers having a clear need for the data in order to accomplish their research project.


Page last revised: November 1, 2017