The maintenance program allows the pharmacist to dispense longer days supply (typically
three months) to patients who are taking a medication (both maintenance and
acute) for a long duration. Promoting longer days supply based on specific criteria
reduces the number of dispensing fees and is often more convenient for the plan
member by reducing the number of pharmacy visits for prescription renewals.
This program is suitable for patients with a condition that can be safely treated
without reassessment for up to 100 days. The maintenance program is not currently
offered in Quebec.
How the Program Works
When the pharmacist submits a claim for less than 42 days for a maintenance
drug, the following message is returned to the pharmacist: "Drug eligible
for 100 day main quantity". At this point, the pharmacist can call the
physician for authorization to dispense a three month supply of the medication.
For acute drugs being taken on a long-term basis, the message "Resubmit
3 month supply" will be returned to the pharmacist after 3 consecutive
monthly prescriptions for the same strength of the same drug. At this point,
the pharmacist can call the physician for authorization to change to a three
month supply of the medication. If the plan member presents a prescription for
an acute drug that has not been taken for three consecutive months, the following
message is returned to the pharmacist: "Resubmit one month supply".
This program is voluntary. At any stage of this program, the pharmacist can
simply submit an override
code (pdf) if the pharmacist or plan member wishes to opt out of the program.
If the plan member opts out of the program, the claim will be subject to our
standard Acute and Maintenance day supply limits as determined by the plan parameters.
Drugs Included in the Program
This program includes all drugs used for the treatment of chronic health conditions.
It excludes narcotics and controlled medications. Examples of drugs generally
included are:
- High blood pressure medication
- Hypercholesterolemia medication
- Oral contraceptives
- Hormone replacement therapy