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Pharmacare Tariff Regulations
made under Section 13 and subsection 17(3) of the
Health Services and Insurance Act
R.S.N.S. 1989, c. 197
O.I.C. 2007-393 (July 13, 2007, effective August 1, 2007), N.S. Reg. 337/2007
Citation
1 These regulations may be cited as the Pharmacare Tariff Regulations.
Interpretation
2 In these regulations,
(a) “AAC” means the actual acquisition cost of a prescription drug, determined in accordance with Section 3;
(b) “Act” means the Health Services and Insurance Act;
(c) “MAC” means the maximum allowable drug cost established by the Minister under the Insured Prescription Drug Plan for an interchangeable drug category;
(d) “Pharmacare allowance” means the discount established under the Insured Prescription Drug Plan of 15% from the MAC of the top 20 interchangeable, multi-source, generic categories billed to the Plan;
(e) “Pharmacare professional fee” is the lesser of the usual and customary professional fee the provider charges to cash customers and the applicable maximum Pharmacare professional fee as set out in Section 4;
(f) “Special MAC” means a MAC that, under the Insured Prescription Drug Plan, is assigned by the Minister to each of the following:
(i) certain groups of drugs that are similar in therapeutic effect,
(ii) specific services for which coverage is established,
(iii) certain unit dose and special delivery formats that are also available in less expensive bulk formats,
(iv) certain different supplies that are used for the same function.
AAC
3 (1) An AAC must be determined by deducting the total value of rebates, allowances and free products received by a provider in respect of the purchase of the prescription drug from the cost of the prescription drug to the provider.
(2) The cost of a prescription drug to a provider must be determined by averaging the price that the provider paid for it over the period for which the provider is making a claim, regardless of whether the current price for the drug is different than the price in effect when the drug was dispensed.
(3) Despite the requirement in subsection (1) to deduct the total value of rebates, allowances and free products, an incentive for payment within 15 days, up to a maximum of 2%, must not be included in the calculation of an AAC.
(4) Calculation of an AAC must not include mark-up or buying profit.
Tariff
4 (1) The Pharmacare tariff for prescription drugs effective August 1, 2007, to March 31, 2010, is as follows:
(a) for ostomy supplies,
(i) the AAC or, if applicable, the MAC or the Special MAC, as determined by the Minister, plus 10% to a maximum of $250 per prescription, and
(ii) a maximum Pharmacare professional fee of $10.42;
(b) for injectables, except insulin,
(i) the AAC or, if applicable, the MAC or the Special MAC, as determined by the Minister, plus 10% to a maximum of $250 per prescription, and
(ii) a maximum Pharmacare professional fee of $10.42;
(c) for all other prescriptions for drugs or supplies, the AAC or, if applicable, the MAC, the MAC less the Pharmacare allowance or the Special MAC, as determined by the Minister, plus
(i) effective August 1, 2007 to March 31, 2008, 0.5% to a maximum of $50 per prescription, plus a maximum Pharmacare professional fee of $10.42,
(ii) effective April 1, 2008 to March 31, 2009, 1% to a maximum of $50 per prescription, plus a maximum Pharmacare professional fee of $10.42, and
(iii) effective April 1, 2009 to March 31, 2010, 2% to a maximum of $50 per prescription, plus a maximum Pharmacare professional fee of $10.42.
(2) A restocking fee of 20% of the AAC, the MAC or the Special MAC, as determined by the Minister, is payable to a provider when the provider returns medications to inventory.
Maximum days’ supply
5 (1) A provider must fill a claim to a maximum of a 100-day supply, if prescribed.
(2) If a provider dispenses less than a prescribed quantity, no additional fees are payable to the provider on dispensing the balance of the prescribed quantity.
Minimum days’ supply
6 (1) Except as provided in subsection (2), a refill of a prescription must be for at least a 28-day supply.
(2) The requirement in subsection (1) for at least a 28-day supply on a refill does not apply to any of the following:
(a) a refill for the intermittent treatment of a chronic disorder;
(b) a part refill of methadone;
(c) a prescription as determined by the Minister.
(3) The requirement in subsection (1) is effective on December 1, 2007, for patients who, on the date that these regulations come into effect, regularly receive refills of prescriptions that are for less than a 28-day supply.
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