What Pharmacists and Physicians Should Know
The Prescription Drug Program includes a number of features to help pharmacists and physicians better serve VAC clients. These include:
Point-of-Service (POS) Technology
- Point-of-Service technology electronically links participating pharmacies (and, potentially, physicians) to VAC'S adjudication system. This allows providers to know almost instantly whether a client is eligible for a particular pharmaceutical benefit.
- The adjudication system also allows VAC to custom build formularies for individuals or for groups of veterans, such as Hong Kong veterans or war amputees, who may have unique or specific health care needs.
VAC Drug Formulary
- VAC'S Standard benefits primarily include mainstay medications. Most medications that physicians prescribe, or that pharmacists dispense, will be readily available to eligible clients through this formulary.
- By contrast, VAC'S Special Authorization benefits primarily consist of higher level medications that require special authorization. Physicians may call the VAC Special Authorization Center to request approval at the time of writing the prescription. If an approval has not already been entered for the client, the pharmacist will be instructed over the POS network to call the Special Authorization Unit.
Special Authorization (SA) Unit
- Special Authorization benefits require pre-authorization from VAC.
- To request a pre-authorization, pharmacists or physicians must contact the Special Authorization Unit at 1-888-822-2884 (1-888-VAC-AUTH). This Unit will be staffed by health care professionals from 8:30 a.m. to 4:30 p.m. (local time) and by an answering service on an extended hours' basis.
- In some instances, the SA Unit will need to confirm information with the client's doctor before issuing a pre-authorization. If a decision cannot be made within one hour, an interim approval may be granted for critical medications.
- This Index is based on the Anatomical Therapeutic Classification (ATC) system.
- The Index links specific pharmaceuticals to medical pension codes established by VAC.
- When a provider uses Point-of-Service technology to seek an approval for a disability pensioner, the Index will quickly identify which drugs meet eligibility criteria that have been established for that client group.
- When the Index cannot make a linkage, pharmacists will be asked to call the Special Authorization Unit to seek a manual decision.
Drug Utilization Reviews (DUR)
- Drug Utilization Reviews help to identify clients who may be at risk through the inappropriate use of drugs. Measures have been put in place to look for cases where clients may be:
- using drugs in dangerous combinations;
- over medicating on similar drugs, or;
- accessing inappropriate quantities of drugs by using multiple doctors and/or pharmacies.
- "Concurrent" DURs are automatically activated when pharmacists use Point-of-Service technology to input client data at the time of dispensing. This enables pharmacists to intervene, as appropriate, when drugs are dispensed.
- VAC also carries out "retrospective" DURs. These occur after the drug has been dispensed and involve reviewing the client's drug utilization history.
How do I Become a VAC Provider?
For more information on how to become an approved VAC Provider, please contact Blue Cross.
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