Dispensing Components Included in the Usual and Customary Fee

GUIDELINE

Published: 1999; Revised 2011

Legislative references:

College Contact: Pharmacy Practice


Purpose: To set out activities associated with the dispensing of a prescription which are remunerated through the Usual and Customary fee set by the pharmacy.


Introduction

Usual and customary pharmacy practice is grounded in clinical knowledge and expressed through effective and appropriate patient communication. The core components of dispensing a prescription include gathering and analyzing information, presenting options to the patient based on the information gathered, dispensing the medication, and offering follow up as required.

Dispensing is comprised of technical and cognitive components. The services remunerated through the usual and customary dispensing fee are performed by members as permitted by the terms, conditions, and limitations of their certificates of registration.


Principles

  1. Patients are partners in their care;
  2. Members are accountable for practicing within their scope of practice and in accordance with their knowledge, skill and judgment;
  3. Members maintain patient confidentiality and privacy in the provision of care;
  4. Members communicate with other health providers where appropriate, communication being central to good patient care; and
  5. Dispensing occurs within the context of the Code of Ethics, Standards of Practice, and the College’s Quality Assurance Program.

Definitions

Dispensing:Dispensing a prescription includes both technical and cognitive components performed by members according to their scope of practice.

Usual and Customary Dispensing Fee:

The single specific amount set by the operator of a pharmacy as required by the Drug Interchangeability and Dispensing Fee Act, 1990. Any adjustment to this fee must meet the conditions established by R.R.O. 1990, Reg. 935 and be communicated to the patient according to R.R.O. 1990, Reg.936.


Guideline

Technical Components:The technical components of dispensing ensure the accuracy and quality of product preparation and release and include:

  • Receiving a prescription or accepting an authorization for renewal;
  • Transcribing a prescription received orally;
  • Creating and managing the patient profile or health record including documentation of demographic information, known risk factors for adverse reactions, allergies and intolerances, and any other information necessary for the continuity of care and the achievement of optimal therapeutic outcomes;
  • Gathering information to contribute to the best possible medication history including over the counter medications for the patient profile
  • Confirming the authenticity, accuracy, and completeness of demographic and prescription information;
  • Selecting the drug or determining the product to dispense, verifying the drug e.g. drug information number (DIN), determining appropriate days supply, counting, and labeling;
  • Checking the expiry date;
  • Reconstituting products and verifying their accuracy and completeness prior to release including selecting the product, verifying the drug e.g. drug information number (DIN), counting, and labeling;
  • Completing and documenting a check of the technical steps required to dispense a prescription; and
  • Completing computer order entry.

Cognitive Components

The cognitive elements of dispensing a prescription are solely within the scope of practice of a pharmacist or intern under supervision. The cognitive components of usual and customary dispensing include assessing the therapeutic appropriateness of a prescription and identifying circumstances requiring intervention with the prescriber. Additional steps include:

  • Confirming that the proposed drug therapy is safe and appropriate for the specific patient, including the dosage form, directions for use, route and length of therapy, reviewing complete patient profile, and considering interactions and contraindications;
  • Providing the patient with necessary information including expected therapeutic effect, potential side effects, contraindications and precautions;
  • Identifying drug therapy problems, including adherence;
  • Educating patients about drug therapy as it relates to their condition, and evaluating their ability to comply with the therapeutic regimen;
  • Providing follow-up when required; and
  • Responding to the patient’s prescription-related questions and concerns as appropriate.