Te Whatu Ora has released details regarding the removal of the $5 prescription co-payments from 1 July 2023.
Toniq will implement these changes in the new Dispensary program update (v5.47) which will be rolled out on the week commencing the 26th of June. Please look out for your program update email.
Key changes in Toniq Dispensary
- Prescriptions from an approved prescriber (coded A4, J4, O4, or Z4) with a dispensing date of 1 July 2023 or later will have a $0 co-payment.
- Prescriptions from an approved prescriber (coded A4, J4, O4, or Z4) with a dispensing date of 1 July 2023 or later will not count to exemption card count.
- Changes to prescription code suggestions. When a patient has a recorded Community Services Card, Dispensary will no longer automatically suggest a prescription code ending in 1, as this could incur a co-payment charge.
- Additional audit suggestions in prescription cycles to alert to prescriptions processed with a 1 script code for approved prescribers.
Please refer to the Appendix for a full prescription code table with co-payments.
Action points
- Check you have the correct program version, 5.47.x, required for $0 co-payments: press F10 About from Dispensary main menu to confirm you have the correct version. This version of Dispensary will automatically apply the correct pricing from the 1st of July.
If your pharmacy is still running Windows 7, Server 2008, or 2008 R2, you will not receive the upgrade, please contact Toniq.
- It is suggested that registered patients are marked with a prescription code of 4 (e.g., A4) and prescribers have the correct PHO type set. This will ensure that Toniq Dispensary will alert on prescriptions processed with a 1 code (indicating a Community Services Card holder) where the prescriber is approved (providing the option Don’t check match of PHO status on Rx/Doctor is not set).
Collected date versus dispensing date
Te Whatu Ora has indicated that all prescriptions collected after 1 July 2023 are to have a $0 co-payment. They will update the claiming system so that any prescription claimed from the 7th of July 2023 will include the $5 co-payment amount if the dispensing date is within the previous 90 days. This means that pharmacy will not need to collect the $5 co-payment from the patient for eligible prescriptions from 1 July, including those processed before 1 July. This will result in claim items showing a positive variance of $4.35.
Claiming action points
- Create your 30th of June claim before opening of business on 1 July.
- Defer uncollected prescriptions from your claim; you will miss out financially if this is not done (click here for details on how to defer items from a claim).
Items dispensed before 1 July but claimed after 7 July will have positive variances, visible in the claim and on claim summary reports. There may also be positive variances on claim items dispensed and collected prior to 1 July due to items being deferred (phone, fax), resubmitted, resent, and claimed after 7 July.
How to reconcile claim variances with co-payments not collected from patients
- For scripts with co-payments created by cycles, see Options for Processing Cycles for Upcoming $0 Co-pay Changes.
If you use Toniq Retail, you can discount the co-payments by creating a Co-pay Adjustment product. This should have a price of -$5, and a Shortcode set (e.g., CA). Also, tick the Non diminishing and Don’t Order options under F4 Stock, as well as Don't report on the second page:
This will allow you to maintain a collection audit trail and do an end-of-month report to check against your positive claim variance amount. Alternatively, you could use this product to charge to an account.
Finding transactions with the Co-pay Adjustment product
From main menu in Retail:
- 6. Reports
- 4. Audit/Utility Report
- 8. Transaction Audit Report
- F3 Add
- Optional: Give Name to save and reselect later e.g., “co-pay adjust report”
- Adjust date range for report
- Press F9 Show full, or Tick "Show full transaction"
- Within ‘Product’ type in CA (or find the ‘co-pay adjust’ product being used) and press [Enter]
- Optional: for multisite stores select the Stock point
- F12 Accept to run report
- Save to file, view pages, or print as required.
Be alert to what items are being discounted as there may still be part charges or other prescription fees which should not be edited using this Co-pay Adjustment product.
Appendix
Prescription codes, co-payments, and pharmacy subsidy card count from 1 July 2023:
| Prescription code | Co-payment $ (PSC count) | Co-payment $ for 14 years and under |
|
| A code: Adult (ages 18 and above) | A1 | $5 (Y) | |
| A3 | $15 (Y) | ||
| A4 | $0 (N) | ||
| X Code: with Prescription Subsidy Card | X1 | $0 (N) | |
| X3 | $0 (N) | ||
| X4 | $0 (N) | ||
| J Code: Junior (ages 14 to 17 years) | J1 | $5 (Y) | |
| J3 | $10 (Y) | ||
| J4 | $0 (N) | ||
| Y Code: Youth (ages 0 to 13 years) | Y1 | $0 (N) | |
| Y3 | $0 (N) | ||
| Y4 | $0 (N) | ||
| Z Code: High User Health Card (HUHC) | A1Z / J1Z (processed Z1) |
$5 (Y) | Y1Z $0 (N) (processed Y1) |
| A3Z / J3Z (processed Z3) |
$5 (Y) | Y3Z $0 (N) (processed Y3) |
|
| A4Z / J4Z (processed Z4) |
$0 (N) | Y4Z $0 (N) (processed Y4) |
|
| H Code: Hokianga Ward of the Far North District | H4 | $0 (N) | |
| H | $0 (N) | ||
| C Code | C1 | $0 (N) | |
| C3 | $0 (N) | ||
| C4 | $0 (N) | ||
| M Code (for future use: not currently implemented in claiming system) | M1 | $0 (N) | |
| M3 | $0 (N) | ||
| M4 | $0 (N) | ||
| O Code: Oral Contraceptive | O1 | $5 (Y) | $0 (N) |
| O3 | $5 (Y) | $0 (N) | |
| O4 | $0 (N) | $0 (N) | |
| NS Code: Non-subsidised | NS | Cost + Margin etc. |
Note:
- There are no changes to the BS and PS prescription codes.
- Pharmac Schedule rules override patient co-payments for some medicines, e.g., TB medicines.
- Product premiums still apply to medicines not fully subsidised.
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