2023: Processing Cycles for $0 Co-pay Changes

Te Whatu Ora has released details regarding the removal of the $5 prescription co-payments from 1 July 2023. They have announced that eligible prescriptions claimed after the 7^th of July 2023 will include a positive variance of $4.35, meaning the patient does not have to be charged the $5 co-payment from 1 July 2023.

Important information regarding cycles

If your pharmacy is processing cycles in June for collection in July, consider the strategies below to ensure you don’t charge the patient co-payments.

In both scenarios, it is important to remember not to charge the patients.

• Option 1: Don't Bill all the cycle prescriptions

When charging prescriptions from the cycle Rx Audit screen, F11 Billing has the option Ticked items only. Work through the list of prescription items generated by the cycle and tick only those that need to be billed. Then, when billing, choose the Ticked items only option so that only the ticked items go through to POS or the required Debtor account.

• Option 2: Discount co-payments

If a cycle is billed to a single debtor account, it is possible to discount the $5 co-payments from that debtor account. This is a two-step process:

Step 1.

Find the total number of co-payments to discount. The easiest way to achieve this is via the Prescription details report (3. Reports > 2. Prescription reports > 2. Prescription details) with the following criteria:

• Enter the Start date and End date, including accurate times (the cycle run date and time plus approximately 3 minutes while the cycle was being generated - check the cycle audit to find the correct date and time.)
• Select the Institution.
• Enter Rx codes: A4,J4,O4,Z4.
• Untick Include Repeats, Show patient address, and Show patient phone no.
• Tick Include Prices.

After running the report, tally up the number of eligible prescriptions with a co-payment. 

Be alert to what items are included - there may be part charges or other prescription fees that should not be discounted.

Step 2.

In Retail, you can discount the co-payments using 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 under F4 Stock, as well as Don't report on the second page:

Using the number of co-payment prescriptions from Step 1 above, sell that quantity of the Co-pay Adjustment product to the appropriate debtor account, offsetting the co-payments charged by the cycle.

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.

Reporting

Patient Charges report

The Patient charges report reflects the prescriptions at the time of dispensing. It will show $5 co-payments if there were charges, i.e. the prescriptions were processed in June. If you require the report to show $0 co-payments you will need to manually edit the price of the individual prescriptions.