1 July 2024 Budget Changes

Te Whatu Ora has released details regarding the reinstatement of the $5 prescription co-payments from 1 July 2024. Toniq has been actively working on solutions for pharmacies in preparation for the upcoming changes (see below).

Preparing for Co-pay Reinstatement outlines steps that can be taken to smooth the transition.

Automatic CSC/PSC Lookup

Toniq has developed an automatic Community Services Card and Prescription Subsidy Card lookup that checks when you select a patient in Toniq Dispensary. This will integrate seamlessly into the dispensing workflow and reduce the administrative burden of asking patients for their cards.

Important

To be able to use this feature, you must complete the form emailed to your pharmacy. This will then be provided to Te Whatu Ora to issue credentials to use the API lookup functionality.

• Please return the completed form to Toniq support as soon as possible.
• If you need another copy of the form, please email [e-mail].

The form must be returned to enable the CSC/PSC lookup functionality.

Two webinars discussed these changes and answered pharmacies' questions. Click the link to view the recording: Co-payments Webinar 2024.

$5 Co-pay Reinstatement

It has been announced that a $5 co-payment is being reinstated for part of the population from 1 July 2024. Toniq has made the required programmatical changes to be able to facilitate the new regulations.

 Toniq Dispensary Rx Code recommendations have been updated so that the program will suggest codes based on patient details (age, CSC status) in accordance with the new pricing structure. For example, it will suggest A1 for an adult with a Community Services Card.

Note: Toniq will not override the prescription code if it has been saved against the patient record.

Addition of a $5 Co-Payment

Prescriptions that have a prescription code of A4, J4, Z4, and O4 will be priced at $5 if dispensed on 1 July or later.

Exclusions:

Patients 65+

Prescriptions will remain $0 co-pay for patients 65 and over for approved provider prescriptions, therefore, a new S Rx Code is being introduced. The new Rx Codes include the S1, S3, and S4 variations. S1 and S4 will have a maximum co-payment of $0 while the new S3 Rx Code will incur a maximum co-payment of $15.

From 1 July, Toniq will recommend the S prescription code for patients 65 and over, to ensure they receive their prescriptions at the appropriate pricing.

• If a patient has '4' Reduced cost PHO ticked on their record, the Toniq program will suggest a 4 script code, e.g. A4, regardless of CSC status. To remove these in bulk, follow the steps in Removing '4' Reduced Cost PHO from Patients in Bulk.
• If a patient has an Rx code set, this will override Toniq's automatic recommendation. The manual process to remove these is described in Removing Rx Code from Patients.

How cycles handle S codes:

For cycles dated July 1 or later, scripts previously coded as A1, A3, or A4, for patients 65 and over will automatically be created as S1, S3, or S4 respectively. Z3 will used if the patient is 65 or over and has a High User Health Card. All such automatic changes will show in the cycle Rx Audit log.

Note: Patients in Prison Institutions will not have Rx Codes changed to S in cycles.

Patients 13 and Under

All patients 13 and under remain with a maximum co-payment of $0. No programmatical changes have been made, as this is current behaviour. All existing Rx Code recommendations will apply.

Community Services Card Holders

Community Services Card holders are exempt from the $5 co-pay from 1 July. Use a prescription code suffixed with 1 to indicate this. A1, J1, Z1, O1, and S1 will price at $0.

In cycles, the Rx Audit log will flag prescriptions generated for patients with a different script code than what Toniq would recommend. For example, if a cycle generated a prescription as A4 but the patient has a Community Services Card, the audit log will show that the Rx Code is 4 but the patient has a CSC card in red.

PSC Card Holders

Patients who have a Prescription Subsidy Card will remain free using X prescription codes. Toniq has made the necessary programmatical adjustments to allow the correct Rx Codes to count toward the Safety Net.

• If the dispensing date is up to June 30 scripts with 1 and 3 prescription codes will count towards the PSC Safety Net.
• If the dispensing date is 1 July or later, 1 prescription code (CSC card holders) will no longer count towards the PSC Safety Net, while 4 Rx codes will.

Prescriptions dispensed before 1 July that counted towards an individual's or family's PSC Safety Net will remain valid after the 1 July changes, even if the Rx Codes on them would not count after the changes.

Note: Prescription Codes marked (Yes) on the table below will count towards the PSC Safety Net.

Toniq has also re-introduced and updated the Exemption certificate/record report. This report shows the prescriptions that counted towards the Prescription Subsidy Card for a family unit and includes a declaration.

Rx Code	Co-pay from 1 July (Count to Safety Net)	Age-based Co-pay (<13 and 65+)	Co-pay before 1 July (Count to Safety Net)
H4	$0 (No)
A1	$0 (No)		$5 (Yes)
A3	$15 (Yes)
A4	$5 (Yes)		$0 (No)
X1	$0 (No)
X3	$0 (No)
X4	$0 (No)
J1	$0 (No)		$5 (Yes)
J3	$10 (Yes)
J4	$5 (Yes)		$0 (No)
Y1	$0 (No)
Y3	$0 (No)
Y4	$0 (No)
A1Z / J1Z (processed Z1)	$0 (No)	Y1Z / S1Z $0 (No) (processed Y1 or S1)	$5 (Yes)
A3Z / J3Z / S3Z (processed Z3)	$5 (Yes)	Y3Z $0 (No) (processed Y3)	New S3Z
A4Z / J4Z (processed Z4)	$5 (Yes)	Y4Z / S4Z $0 (No) (processed Y4 or S4)	$0 (No) New S4Z
S1	$0 (No)		New
S3	$15 (Yes)		New
S4	$0 (No)		New
C1	$0 (No)
C3	$0 (No)
C4	$0 (No)
M1	$0 (No)
M3	$0 (No)
M4	$0 (No)
O1	$0 (No)	$0 (No)	$5 (Yes)
O3	$5 (Yes)	If Y Rx Code $0 (No) (S Rx Code $5)
O4	$5 (Yes)	$0 (No)	$0 (No)
NSS	Cost + Margin etc.

Claiming

Toniq has not been advised whether there will be any specific claiming requirements as pharmacies transition from free prescriptions to $5 co-payments. We will update our communications as we are informed.