ACPC AGM 2012 April 21, 2012 Toronto, ON ACPC/ Telus Solution ACPC AGM 2012 April 21, 2012 Toronto, ON

Outline of the Problem Telus Letters to our Membership Instructing pharmacies to accept Telus cards for compounded prescriptions or risk losing ability to bill Telus for any Rx Pharmacies continue to get clawed back when they do bill Telus

History of Meetings ACPC/Telus February 2011- initial meeting April 2011 Telus attended our AGM September 2011- shared frustrations March 2012- proposed solutions/ mutual agreement

Proposed Solution COST- wholesaler costs of chemicals TIME- $1.50 per minute; follow Telus guidelines FEE- usual and customary fee COMPOUNDING SUPPLEMENTAL FEE- see checklist

Compounding Supplemental Fee Checklist Chemical Sourcing Fee pH Adjustment Formula Development Special Equipment- EMP, Ointment Mill, Capsule Machine, tube sealer, Syringes Nitrile gloves, FIT tested HEPA Mask for hormones Powder Containment Hood or Sterile Facility Sample Testing

EXAMPLE Rx presented for BiEst 80:20 0.5mg/gm for 35 grams in Topiclik by customer with an Assure drug plan We look up what it would cost for a cash customer. Example $ 65.00 Calculate what Telus Reimbursement Guidelines would allow us to bill

Example continued Ingredient costs- estriol, estradiol, cosmetic HRT cream, Topiclik device= $12.18 + 10%= $13.40 Time- as per Telus guidelines= 16min x $1.50= $24 Fee- $11.99 (my usual and customary) Difference between what Telus will pay ($49.39) and what I want a cash customer to pay ($65.00) will become my Compounding Supplemental Fee= $15.61

Example continued Explain to customer what the Compounding Supplemental Fee will cost them and why we are charging it; For example: Mrs. Smith, this Rx requires us to specially compound this hormone formulation in our hood, our staff has to use special equipment such as double nitrile gloves and hepa mask and then the final product is put into a user friendly applicator for you. This is the reason for the extra fee.

Example Continued Have patient sign off on the Compounding Supplemental Fee- bill this separately Call Telus to confirm they will pay for the compound; they will ask ingredients and quantities; get a ticket # and agent name for approval; they will confirm coverage but not price; do not bill them the supplemental fee Have to call Telus on any new Rx for that client or change in drug plan

Next Steps for ACPC Talk with members in provinces other than Ontario to see if this will work for them Clarify procedure with Telus for ingredients not found in the wholesalers. Help develop improved sterile compounding reimbursement guidelines Continued meetings with Telus to keep lines of communication open