Newfoundland and Labrador is planning updates to its drug adjudication system to put more real-time information in the hands of its pharmacists.
The Newfoundland and Labrador Prescription Drug Program (NLPDP) offers subsidies to qualifying residents in the province, including low-income seniors and those on income support. The program has traditionally been run on a batch-based system, but will shortly be updated to allow for information to be processed on a more immediate basis.
Pharmacists typically run batches of drug claims to the government on a daily or even weekly basis, said Colleen Janes, director of the Department of Health and Community Services Pharmaceutical Services Division.
The issue before these pharmacies isn’t necessarily the expediency of the payment but immediate access to essential information like the recipient’s eligibility in the drug program overall.
“They have not raised any issues at all as to a more frequent payment schedule,” explained Janes. “Their concern was that right now when they were sending in claims, it would be two weeks before they would receive notification that, for example, the patient’s card was no longer efficient or the particular drug they billed us for was not (covered) under the program.”
The new system will be deployed via a contract with Xwave, a division of Bell Aliant. Xwave has been responsible for maintaining the NLPDP drug claims adjudication system for the past 12 years, but won the right the design a new, real-time engine through an RFP issued in April.
“We will over the coming months develop and deploy the new solution based around that adjudication engine. The contract also involves the ongoing operation of the system for the next five years,” said June Turpin, regional director for Xwave.
About $13 million has been allocated to the project, which will also involve support and technology from local firms DeltaWare and Triton Data.
A total of about 200 community and hospital-based pharmacies will have access to the real-time system, said Janes, a group of which were involved in the decision-making process starting with the RFP.
Pharmacists should have no problem using this new billing system as long as it conforms with the standards used for other billing/adjudication systems they might use, she said.
“Pharmacies have arrangements with software vendors that supply their computer systems. That computer system needs to interact with the system we are building. We have no role in terms of who the vendors are that they choose for their pharmacy software but we do need to interface with those people,” she said.
The system, which will be ready for adoption in January 2007, is decided to expedite patient data, but may also help the province save money. The system will feature improved data analysis, for example, allowing lower-priced drugs to be dispensed when they have been proven to have the same health benefits of more expensive pharmaceuticals.
The system will also coincide with an expansion of the NLPDP, providing drug coverage to an additional 97,000 people in the province, almost doubling the number of covered citizens to 200,000. The new assessment method will be morely closely tied to income, said Janes.