MedsCheck and Diabetes MedsCheck

Medscheck and Diabetes Medscheck has been designed to provide a in-pharmacy medicine review between pharmacists and consumers to enhance quality use of medicines and reduce the number of adverse medicines events.

A MedsCheck provides an in-pharmacy review of a patient’s medicines. It focuses on education and self-management, aiming to identify problems that the patient may be experiencing with their medicines, help them learn more about their medicines, improve their effective use of medicines and educate them about how to best store their medicines.

A Diabetes MedsCheck provides an in-pharmacy review with a focus on the patient’s type 2 diabetes medicines management, monitoring devices, education and self-management. This service is targeted at patients who are unable to gain timely access to other diabetes education or health services in their community. It aims to optimize a patient’s effective use of medicine, blood glucose monitoring and blood glucose control. This is achieved through improving understanding of, and compliance with, their diabetes medication therapy and through training and education.

Participation

MedsCheck and Diabetes MedsCheck services must be conducted in an approved Section 90 pharmacy. Pharmacies must accept and abide by the 6CPA General Terms and Conditions and the MedsCheck and Diabetes MedsCheck Programme Specific Guidelines.

The Guild must approve an applicant’s request to provide MedsCheck services before the services are provided. Approval as a Service Provider must be sought via the 6CPA Registration and Claiming Portal registration process.

For a patient to be eligible for a MedsCheck they must:

  • be a Medicare and/or Department of Veterans’ Affairs (DVA) cardholder;
  • have not received a MedsCheck, Diabetes MedsCheck, Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) in the last 12 months;
  • be living at home in a community setting;
  • be taking five or more prescription medicines or have had a recent significant medical event.

For a patient to be eligible for a Diabetes MedsCheck they must:

  • be a Medicare and/or Department of Veterans’ Affairs (DVA) cardholder;
  • have not received a MedsCheck, Diabetes MedsCheck, Home Medicines Review (HMR) or Residential Medication Management Review (RMMR) in the last 12 months;
  • be living at home in a community setting;
  • have recently been diagnosed with type 2 diabetes (in the last 12 months) or have less than ideally controlled type 2 diabetes; and
  • be unable to gain timely access to existing diabetes education /health services in their community.

Reasonable steps the pharmacist can take to determine patient eligibility include targeting patients for whom the pharmacy has established medication management records, asking the patient if they have had a sit-down discussion about their medicines with a pharmacist before and contacting the patient’s general practitioner (GP).

Claiming and Payments

Claiming

Each approved Service Provider may conduct and claim up to a total of ten (10) MedsCheck services (MedsCheck and Diabetes MedsCheck) in any calendar month. The total of ten can be any combination of MedsCheck and Diabetes MedsCheck Services as long as the total is no more than ten (10) services per calendar month.

Claim Submission

Claims must be submitted via the 6CPA Registration and Claiming Portal within 30 days from the date of service (patient interview).  Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

Claim Amendments

Claims that are submitted with incomplete information or incorrect Patient, Service Provider or Registered Pharmacist details will be required to be amended within thirty (30) days of the amendment notification. Claims that are not amended within thirty (30) days of the amendment notification will not be paid.

Claims that are submitted outside the required timeframe (within 30 days from the date of service) cannot be resubmitted.

Claims submitted that exceed a Service Provider’s monthly cap of ten (10) combined MedsCheck and Diabetes MedsCheck Services will not be paid and cannot be resubmitted.

Payments

A pharmacy approved to provide MedsCheck services, where the patient eligibility criteria has been met, will be paid the set service fee for each MedsCheck and Diabetes MedsCheck service. The fees for each service are indexed each year to 30 June 2015. The current fees for services conducted on or after the 1st July 2014 are $62.99, per MedsCheck service and $94.48 per Diabetes MedsCheck service.