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.

For the purpose of the program a MedsCheck is an in-pharmacy, patient-centred service that includes a review of a patient’s medicines, focusing on education and self-management and aims to identify problems that the patient may be experiencing with their medicines; help the patient learn more about their medicines including how medicines affect medical conditions; improve the effective use of medicines by patients; and educate patients about how to best use and store their medicines.

For the purpose of the program a Diabetes MedsCheck is an in-pharmacy, patient-centred service that provides a review of medications 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 and aims to optimise a patient’s effective use of medicine through improving understanding of, and compliance with, their diabetes medication therapy; improve a patient’s effective use of blood glucose monitoring devices through training and education; improve blood glucose control; and reduce the risk of the patient developing complications associated with type 2 diabetes.

Participation

Pharmacy:

To be eligible to receive payments under the MedsCheck or Diabetes MedsCheck Programs, a community pharmacy must:

  • be approved under Section 90 of the National Health Act;
  • abide by the 6CPA General Terms and Conditions;
  • deliver the services in accordance with the most current version of the 6CPA MedsCheck and Diabetes MedsCheck Program Rules and relevant Professional Standards;
  • register for the program via the 6CPA Registration and Claiming Portal;
  • continue to meet the eligibility criteria outlined in clause 3.1 of the Program Rules while participating in the MedsCheck and Diabetes MedsCheck Program.

Note that MedsCheck and Diabetes MedsCheck services must be conducted in an approved Section 90 pharmacy in an area defined with the Program Rules.

Patients:

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; and
  • be taking five or more prescription medicines; or
  • has had a recent significant medical event. A recent significant medical event can be defined as a recent event or new diagnosis that has the potential to impact on the Patient’s medication adherence or knowledge of their medicine regime and may increase the risk of medication misadventure; or
  • is taking a medication associated with a high risk of adverse events.

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;
  • is unable to gain timely access to existing diabetes education/health services in their community; and
  • has recently been diagnosed with type 2 diabetes (in the last 12 months); or
  • has less than ideally controlled type 2 diabetes.

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 twenty (20) MedsCheck services (MedsCheck and Diabetes MedsCheck) in any calendar month. The total of twenty can be any combination of MedsCheck and Diabetes MedsCheck services as long as the total is no more than twenty (20) services per calendar month.

This information will be recorded on the appropriate MedsCheck claiming templates. Service Providers will need to attach this to the claim as well as indicating the number of eligible MedsChecks provided during the claiming period.

Claim Submission

From 1 July 2017, MedsCheck and Diabetes MedsCheck services must be claimed by the end of the next calendar month (e.g. services undertaken in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

From 1 February 2018, MedsCheck, Diabetes MedsCheck, Patient Registration and Follow Up services must be claimed by the end of the next calendar month (e.g. services undertaken in March must be claimed by 30 April). Claims submitted outside this timeframe will not be paid and cannot be resubmitted.

A Follow Up service claim can only be made where an initial MedsCheck or Diabetes MedsCheck has been successfully claimed.

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 twenty (20) combined MedsCheck and Diabetes MedsCheck services will not be paid and cannot be resubmitted.

Payments

The table below summaries the payments for which participating Service Providers are eligible to receive as part of the 6CPA MedsCheck and Diabetes MedsCheck Programs from 1 July 2017.

Fee
(per patient)
Description
$64.70 Initial MedsCheck service
$97.05 Initial Diabetes MedsCheck service

Note that for a service provided as part of the 6CPA Program, no additional patient charges may be levied.

The table below summaries the payments for which participating Service Providers are eligible to receive as part of the 6CPA MedsCheck and Diabetes MedsCheck Programs from 1 February 2018.

Fee
(per patient)
Description
$64.70 Initial MedsCheck service
$97.05 Initial Diabetes MedsCheck service
$31.90 Collection of data at Patient Registration
$31.90 Collection of data at Follow Up service

Note that for a service provided as part of the 6CPA Program, no additional patient charges may be levied.

Record Keeping and Auditing

Service Providers participating in 6CPA Programs must keep all relevant records for seven (7) years, inclusive of service records, claim records and patient information for Program evaluation. The records may be electronic or hard copy.

The Department of Health is responsible for auditing 6CPA Programs. Anomalies observed by the 6CPA Administrator will be reported to the Department. If an audit is conducted, the Service Provider will be required to produce supporting documentation within a specified timeframe. Service Providers found to be in breach of the Program Rules may be subject to harsh penalties.