Pharmacy claims cover the medicine subsidy and dispensing costs associated with supplying prescribed pharmaceutical items to patients.
The Services are defined in the Agreement. Pharmacy payments are determined by the Agreement and variations to the Agreement.
Different transaction types generally have different processing requirements. For example:
- supply orders and Controlled Drug items have no patient contribution (known as abatement)
- the patient contribution for Special Food items are calculated differently when different flavours are claimed on the same prescription form
- Owe and Wastage items have no abatement or dispensing fees.
PHARMAC supplies a monthly Pharmaceutical Schedule, containing pharmaceutical pricing and dispensing regulations, which are used to determine the subsidies.
Dispensing costs are defined in the Agreement, and are funded by the district health boards.
Who do I contact to order more pharmacy stationery?
- High Use Health Card applications
- Bulk Supply Order forms
- Practitioner’s Supply Order forms
- Batch Record Sheet (these are also available from within the Pharmacy Software; please contact your software vendor if you have any questions)
Please note that we will request your claimant details.
How do I obtain a Pharmacy Agreement?
If you have any questions or wish to arrange an agreement then please contact your district health board in the first instance.
My pharmacy claims electronically. What do we do with the hard copy prescriptions?
Pharmacies must retain prescription batches for 5 months. After the 5-month period, prescription batches must be submitted to Sector Operations once or twice each month.
Send all completed claims to:
Ministry of Health Archives Warehouse
137 London Street
Remittance Advice Codes
The following table lists codes that are the standard approach to referencing/coding payments on the pharmacy's remittance advice.
|Remittance Code||Description of Remittance Advice Codes|
|Casemix ADV (month/year)||Advance Case mix for that month|
|Casemix REV (month/year)||Reversal of Case mix that month|
|Casemix ACT (month/year)||Actual Case mix for that month|
|APASM (month/year) APASR (month/year)||Both APAS payments for that month|
|LTCYYYYMM||LTC for that month|
|LTCYYYYMM-2-OOC||LTC Out of cycle payment - separate payment calculated if the pharmacy has changes ownership and has missed the LTC monthly payment or pharmacy has technology problems and missed LTC payments|
|A3/J3||Paid quarterly based on the agreement calculation and number of prescriptions within each pharmacy's claim that were claimed as A3/J3|
|Qtr||Case Mix 3 monthly wash up - calculated as per the pharmacy agreement|
|S26/S29||Paid quarterly based on the number of prescriptions within the last quarter the pharmacy had dispensed under these two services.|
|COO” Anything with the above references but also has the additional code of COO||Change Of Ownership payments - usually moved from old owner to new owner|
- Pharmacy Procedures Manual (on the TAS website)
Please note: you should not rely solely on the answers provided here; the contracts applicable to each provider and all relevant legislation must be consulted to determine the full rights & liabilities applicable to any service provider or funder.