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Author: Admin | 2025-04-28
Message with an intervention code, "MR". They must complete and retain the appropriate documentation on the nature of the intervention directly on the prescription or on any hard or electronic version of the client file. To avoid the recovery of claim payment during the claims verification process, proper documentation of any intervention is required. This may include: date of the intervention summary of the intervention by the pharmacy provider documented communication with the prescriber, caregiver or patient reason for early refill (for example, medication lost) 2.12.3 Community evacuation In the event of a community evacuation as a result of a wildfire, flood, etc., affected NIHB clients may not have access to their medications and will require a refill or replacement. If a pharmacy receives a rejection code (ME, MW, MY or NE) when submitting claims for refills or replacements as a result of a community evacuation, please use the most applicable Canadian Pharmacist Association (CPhA) intervention code as outlined in section 7.5.1. CPhA Intervention Codes of the Pharmacy Claims Submission Kit available on the Express Scripts Canada NIHB provider and client website. 2.13 Client safety initiatives The NIHB program no longer restricts clients to a sole prescriber or prescriber group for drugs of concern, under the Client Safety Program (NIHB-CSP). Other client safety measures, detailed below (from section 2.13.1 to 2.13.4.4), remain in place. 2.13.1 Dose limits To promote safe, therapeutically effective and efficient use of drug therapy, NIHB has implemented dose limits for several medications, including opioids, benzodiazepines, gabapentin, pregabalin, stimulants and nabilone. Claims that exceed the dose limit without prior approval are rejected at point of sale. Providers must contact the Drug Exception Centre for prior approval. Please refer to the Drug Benefit List for product-specific dose limits. 2.13.2 Opioid, benzodiazepine, gabapentin, pregabalin, stimulant and nabilone dispensing The NIHB program has a 30-day maximum dispense policy for all opioids, benzodiazepines, gabapentin, pregabalin, stimulants and nabilone. The policy applies to all drugs in these classes, regardless of their benefit category. One full dispensing fee will be paid per 30-day dispense (or less, if prescribed in a smaller quantity). Where
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