10. PROGRAM CLAIMING POLICIES The term ‘Provider’ in the Newfoundland and Labrador Prescription Drug Program Provider Guide, including this section, refers to a community-based retail pharmacy or

Where the Prescriber writes “all regular meds” or “diabetes supplies”, the Program will allow the Hardcopy of the prescription to be used to provide the details when the Beneficiary has a documented history of the medication. [...] For claims billed to the Program, reimbursement will occur when: • The medication billed is an eligible benefit of the Program; or • The Beneficiary has a Special Authorization in place for the claimed DIN; AND • The medication substituted is equal to or less than the cost of the medication prescribed. [...] The requirement to retain the Original Prescription for two years after the date of the last refill means the original may be retained for up to 3 years, depending on the date of the last refill. [...] For claims billed to the Program, reimbursement will occur when: a) The medication is an eligible benefit of the Program, or b) The Beneficiary has a Special Authorization in place for the medication; and c) If adapting a prescription or making a therapeutic substitution, the medication being substituted is equal to or less than the cost of the medication prescribed. [...] If a pharmacist submits a request for a Special Authorization medication as a Prescriber and would like to be notified of the assessment outcome, the pharmacist must: • Indicate at the top of the Special Authorization Request Form that they would like to receive a response letter regarding the outcome of the request; and • Fill out the address section of the Special Authorization Request Form.