Pharmacies: controls strengthened

No more risk of errors or fraud…From now on, all pharmacies in the country must verify online the insurance status of all patients who come to the cashier. Since the end of June, every pharmacy is connected to the MyCareNet electronic network, which allows the secure exchange of information between health insurance funds and service providers. Beginning in the fall, physicians will be included.

A six-month transition period is now in effect in pharmacies: the new system is usable on a voluntary basis. However, beginning January 1, 2014, the pharmacist will be required to verify the patient’s coverage through the MyCareNet intermediary. The advantage of this online control system is that the correct reimbursement rate will be automatically applied to the patient’s prescription. This is not guaranteed by verification via the SIS card, because it is not always up to date.

 

Until now, pharmacies read the beneficiary’s SIS card to determine his or her insurance status and the co-pay required based on that status (ordinary insured, Omnio patient, chronically ill…), but errors, not to mention refusals of coverage, happened regularly. MyCareNet changes the deal: the system allows the patient’s status to be verified in real time; in its second phase, it will allow specific situations to be managed, such as payments authorized by the medical consultant, the “maximum billable amount,” or the care plan.

 

Concretely, the patient who comes to the pharmacy with a prescription must show an electronic ID card (or the SIS card, until the end of the year), which the pharmacist will insert into a card reader connected to the MyCareNet secure network and the eHealth platform, reserved for care providers. The patient may also be identified via the national registration number (NISS), taken from the mutual’s prescription label or maintained in the pharmacy’s records. In less than a second, the network will provide the patient’s insurance status and a guarantee of payment: the price of the product will be set according to the exact insurance rate given to each insured patient.

 

In case of connection problems, MyCareNet is able to reuse a guarantee from previous payments (as long as the prescription was filled in the preceding month). The pharmacist may also fall back on the SIS card (until December 31, 2014). If necessary, the patient may pay the full price of the prescription and obtain reimbursement from his or her mutual.

 

RICARDO GUTIERREZ

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