Ontario Publicly Funded Minor Ailment Services

On January 1, 2023, the scope of practice for Ontario pharmacists expanded to include the provision of Minor Ailment services. The assessment and prescribing for 13 Minor Ailments were announced as part of this scope. If the service is provided to an eligible patient, a fee can be claimed from Ontario Drug Benefit (ODB). The claim must be submitted electronically, and appropriate documentation must be recorded for the consultation. For more information on funding for Minor Ailment services, refer to the Executive Officer Notice and FAQ.

In Propel Rx, a subscription-based integrated solution is available for Ontario Minor Ailments. In PharmaClik Rx, fee for service claim submissions are supported.

This topic contains the following sections:

Billing a Minor Ailment Service Claim to ODB

Third Party Information

Minor ailment services can be provided by pharmacists to patients with a valid Ontario health number. Depending on whether the patient has ODB coverage, the third party information required for submitting the claim varies. Refer to Table 1 for required third party information.

Table 1. Third party information for submitting Minor Ailment claims.

Patient

Bill Code

Client ID

Intervention Codes*

ODB-eligible

DB

Ontario Health Card number

PS

Non-ODB

ON (Carrier ID = S)

Ontario Health Card number

PS and ML

*Intervention codes auto-populate in Rx Detail when a prescription is filled for the Minor Ailment service.

Minor Ailment PINs

Unique PINs have been issued for each Minor Ailment. As Minor Ailment services can be provided in person or virtually as well as result in a prescription being issued or not, each Minor Ailment has four PINs that can be used for billing. These PINs have been created as Drug Folders in PharmaClik Rx. Refer to Table 2 or the Executive Officer Notice for the list of PINs.

All minor ailment Drug Folders have a trade and generic name beginning with “ASSESS & PRSCRBE” followed by the minor ailment name. Use the name to search for the Drug Folder.

Minor Ailment Service Prescription

To claim the fee for a minor ailment service, a prescription must be billed to ODB on the same day the service is provided. As maximum claim limits have been set for each minor ailment, you should confirm the number of consultations that the patient has already received for the applicable minor ailment before submitting a claim.

A provincial clinical viewer (ClinicalConnect or connectingOntario) can be used to view the professional service history for the patient. This allows you to confirm if the patient already received the maximum number of minor ailment services. For more information on clinical viewers, click here.

To fill a minor ailment service prescription:

  1. Select New from the Workbench or Patient Profile.

  2. Enter the following information:

    • Patient if not already entered

    • Drug = PIN

    • Doctor = pharmacist providing or supervising the minor ailment service

    • Qty Auth = 1

      If the minor ailment service was provided remotely by a pharmacist working in a rural pharmacy, enter 2 as the Qty Auth and Qty.

    • Qty = 1

    • SIG

      You can use the SIG Code “MedCP” to quickly auto-populate the phrase “Consultation provided by” in the SIG.

    • Days Supl = 1

  3. Select Process Now. The prescription opens in Rx Detail.

  4. Confirm the Bill field includes Drug Benefit and Cash.

  5. Confirm the cost and markup are $0.00.

  6. Confirm the fee is as follows:

    • $15 if the consultation was conducted virtually

    • $19 if the consultation was conducted in person

  7. Select the Third Party tab.

  8. Confirm the intervention codes are entered as follows:

    • PS if the patient is an ODB recipient

    • PS and ML if the patient is not an ODB recipient

  9. Select Fill. If your store has Digital Workflow, the minor ailment prescription will skip Workflow as the Drug Folder is flagged as PFS.

Documenting a Minor Ailment Service

There are 3 methods for documenting a minor ailment service. Each method is outlined below:

Consult Note

Dialogue Note

Manual

Helpful Resources

If your store belongs to a banner group, we recommend reaching out to your member account executive for guidance on minor ailments.