How does PharmaNet adjudicate claims?

When a patient presents a prescription at a pharmacy, the pharmacist transmits the patient's Personal Health Number (PHN) and the details of the prescription on PharmaNet.

PharmaNet:

• Validates the security authorization for the pharmacy.
• Checks the patient's eligibility for the benefit.
• Checks that the benefit is eligible under the patient's PharmaCare plan(s).
• Determines the portion of the total prescription costs payable by the patient and by PharmaCare and (where applicable) determines the portion of the total cost to accumulate towards the patient's deductible.