Pharmacare

Apr 12, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Despite my beautiful forehead, apparently I'm not aging gracefully. I was walking towards the pharmacy with my son Eric. I had my white coat on and someone stopped to chat with us. I told the person Eric was going to hang out at the pharmacy with me for a few minutes and the person said, "Oh, he is so cute! Is he your grandson?" Honestly, that shocked me so much I think I might have just nodded my head and moved on. This April, while I am being mistaken for my father (who by the way has a full head of hair with hardly any grey in it), Jaromir Jagr, born the same year as me, is headed for the NHL playoffs. Again.

With the Jets out of the playoff, April 2016 won't be nearly as exciting as April 2015. And many people find pharmacies disappointing in April as well. That is because if a person goes over their Pharmacare Deductible, in March their medication is free. In April, people have to pay for their medication again. So, everyone wants to fill up on free medication before March ends. If you don't know what Pharmacare is, you are not alone.

Manitoba Health defines Pharmacare as "…a drug benefit program for any Manitoban, regardless of age, whose income is seriously affected by high prescription drug costs." Some of the tax money we pay the Manitoba Government goes into a big pool. If we need a prescription medication and meet certain conditions, Manitoba Health will pay for our medications out of that big pool. This pool of money to pay for medications is called Pharmacare.

Under what conditions will Pharmacare pay for my medications? First, you have to apply for the Pharmacare program. If you don't apply, no matter what your income is or how expensive your medications are, Pharmacare won't pay for anything. The good news is the application form is only one page long and you can pick one up at any pharmacy or at the Manitoba Health website. Your pharmacist can help you fill it out. A Pharmacare form has two options on it. I recommend most people select Option A. This means you will only have to apply for Pharmacare once. Manitoba Health will keep your information on file for future years. Option B means you will have to apply for Pharmacare every year.

Once you have applied for Pharmacare benefits, in 4 to 6 weeks, Manitoba Health will send you a letter stating your Pharmacare Deductible. Your Deductible is the amount of money you have to spend on eligible prescription medications before Pharmacare starts paying. Your Deductible is based on your income. The higher your income, the more medication you will have to buy for before Pharmacare starts to pay.

The Pharmacare year runs from April 1 to March 31. Every year, everyone has to start paying for their medications again after April fool's day passes. Then as you pay for your eligible prescriptions, you may eventually spend more than your Deductible. If you spend more than your Deductible, Pharmacare will start paying for your eligible prescription medications until the next March 31.

What is an eligible prescription medication? Pharmacare has a formulary. A formulary is a list of all the medications that Pharmacare will pay for. Not every medication a doctor can prescribe is on the formulary. Two common questions I get asked are: "My doctor prescribed it. I need it. That means the government pays for it, right?", and "This new medication is now approved for sale in Canada. If my doctor prescribes it, it will be covered, right?" Unfortunately, the answers to both those questions can be, "No." Health Canada approves medications for sale, if they determine the medication is safe and effective. Manitoba Health determines which medications it wants to pay for. It puts those medications on the Pharmacare formulary. New medications are usually not covered for a few years after they are released. Manitoba Health only has a limited amount of money with which to pay for prescription medications. So it must make a list of medications it feels it can afford. Unfortunately, if the medication you need isn't on the formulary, Pharmacare won't pay for it.

Actually, the government doesn't make the formulary as simple as a medication is covered or not. There are actually three different parts of the formulary. Part 1 of the formulary are medications that any doctor can prescribe for any condition and Pharmacare will pay for them. Part 2 (EDS Part 2) are medications that Pharmacare will not pay for unless the drug is used for a specified condition for a specified time. The doctor is supposed to indicate that the medication meets these criteria by writing "Meets EDS" on the prescription. Part 3 (EDS Part 3) or Exceptional Drug Status is really all other medications that Manitoba Health doesn't normally pay for. Your doctor can contact Manitoba Health and ask for an exception in your case (exceptional drug status) and hope that Manitoba Health will pay in your exceptional case.

Way back in 1990, I graduated from highschool and went to the University of Manitoba. Jaromir Jagr got drafted to the NHL. In 1994-95 Jagr won his first NHL scoring title, and I went to my 2 year of pharmacy school. In 1997, I escaped the Flood of the Century and moved to Dauphin. Jagr got another scoring title, which would turn into 4 straight years of the Art Ross. In 2016, I'm mistaken for my son's grandfather and Jagr is the oldest player in the NHL by 4 years. The combined age of his linemates is 42. Jagr is 44. Although, I much preferred Lemieux to Jagr in the 1990's, I guess I better cheer for the Panthers and old guy this playoff run.

As always if you have any questions or concerns about these products, ask your pharmacist.

Pharmacare Deductible estimator: www.gov.mb.ca/health/pharmacare/estimator.html

Pharmacare application form: www.gov.mb.ca/health/pharmacare/docs/pharmform.pdf

The Enduring Power of Jaromir Jagr - http://www.nytimes.com/2016/04/09/sports/hockey/jaromir-jagr-still-playing-with-florida-panthers.html?_r=0

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 


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