Mar 14, 2011
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Ive been getting a lot of questions about Pharmacare lately. People are talking about how the Pharmacare year ends March 31. They will need to pay for their medications in April. Other people dont understand how Pharmacare works. Some people dont know they can get Pharmacare benefits if they are under the age of 65. Some people dont even seem to know they are entitled to Pharmacare benefits at all. Finally people are starting to ask how the Dauphin Clinic Pharmacy Pre-Pay program can save them money.
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. The program that pays 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 dont apply, no matter what your income is or how expensive your medications are, Pharmacare wont 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. 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, Pharmacare 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. So every year, everyone has to start paying for their medications again once April fools day passes. Then as you pay for your eligible prescriptions, you may eventually spend more than your Deductible. Once 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 to pay for. Unfortunately, if the medication you need isnt on the formulary, Pharmacare wont pay for it.
Actually, the government doesnt make the formulary as simple as a medication that is covered or not. There are actually three different parts of the formulary. Part 1of 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 doesnt 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.
The last question I am often asked is about Pharmacare Pre-Pays. A Pre-Pay is if you want to pay off your whole Deductible at once. Pre-Pays are a Dauphin Clinic Pharmacy program and dont involve Pharmacare or Manitoba Health. Pharmacare doesnt want all your Deductible money up front. But, if you go to the Dauphin Clinic Pharmacy, you can pay off your whole Deductible at once. We put your money as a credit on your account. When you fill prescriptions, we charge them against that credit. When the credit runs out, you will be over your Deductible and Pharmacare will start to pay. And the best part about paying your deductible up front is the Dauphin Clinic Pharmacy will give you 10 percent of your deductible back. So if you take advantage of the Dauphin Clinic Pharmacy pre-pay program, your medications will be cheaper than if you get them anywhere else.
As always if you have any questions or concerns about these products, ask your pharmacist.
Pharmacare application form: www.gov.mb.ca/health/pharmacare/docs/pharmform.pdf
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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.