Mar 26, 2015
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
What do you do when you see a Fire Fighter's boot dangling from a rope off the Mall? Put money in it! The Dauphin Fire Department had their Roof Top Camp-Out for Muscular Dystrophy last week. It was a huge success. At the time of writing, they were well on their way to passing their fund raising goal. The Dauphin Clinic Pharmacy was proud to sponsor this inaugural event in Dauphin. That meant the DFD let Pat Lamborn and I come up on the roof of the Mall last Wednesday and have supper with them. We were served delicious King Burgers from Corinna's, and coffee and donuts from Timmy's. (For the record, I had a delicious Cameron Mochiato in honor of Chief Cam Abrey from Coffee Creations last week too. A dollar from each went to MD). Pat was smart enough to leave the Mall roof after supper, but I asked the DFD if I could sleep in the tent for a night. Whens the next time I'd get to camp out on the Mall roof?
While chatting with the Fire Fighters, Cody Langlois asked if the pharmacy was busy. I said yes that March was our busiest month. 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 dont 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 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. 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 fools 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 isnt on the formulary, Pharmacare wont pay for it.
Actually, the government doesnt make the formulary as simple as a medication 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 Camp-Out for MD with the DFD was a lot of fun. Cody Langlois and Robbie Tomkins were fantastic hosts and organizers. I learned Marie Sorlie just celebrated ten years on the DFD. Dave Height explained the DFD had about 40 members total. Dave was impressed how much more success the DFD had recruiting and retaining members than the previous fire department he had served with in another southern Manitoba town. I'm as always impressed by the people of the Dauphin Area. When you see a fire fighters boot dangling off the side of a building, you don't ask questions. You just fill it with money. This has got to be the most generous town that I know of.
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
Muscular Dystrophy Canada www.muscle.ca
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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.