Manitoba Pharmacare Program

Apr 9, 2019

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Spelling and yelling. I remember that epoch of poor parenting like it was yesterday. When Emily was about 7, she got a 10 word spelling test every week. The words were handed out every Monday. The test was every Friday. Every week was a monumental struggle. Every weeknight we would review the words orally, and we wrote them down, and we made flash cards. Every weeknight there would be tears and screams of "I hate you" from Emily and eventual yelling from me as I lost my cool. Each day of minimal spelling progress would tick ominously towards the dreaded Friday spelling test. Eventually, we discovered Emily's eyes didn't focus on the same spot. Knowing that, it made sense that Emily couldn't read or spell. She couldn't see the words properly. After Specialist Optometrist visits, eye exercises, reading glasses, and a tutor Emily's reading and spelling slowly got better. Spelling and yelling died a natural death in elementary school.

It's April. If you are having problems focusing in the pharmacy because your bill suddenly went up, you are enjoying Manitoba Health's yearly April Fool's joke. Many people in Manitoba don't have to pay for their prescription medications in March, but have to start paying for them again in April. This is because of a program called Pharmacare. 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 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 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.

A decade later and Emily is now 17. She often works late at a gas station. Close to 11 pm one night after her shift, she asked me for help with her physics homework. I tried, but I was way too tired. I said I'd help her the next day. At 6:15 am, I got a reluctant and groggy Emily out of bed. We started going over how to calculate the gravitational force between two objects. I got quite excited showing her how you cross off the Newtons and the kilograms squared to make sure the units stayed intact. Then I was showing her a neat trick when you move all the exponents to one end of the equation, and they can cancel each other out when Emily exploded. In the last decade, apparently, she has learned much more colorful ways to say, "I hate you" and "I would prefer to still be in bed Father". It was déjà vu of spelling and yelling all over again. But, there were two small improvements over the decade. If you use Emily's scatological repertoire as a metric, then Emily's vocabulary has improved greatly. And this time Emily did all the yelling, and I remained calm. Maybe a decade has brought me a tiny bit of wisdom with my longer belts. Despite the lack of rhyming, I'm calling physics and not yelling a parenting win.

As always if you have any questions or concerns, please 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 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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