The beginning of a NEW pharmacare year

Apr 7, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The house phone rang. I answered. The voice at the other end was polite but firm. It was a neighbor. Eric had just let our dog crap his lawn. Then Eric did not pick it up. Fantastic. There is nothing that makes the neighbors love you more than dog excrement on their lawn. I sent Eric back to clean up the mess. Of course, the discussion started with denials. Eric didn't walk that far. Sheldon, the dog, only peed. Eventually, after a few choice words, Eric went back with a plastic bag in hand. This is a kid who has had a dog since he was born. He knows you have to pick up the poop. This is also a kid who delivers papers to this neighborhood. Not only do they pay his salary, they all know who he is. For a very bright kid, some basics of customer service and human recognition seem to have eluded him.

It's April. If your pharmacy bill makes you feel like someone has crapped on your lawn, you aren't alone. You are enjoying Manitoba Health's yearly April Fool's joke. Many people in Manitoba don't pay for their prescription medications in March, but they 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 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, and you give Manitoba Health permission to contact the Canada Revenue Agency (CRA) about your income in previous years. Option B means you will have to apply for Pharmacare every year with income statements you have obtained from CRA.

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 provincial 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. 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 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 are 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.

Eight-year-old Eric was very responsible. He had hearing aids in Grade 3. Hearing aids are very small and very expensive. Eric didn't lose them, ever. There is a specific cleaning routine for hearing aids. Eric followed that routine religiously every night. Almost 15-year-old Eric can't remember to wear his winter boots home on his -30 C foot commute from school. He loses his cell phone often. Now, he's let the dog crap on the lawn of both a neighbor and paper delivery customer without cleaning it up. Obviously, Eric's problems stem from poor parenting. Please keep reporting on Eric to me. We'll call this a group experiment in social influencing. Sooner or later I'll figure out how many days without Xbox will get him to think a little bit before acting.

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 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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