PHARMACARE AND PRE-PAYS

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

“How do I grow my own spaghetti tree?”  Hundreds of people were calling the BBC with this question in 1957.  Diplomatically, they were told, “Place a sprig of spaghetti in a tin of tomato sauce and hope for the best.”  I think this is still my favorite April Fool’s story.  On April 1, 1957 the BBC ran a documentary showing the Swiss Spaghetti Harvest.  Young women were carefully plucking strands of spaghetti from trees and drying them in the sun.  The video is still remarkable and believable today.

A good April Fool’s joke is funny and no one gets hurts.  Manitoba Health should learn from the BBC.  Every year Manitoba Health plays a cruel April Fool’s joke on many people.  For people who go over their Pharmacare Deductible, in March Pharmacare pays for their medication.  In April, people have to pay for their own medication again.  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.  So 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.  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.  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.

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 and get 10% back for doing so.  Pre-Pays are a Dauphin Clinic Pharmacy program and don’t involve Pharmacare or Manitoba Health.  Pharmacare doesn’t 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 for your medications.  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.

So here’s to Spring!  Here’s to a bumper spaghetti crop! Even if Manitoba Health and Mother Nature don’t seem to have a sense of humor, the arrival of April is still a good thing.

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

BBC Swiss spaghetti harvest www.youtube.com/watch?v=27ugSKW4-QQ

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.