Every year, dozens of new drug
products come on the market in Canada. For many of the new drugs
made available to the public, we have to decide if the medication should
be added to the Pharmacare drug benefit program.
Before a new drug
is considered for Pharmacare coverage, the manufacturer must send a drug
submission to the Manitoba Drug Standards and Therapeutics
Committee. This information includes reviews of scientific
literature, comparable drug therapies, anticipated drug costs, and
therapeutic benefits.
Pharmacare's drug benefit list currently
consists of approximately 5,000 drugs. In 2004, the Manitoba Drug
Standards and Therapeutics Committee met three times. To ensure that
appropriate drug benefits were made available to the public on a timely
basis, 212 drugs were added to the Pharmacare benefit
list.
What is the Manitoba Drug Benefits Formulary?
The
Manitoba Drug Benefits Formulary lists therapeutically effective drugs of
proven high quality that are approved for coverage under the Pharmacare
drug benefit program. It is compiled with the advice of the Manitoba
Drug Standards and Therapeutics Committee and the Common Drug Review, assisted by Manitoba Health
staff and outside consultants.
Updates to the Manitoba Formulary
are provided to health professionals every three or four months--either by
bulletin or on the Internet.
How do I know if a drug is in the Formulary?
Doctors and pharmacists all receive a copy of the
Formulary. Ask your pharmacist, physician, or the Pharmacare office
if a drug is covered, before you purchase your
medication.
Pharmacare may be reached at (204) 786-7141 or
toll-free in Manitoba at 1-800-297-8099.
Are all drugs covered equally?
No. It depends on the
recommendation of the Manitoba Drug Standards and Therapeutics
Committee. The goal of the Committee is to list a variety of drugs
that doctors can choose as an effective course of therapy for most
patients. Sometimes a new drug simply doesn't offer enough benefits
compared to other drugs or treatments and services in the health
system.
The Pharmacare drug benefits list is divided into three
parts. Part I includes drug products that are eligible for
Pharmacare benefits under all prescribed circumstances. Part II
includes drug products that are eligible for Pharmacare benefits only when
prescribed for the terms and conditions indicated.
When a drug is
not listed in Part I or part II, a request for Exception Drug Status
coverage will be considered under Part III for each individual's specific
circumstance. Your doctor can apply to the Pharmacare Exception Drug
Status program, at 300 Carlton Street, Winnipeg, Manitoba R3B
3M9.
Under this program physicians are able to apply to obtain drug
coverage (for each person) for medication not normally covered. The
approval is generally given for a one-year period, after which time the
person's doctor must reapply. A one-time notification indicating
drug coverage dates are sent to individuals at time of approval.
How does the drug approval process work?
The following flowchart shows the steps in the process when a new
drug is considered for coverage under the Pharmacare drug benefit
program.
Manitoba Drug Standards and Therapeutics Committee
The Manitoba Drug Standards and Therapeutics Committee is
independent of government. It includes two physicians and three
pharmacists. Committee members provide recommendations on drug
interchangeability and on the therapeutic and economic value of drug
benefits. Nominations for committee membership are provided by the College
of Physicians and Surgeons of Manitoba, Manitoba Medical
Association, Manitoba
Pharmaceutical Association, and the University of Manitoba.
Based
on the Committee's recommendations, the Minister of Health gives the final
approval for benefits under the Pharmacare Drug Benefit
program.
Is there an appeal process to obtain coverage
for a drug?
Yes. An individual or doctor can appeal any
decision that has been rejected by the exception Drug Status Program
through the Manitoba Drug Standards and Therapeutics Committee by writing
to the address below.
For more information please contact:
Manitoba Health - Provincial Drug Programs 300 Carlton
Street Winnipeg MB R3B 3M9
In Winnipeg, call (204)
786-7141 Outside of Winnipeg 1-800-297-8099 (toll-free)
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