Prescription Drug Program (POC 10)

General Information

This program provides drug products and other benefits dispensed by a pharmacist. Included under the VAC programs are:

A. Standard Benefits which include many over-the-counter and prescription drugs, plus medical devices that are considered by VAC to represent "common" therapies. All products on this formulary are readily accessible to eligible clients who have a prescription. Prescriptions may be written by your physician, dentist, or other person authorized to prescribe pharmaceuticals under the laws in force in the province or the country where the pharmaceuticals are provided.

Special Authorization Benefits provide eligible clients with less common or higher cost therapies approved by VAC as part of a managed health care approach. Clients need a prescription and must be able to demonstrate a medical need that is most appropriately met with the requested therapy. Clients may be required to submit medical test results prior to being approved for these benefits. Alternatively, clients may be asked to try more common therapies before receiving special authorization products.

Exceptional Approvals: VAC provides a very comprehensive Pharmacy Program. Even so, there are products which are not included on VAC's formulary. VAC may approve these items on an exceptional basis provided the client has a medical need and can clearly demonstrate that the product offers specific and necessary therapeutic value in the most reasonable and medically appropriate fashion.

Your pharmacist can verify your eligibility for a benefit at the time that you present the prescription from your physician or dentist. Your pharmacist is aware of the available benefits.

Examples of covered benefits:

• prescription drugs
• some over-the-counter medications
• some medical supplies

Pharmaceutical products which VAC does not generally cover:

• Talwin
• Rogaine
• Glucosamine
• Dextronex
• Visudyne Kit
• Xenical caps

What is the Prescription Drug Program?

The Prescription Drug Program (POC 10) is one of 14 treatment benefit programs, or Programs of Choice (POC), offered by VAC to eligible clients. POC 10 provides drug products and other pharmaceutical benefits to eligible clients who have:

• a demonstrated medical need and;
• a prescription from their physician or dentist.

The Program is administered for VAC by Blue Cross of Atlantic Canada through the use of the Treatment Accounts Processing System (TAPS), an automated adjudication system.

How Does POC 10 Benefit Clients?

In keeping with VAC'S client-centred service approach (CCSA), POC 10 is based on the needs of individual clients. The Program is structured to:

• safeguard client health;
• promote positive client health outcomes;
• provide clients with timely access to appropriate health care benefits.

Who Is Eligible?

Clients must have a VAC Health Care Identification Card on which an "A" and/or "B" is indicated under the heading "Program Number 10."

• Group A clients may only use their card to obtain benefits directly related to the treatment of their VAC pensioned medical condition.
• Group B clients are eligible for approved benefits providing they have a clearly demonstrated health need and the benefits are not available to them under a provincial health plan.