May 04, 2006

An expert panel will be struck to review the auditor general’s recommendations for the pharmacare program, with a particular focus on patient care and safety and a cost-benefit analysis of the proposals, Health Minister Tim Sale announced today.

The minister was responding to the release today of the auditor general’s Audit of the Pharmacare Program, Manitoba Health. The report contains 22 recommendations, some of which suggest revising existing relationships between patients, doctors, pharmacists and government administrators.

Although the auditor’s recommendations focus on cost reduction, Sale noted that implementing the report’s recommendations may also require a significant expansion of the pharmacare program’s administrative costs. "The expansion of administrative staff to oversee the prescribing and dispensing practices of doctors and pharmacists may have significant costs," said Sale. "We believe a cost-benefit analysis of these recommendations is needed to ensure the benefits to patients will be there."

"Our top priority is patient safety and care and any action we take to reduce costs must first and foremost be best for patients," said Sale. "We are always interested in recommendations that could reduce costs – the more cost effective the program, the more drugs we can make available to more families. We intend to take a collaborative approach to ensure Manitobans get better care, sooner."

The audit recognized Manitoba’s pharmacare program for being one of the most "comprehensive drug benefit programs in Canada" with a "comprehensive computerized management system" and procedures for assessing drugs for selection and listing on the formulary.

The Pharmacare Audit Expert Review Panel will provide advice to the minister of health regarding the implementation of recommendations outlined in the report and is due to the minister in this fall.

This advice will be developed with consideration given to:

• impact on patient care and safety;

• cost implications for Manitoba's health system; and

• impact on the role and professional responsibilities of physicians, pharmacists and administrators.

The panel will be appointed by the minister of health and will include doctors, pharmacists, drug experts, patient-safety experts, a health economist and consumer representatives from community-based organizations serving populations that have significant access to pharmacare.

Panelists will include:

• Dr. Bill Pope, senior registrar, College of Physicians and Surgeons of Manitoba;

• Ron Guse, senior registrar, Manitoba Pharmaceutical Association;

• Dr. Al Eros, chair, Manitoba Drug Standards and Therapeutic Committee;

• Dr. Paul Thomas, chair, Manitoba Institute for Patient Safety;

• Mike Payne, executive director, Nine Circles Community Health Centre;

• Norma Drosdowech, chair, Manitoba Council on Aging;

• Dr. Robert Chernomas, economics professor, University of Manitoba; and

• Dr. John Loxley, economics professor, University of Manitoba.

Sale said that a number of initiatives have been implemented to help strengthen program delivery and contain costs since 2003-04, the period of the audit. These include:

• establishment of a Drug Policy Management Unit in the fall of 2005;

• streamlining the process for approving pharmacare coverage of cheaper generic drugs; and

• participating in the Common Drug Review established in co-operation with the federal, provincial and territorial governments.

These cost containment measures have led to a significant decline in the growth rate of the program to a 5.8-per-cent increase in 2005-06 from a 27.2-per-cent increase in 2000-01. The average growth of the program since 2000 is 16 per cent.

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• Pharmacare currently lists approximately 5,000 drugs. Over 1,500 have been added to the formulary since 1999.
• Since 1999, the number of families benefiting from the program has increased by over 31,000 from 56,375 in 1998-99 to 87,500 in 2005-06.
• The average pharmacare benefit has more than doubled to $2,164 from $976 since 1996-97. That’s an average benefit increase of $1,188. Over the same time period, the average deductible paid by Manitobans increased by just $265 to $801 from $536.
• Manitoba’s pharmacare covers 100 per cent of drug costs once the income-based deductible is reached regardless of age, medical condition or access to private insurance. For example, after spending $1,340 on eligible drugs, a family with an income of $35,000 receives 100 per cent of its eligible drugs at no cost.
• Examples of high-cost drugs include:

- Betaseron, for patients with multiple sclerosis, costs $21,384 per year for a patient. Pharmacare pays over $19,000 of this cost for the average patient.

- Gleevec, for cancer patients, costs $49,058 per year. Pharmacare pays more than $47,000 of this cost for the average patient.

- Enbrel, for patients with rheumatoid arthritis, costs $18,945 per year. Pharmacare pays almost $17,000 of this cost for the average patient.

- Pegetron, used in the treatment of hepatitis C, costs $13,939 per year. Pharmacare pays over $12,000 of this cost for the average patient.

• Drugs listed under pharmacare are categorized into three parts:

- Part I includes drugs eligible for pharmacare benefits under all prescribed circumstances.

- Part II includes drug products eligible for pharmacare benefits only when prescribed for the terms and conditions indicated.

- Part III is considered when a drug is not listed in Part I or Part II and a request for exceptional drug status is required to consider the individual’s unique circumstances. Under this program, physicians can apply to obtain drug coverage that is not normally covered for their patients. The approval is generally given for a one-year period. The physician can reapply if necessary.

• Manitoba was the third Canadian jurisdiction to have specific programs for monitoring the prescribing and dispensing of narcotic and controlled drugs. There are now five jurisdictions with such programs.
• Manitoba has introduced a number of initiatives since the audit period in 2003-04: