May 10, 2006
Another step in the improvement of Manitoba’s pharmacare program was taken today with a new initiative that will give Manitobans with high drug costs relative to their income the option to pay their pharmacare deductible in monthly instalments, Health Minister Tim Sale has announced.
"The rising costs of prescription drugs continue to present challenges to government and to individual Manitobans," said Sale. "This income-based program is designed to help those with high drug bills finance their share of prescription drug costs more manageably."
"Many people affected by multiple sclerosis face high drug costs. The ability to pay the deductible over 12 months will ease their financial burden," said Norm Velnes, president of the Manitoba Division of the MS Society of Canada. "We congratulate Manitoba Health for finding a creative solution to this problem. It is a positive step in easing the high drug costs faced by many people."
To participate in the program, beneficiaries must have a monthly drug expense that equals or exceeds 25 per cent of their monthly income. It is not assessed by age, disease or on which member of a family requires medication. It is estimated that 19,000 pharmacare beneficiaries are eligible to participate in the monthly deductible instalment program.
The Manitoba Society of Pharmacists will administer the new program.
"Pharmacists want their patients to have access to the medications they need to maintain and improve their health," said Brent Havelange, president of the Manitoba Society of Pharmacists (MSP). "MSP is pleased to be involved in this important initiative to ensure that Manitobans gain access to these medications in a timely manner."
Sale also announced that people utilizing this new program will be able to pay their monthly deductible through Manitoba Hydro’s bill payment system.
"We are pleased to be able to assist in making this monthly payment of the pharmacare deductible possible, utilizing our existing billing system and reaching virtually all Manitobans who might make use of this option," said Bob Brennan, president and CEO of Manitoba Hydro.
Sale said prescription drugs are an integral part of delivering effective health care and providing a high quality of life for Manitobans. The province’s pharmacare program ensures Manitobans can afford this important health-care service.
According to the Canadian Institute of Health Information in 2005, 50.9 per cent of prescribed drugs in Manitoba were covered publicly, the greatest percentage of any province in Canada.
Manitoba’s pharmacare covers 100 per cent of drug costs once the income-based deductible is reached. Manitoba and the Yukon are the only two jurisdictions with a deductible structure as the sole cost-sharing requirement. All other jurisdictions mandate co-payments in conjunction with deductibles and/or premiums.
"The government is committed to improving pharmacare. Since 1999, over 1,500 drugs have been added to the approved pharmacare list and the number of families benefiting from the program has increased by 31,000," said Sale. "However, drug costs are the single fastest-growing expense in our health-care system and we need a national pharmaceuticals strategy to help all provinces cope with these escalating costs."
The new system is expected to be in place in the fall of 2006.
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BACKGROUND INFORMATION
MANITOBA PHARMACARE PROGRAM
Manitoba pharmacare is a universal, comprehensive prescription drug benefit program for any Manitoban regardless of age or disease who meets the deductible criteria for eligible prescription drug costs. The deductible system ensures pharmacare’s resources are targeted to those who need the support most and ensures drug expenses remain relative to total family income.
In Canada, there is a wide variation in drug plan eligibility criteria (age, disease, income), range of benefit coverage (drug listings) and cost-sharing requirements. In Manitoba, access to pharmacare is not based on age, disease or on which members of the family require medications.
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.
Income assistance recipients do not pay any pharmacare deductibles.
The Palliative Care Drug Program provides assistance to patients who choose to die at home by providing their drugs free.
The new monthly payment option for the deductible will provide assistance for many Manitobans. For example:
Scenario 1
Clients: A senior couple (65+ with one dependent)
Condition: Asthma/cardiovascular disease
Example of Drugs: Prednisone, Furosemide, , Salbutamol HFA, Symbicort 200, Atrovent HFA
Annual gross income: $16,296
Annual drug cost: $ 5,540
Annual pharmacare deductible: $ 340
Pharmacare benefit: $ 5,200
Current deductible system: $ 340 (paid up front)
New monthly payment option: $ 28
Scenario 2
Clients: A family where one is being treated for HIV
Condition: HIV/Aids
Example of Drugs: Viracept, Combivir
Annual gross income: $38,063
Annual drug cost: $20,101
Annual pharmacare deductible: $ 1,343
Pharmacare benefit: $18,758
Current deductible system: $ 1,343 (paid up front)
New monthly payment option: $ 112
Scenario 3
Clients: A family where one is being treated for MS
Condition: Multiple sclerosis
Example of Drugs: Prednisone, Betaseron
Annual gross income: $54,533
Annual drug cost: $27,941
Annual pharmacare deductible: $ 2,273
Pharmacare benefit: $25,668
Current deductible system: $ 2,273 (paid up front)
New monthly payment option: $ 189
Scenario 4
Clients: A family where one is being treated for hepatitis C
Condition: Hepatitis C
Example of Drugs: Pegasys RBV
Annual gross income: $84,860
Annual drug cost: $33,211
Annual pharmacare deductible: $ 4,510
Pharmacare benefit: $28,700
Current deductible system: $ 4,510 (paid up front)
New monthly payment option: $ 376
- 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.
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