Information for Health Professionals
Changes to Part 3 EDS Approval Process & Expiry DatesEffective Oct. 1, 2017 |
- Pharmacy Claims Submission Procedures and Audit
- Drug Benefits and Interchangeability Formulary
- Submitting New or Updated Pharmacy Information
- Current Topics & Client Resources
- Additional Client-Related Resources
- Provincial Acts and Regulations
- Contact Information
Pharmacy Claims Submission Procedures and Audit
Manitoba Health’s current claim submission procedures and audit processes for community pharmacies are available below. (For all documents related to Claim Submission Procedures, the word “Manitoba” refers to “Manitoba Health, Seniors and Active Living.")
Notices
- Notice – Tiered Biologics Reimbursement Policy
- Tiered Biologics Flowsheet (UPDATED September 2018)
- Tiered Biologics Overview (UPDATED September 2018)
- Tiered Biologics by Specialty (UPDATED September 2018)
- Notice – Changes to Gabapentin Status Announced in Bulletin #99 – June 22, 2018
- Notice – Approved Compounds for Pain Management – January 19, 2018
- Notice – Monitor and Feedback Process for Implementation of Claims Submission Procedures – December 11, 2017
- Notice – Monitor and Feedback Process for Implementation of Claims Submission Procedures – September 22, 2017
Pharmacy Submission Procedure Manual (DPIN Pharmacy Manual)
The DPIN Pharmacy Manual may be updated from time to time, as communicated directly to pharmacies. The current version includes all Claims Submission Procedures and associated lists/forms provided below.
- Letter – NEW Intervention & Exception Code to Distinguish Administered vs. Dispensed Vaccines (PS Code) – August 21, 2018
- Claims Submission Procedure – Professional Fee Cap
- Claims Submission Procedure – Oral Oncology Drugs Dispensed at CancerCare Manitoba
- Claims Submission Procedure – Extemporaneous Products (Compounding)
- Claims Submission Procedure – Outsourced Extemporaneous Products
- Claims Submission Procedure – Special Authority Compounding
- Claims Submission Procedure – Manitoba Designated Drug Shortages
- Claims Submission Procedure – Epinephrine Auto-Injector (UPDATED – September 21, 2018)
- Update – Doxylamine Pyridoxine and Tetrabenazine
- Drug Shortage Compound: Cotrimoxazole 40mg – 8mg per ml Oral Suspension
- Drug Shortage Compound: Dalacin T 1 Topical Solution
- Claims Submission Procedure – Celebrex 100mg – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – Acebutolol 200mg – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – Acebutolol 100mg – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – DILANTIN – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – ZELDOX (ALL strengths) – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – DEXEDRINE 10mg & 15mg SR – Generic Manufacturer is able to Supply
- Claims Submission Procedure – RITALIN 20mg – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – RITALIN 10mg – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – WELLBUTRIN XL 150mg and 300mg – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – CONCERTA – 54mg ER – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – AGRYLIN - 0.5mg – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – ACULAR 0.5% - No Generic Manufacturer is able to Supply
- Claims Submission Procedure – DILANTIN 25mg/ml – No Generic Manufacturer is able to Supply
- Claims Submission Procedure – VASERETIC 10/25mg – No Generic Manufacturer is able to Supply
- UPDATE – Claims Submission Procedure – ATROPINE 1% Eye Drops
- Claims Submission Procedure – Dispensing Frequency
- Claims Submission Procedure – Claims with Cost Exceeding $9999.99
- Claims Submission Procedure – Methadone
- Claims Submission Procedure – Pharmaceutical Distribution Rate Changes (UPDATED – October 2018)
- FAQ – Pharmaceutical Distribution Rate Changes (UPDATED – October 2018)
- List of Designated High-Cost Drugs for Reduced Pharmaceutical Distribution (UPDATED - September 2018)
- FAQ – Pharmacare Audit and Investigations
- FAQ – Professional Fee Changes
- Form – Reversal/Adjustment
- Template – Pharmacy Agreement
If your questions are not answered by reviewing the Claims Submission Procedures and FAQs provided here, please contact PDPInfoAudit@gov.mb.ca.
Drug Benefits and Interchangeability Formulary
About the Manitoba Drug Formulary
- Bulletin Archive
This is the archive of Manitoba Drug Benefits and Interchangeability Formulary Amendments. - Manitoba Drug Formulary
The Manitoba Drug Formulary details which drugs are considered eligible under the Manitoba Pharmacare Program. - Manitoba Drug Interchangeability Formulary
This regulation under The Pharmaceutical Act includes a list of interchangeable drugs, categories and prices. Please note that Manitoba Pharmacare will reimburse only up to the lowest price in an interchangeable category for those interchangeable drugs which are Pharmacare benefits.
- Manitoba Drug Formulary Lookup
Search the Pharmacare Drug Benefits Formulary by brand name, active ingredient, Drug Identification Number (DIN); or more advanced search options such as Therapeutic Classification. - Manitoba Drug Formulary Glossary of Terms
- Part 3: EDS
Certain drugs are approved for coverage under the Exception Drug Status (EDS) Program when the use meets specific criteria as recommended by the Manitoba Drug Standards and Therapeutics Committee (MDSTC). - pCPA
The pan-Canadian Pharmaceutical Alliance (pCPA) conducts joint provincial/territorial negotiations for brand name drugs in Canada to achieve greater value for publicly funded drug programs and patients. - CADTH Common Drug Review (CDR) Reports
Through the Common Drug Review (CDR) Process, CADTH conducts thorough and objective evaluations of the clinical, economic and patient evidence on drugs, and uses this evaluation to provide reimbursement recommendations and advice to Canada’s federal, provincial and territorial public drug plans.
Submitting New or Updated Pharmacy Information
Current Topics & Client Resources
Pharmacare
- About Pharmacare
- Deductible Instalment Payment Program for Pharmacare (DIPPP)
- Blood Glucose Test Strip Coverage
Naloxone Kits
Drug Shortages Canada
- The website for reporting drug shortages and discontinuations in Canada.
Provincial Acts and Regulations
Provincial Acts and Regulations are available through the website of the Statutory Publications Office.
- The Prescription Drugs Cost Assistance Act
- Prescription Drugs Payment of Benefits Regulation
- Specified Drugs Regulation
This is the regulation that provides for the benefit lists of specified drugs under The Prescription Drugs Cost Assistance Act. It lists the drugs and criteria for eligibility for the Manitoba Pharmacare program.
Effective: April 20, 2017
- The Pharmaceutical Act
- Manitoba Drug Interchangeability Formulary
This regulation under The Pharmaceutical Act includes a list of interchangeable drugs, categories and prices. Please note that Manitoba Pharmacare will reimburse only up to the lowest price in an interchangeable category for those interchangeable drugs which are Pharmacare benefits.
Effective: April 20, 2017
- Manitoba Drug Interchangeability Formulary
- The Personal Health Information Act (PHIA)
- PHIA - Information for Trustees
- The Personal Health Information Regulation
This regulation has no legislative sanction and the original should be consulted for purposes of interpreting and applying the law.
Contact Information
Provincial Drug Programs
Manitoba Health, Seniors and Active Living
300 Carlton Street
Winnipeg MB R3B 3M9
PDP Information and Audit
PDPInfoAudit@gov.mb.ca
Fax: 204-786-8560
--page updated Oct. 18, 2018
