THE LAST WORD …
A Dispensation for Snowbirds: Liberalized
Regulations for Out of Country Rx Affect Few
By ANDREW ALLENTUCK
A
t the end of October, Manitoba
Health Minister Dave Chomiak
announced new and more liberal
rules for Pharmacare reimbursement of
prescribed drugs for Manitobans travelling outside of Canada for extended
periods. The plan, which Chomiak
described as “improving the continuity of
care,” is less a change in policy from a
progressive restriction of drugs that are
covered under Pharmacare, than a
modest and very inexpensive way to
help Manitobans who are out of Canada
for extended periods. For those who
want to see the extension of maximum
reimbursable drug quantities as a move
to a less restrictive Pharmacare policy, the
truth is, simply, it’s not. Years of exclusion of maintenance drugs from the
Manitoba formulary and imposition of
income tests are not coming to an end not, at least, with the amended policy on
dispensable quantities.
A change from the previous limit for
payment, 100 days, to 200 days, was made.
Explained the Minister, “this change
doubles the previous limit, improving the
continuity of care and making it possible
for people to have enough medication to
meet their needs while they are away.”
Under the new rules, pharmacists may
charge for two prescriptions when
dispensing two 100 day maximum
supplies of medications. Call this a modest
gift to pharmacists or elimination of potential opposition to the plan. It’s really a
gentle political prophylactic.
Under the new rules, persons eligible
for Pharmacare benefits who are out of
Canada for more than 100 days will
benefit. Explains Olaf Koester, Director of
Provincial Drug Programs at Manitoba
Health, “it would be unfair to penalize
Manitobans who are traveling. We want
to make sure that people have access to a
benefit to which they are entitled to in
22
the Province of Manitoba. So we have
changed a process that used to be
retroactive, by which patients might buy
a 100 day supply of drugs before they
leave, even a 200 day supply, and then
request reimbursement after their return.
Now, a Manitoban can apply to Manitoba
Health for an out of province travel
certificate and get an extended supply of
drugs covered.”
The lifting of the previous 100 day
limit for reimbursement of prescribed
drugs, a measure that had been imposed
to “eliminate stockpiling or wastage,”
according to the Insured Drugs Branch,
will help people leaving Manitoba avoid
having to get drugs shipped to them and
possibly detained or even confiscated by
foreign customs agents, says Winnipeg
pharmacist and MSP President Elect
Chuck Narvey. “Manitobans who are
traveling in other provinces for extended
periods are not covered since they can
get drugs shipped by mail, courier or
other means, without interference by
foreign customs agents,” he notes.
Extension of the previous 100 day
drug reimbursement limit to 200 days
makes life easier for a small number of
snowbirds, says Malcolm Joyce,
Manitoba board member of the Canadian
Snowbird Association, a Toronto-based
national association of travelers. He notes
that Manitobans who traveled to certain
third world countries could not depend
on mail and that, even in the U.S., where
mail service is at an acceptable level,
there was a potential problem of seizure
by customs authorities.
How popular will the new, extended
rules be? To date, only 81 families or
family units have registered for the
extended out of country Pharmacare
benefit, Mr. Koester says. To his knowledge, no applicant has been turned
down, yet it is, of course, rather early to
see how popular the program will be.
Chances are, the number of persons able
to take advantage of the new limits will
be very small.
The new regulations, which apply to
what Mr. Joyce says is an estimated 3,200
snowbirds in Manitoba, will really be
used by a smaller number. Because
Pharmacare reimbursement is income
tested, only those buying drugs over the
deductible limit can be paid for extended
drug prescriptions. At an income of
$15,000 or above, the deductible is 3 per
cent or $450, at $50,000, it is $1,500 and at
$100,000, it is $3,000. Very ill persons are
unlikely to travel for long periods, if only
because out of country, third party travel
health insurance is very costly. As well,
some persons in the theoretically eligible
snowbird pool or other Manitobans who
go abroad for extended and uninterrupted periods may have third party
drug insurance coverage, further reducing their need to seek reimbursement
from Manitoba Health.
Liberalization of rules for reimbursement of drug costs is modest in cost, fair
to those who need to take drugs on out
of country trips for extended periods,
and unlikely to be a model of extensive
change in drug insurance policy. The
rules, as implemented, make life easier
for those who qualify, a number that
appears destined to remain small. But
rule liberalization shows that Pharmacare
is both sensitive in its handling of those
going on extended, out of country trips,
and aware that they had a solution. As
one pharmacist notes, one could get two
drug claims approved even with the 100
day limit, a total of 200 days, but it took
patience and filing and retrieval and
making separate claims.
Call it bureaucratic convenience or
just being sensitive to the needs of
Manitoba, Pharmacare has gotten plaudits for good work. But does the
extension of insurance coverage to 200
days worth of drugs at a time portend
liberalization of coverage of drugs? Not
likely. There is no connection between
policy on the expansion of insured drug
benefits time periods and the inclusion of
products in the Manitoba formulary. ■
COMMUNICATION NOVEMBER/DECEMBER 2000