Exception Drug Status/MB Pharmacare[1]

The group benefits plan provides coverage for Drugs that require a prescription and are eligible under the provincial formulary. The Manitoba Formulary renews and updates eligible Drugs on a regular basis. You are encouraged to discuss with your doctor and/or pharmacist to determine whether your medication is considered formulary or non-formulary and to make sure it is the right choice for you.

The Manitoba Drug Formulary covers three classifications of medications:

• Part 1 – regardless of the need, the prescription is covered.
• Part 2 – the prescription is covered only when prescribed for a specific condition which must be noted on the prescription; if the condition is not specified or not eligible, the medication will not be eligible.
• Part 3 – Exception Drug Status (EDS) medications – the requesting Doctor must submit a request to Manitoba Health on the patient’s behalf to have the medication covered. If approved, the patient receives notification from Manitoba Health.

In addition, if you have high drug costs Pharmacare may pay your prescription drug costs once you have reached your annual deductible. Pharmacare coverage is based on both your total family income, and the amount you pay for eligible prescription drugs.

Our plan requires generic substitution, which means that the drug prescribed by the doctor will be automatically exchanged with the lowest priced generic equivalent. The only exception to this is if your doctor has indicated on the prescription that there is no substitution allowed. Please note, a generic equivalent must have the same therapeutic benefit as the associated brand name medication.

For more information or to check if your drug is eligible under the Manitoba Formulary click here.

Dispensing Fee Reminder

The price of every drug prescription is made up of two parts (a) the cost of the ingredients to make the drug, and (b) the cost of the pharmacist’s services and advice called the dispensing fee. Dispensing fees can differ from pharmacy to pharmacy, and from drug to drug.

Extended Health Care Options 4 and 5 both have a drug deductible. Option 5 has a $4 deductible per prescription whereas Option 4 has a dispensing fee deductible; this means that your deductible will be equal to the dispensing fee.

You can, of course, go to any pharmacy you choose. When considering your out-of-pocket costs, you should also take into consideration the familiarity that the Pharmacist has of your state of health and how comfortable you are with the individual. Having said that, you have every right to ask the pharmacy the amount of the dispensing fee they charge.

Supporting Your Wellness

The LifeWorks website contains useful tools and articles to help you and your family. You even have access to seminars at www.lifeworks.com.

From being over-scheduled to feeling overloaded, LifeWorks resources can help you handle your work-life challenges. Check out these recommended resources:

• Podcast – Mindfulness at Work
• New Seminar – Navigating Work and Life

[1] Manitoba Pharmacare Program. Manitoba. http://www.gov.mb.ca/health/pharmacare/index.html.