Over-the-Counter Culture: Who pays for medication? How Pharmacare works in Manitoba

The cost of prescriptions can add up fast. While many Manitobans have access to some coverage through work, union or individual insurance plans, others will turn to Pharmacare.

Pharmacare coverage is based on a family’s total income and the cost eligible prescription medication. It is adjusted to include a spouse and the number of dependents with the deductible based on the family’s adjusted income.

“We cover all Manitoba Health clients,” Patricia Caetano, the executive director of Manitoba’s drug programs. “For a large list of drugs once you have reached your deductible, we cover all of your drug costs.

“It’s not a free drug program.”

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Caetano told Global News the overall annual budget for Pharmacare is $270 million. It does not include drugs prescribed in hospitals.

For people who have an annual income of $15,000 or less, the deductible is 3.09% of their income, with a minimum deductible of $100.

LISTEN: Patricia Caetano, executive director of Manitoba’s drug programs on the big questions she gets from clients.

Around a dozen drugs covered in Manitoba cost between $250,000 to $500,000 a year.

Roughly 1,100 Manitobans will soon be paying more for their medication. They are enrolled in a Special Drug Program and have been told they would no longer be exempt from paying deductibles effective this month. The government also reduced the amount it will cover in the distribution of those high-priced medications.

READ MORE: Some Canadian patients struggling to pay for cancer treatments

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And even though a person might be prescribed a certain drug, there is no guarantee its covered. It is especially the case with new medications not listed on the provincial drug formulary that would result in Pharmacare coverage.

“It is a complex system,” Caetano acknowledges. “We are talking about a drug supply chain that impacts so many people and so when decisions are made about whether we are going to list a drug or not.”

“It affects the patient, the pharmacy, the physician that wants to use everything they can to treat somebody but might not be available to the patient.”

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For more information on Manitoba Pharmacare click here.