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Urgent: Action needed as government changes affect your drug plan coverage

Important information about bc government changes that affect your drug coverage plan

The BC Government has announced that the Reference Drug Program, which forms part of the provincial PharmaCare plan, will be expanding effective December 1, 2016.  What this means for all HSA members who work under public sector contracts (HSPBA, NBA, CSSEA, CBA) is that some medications which are currently covered under PharmaCare will only be eligible for partial or reduced coverage, or will no longer be covered at all.
 
The categories of drugs which are impacted by this change are:
 
ARBs (angiotension receptor blockers) – high blood pressure and heart disease
ACEIs (angiotension converting enzyme inhibitors – high blood pressure and heart disease
CCBs (Dihydropyridine calcium channel blockers) – high blood pressure and heart disease
Statins (HMG-CoA reductase inhibitors) – high cholesterol
H2 Blockers (histamine 2 receptor blockers) – significant stomach acid issues, such as acid reflux/ulcers
PPIs (proton pump inhibitors) – significant stomach acid issues, such as acid reflux or ulcers
 
If you or your dependents currently take any of the following medications, your PharmaCare coverage may be impacted by the upcoming changes:
 

Drug for which coverage is changing

Used to treat

  • Captopril
  • Cilazapril with/without hydrochlorothiazide
  • Eprosartan with/without hydrochlorothiazide
  • Felodipine
  • Irbesartan with/without hydrochlorothiazide
  • Olmesartan with/without hydrochlorothiazide
  • Quinapril with/without hydrochlorothiazide
  • Trandolapril

 
High blood pressure and heart disease

  • Fluvastatin
  • Lovastatin
  • Pravastatin
  • Simvastatin

 
High cholesterol

  • Cimetidine
  • Esomeprazole 20 or 40 mg
  • Lansoprazole 15 or 30 mg
  • Omeprazole 20 mg
  • Pantoprazole sodium 40 mg

 
Significant stomach acid issues,
such as acid reflux or ulcer

 
If you or your dependents take these medications, it is important that you take steps to ascertain whether you or your family members have been pre-approved for continued coverage for the medications, or if you will be required to have your doctor submit a request for a Special Authority for coverage.

Members and dependents who already have a Special Authority in place for one of the above-noted PPI or ARB medications will need to submit an additional Special Authority request in order to have continued full coverage as the existing special authority will no longer be effective.
 
You may wish to consider making an appointment with your doctor for a prescription renewal prior to December 1, 2016 while you take steps to obtain special authority coverage or ensure pre-approved continued coverage.  Any prescriptions filled or re-filled after December 1, 2016 will be subject to the new coverage rules.
 
If you are pre-approved for continued coverage, please note that you must obtain documentation from Health Insurance BC and submit that paperwork to Pacific Blue Cross in order to ensure it is noted on your file for coverage when you go to the pharmacy. 
 
Similarly, if your doctor’s application for a Special Authority is accepted by PharmaCare, you must obtain a copy of the approval and submit it directly to Pacific Blue Cross before you will receive coverage.
 
Please be aware that Special Authority coverage is not retroactive and, in order to receive coverage, the paperwork must already be on file with Pacific Blue Cross prior to a prescription being filled.
 
Pacific Blue Cross has posted information on the CaresNet section of their website providing answers to Frequently Asked Questions, as well as information about how to find out if you or your dependents have been pre-approved for ongoing coverage of a non-reference drug:  http://www.pac.bluecross.ca/collat/articles/0753.RDP_ReferenceDrugPricing-2016.11.pdf
 
For more information about the changes to the Reference Drug Program and why the Ministry of Health is making these changes, go to this link:  http://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/what-we-cover/general-coverage-policies/reference-drug-program
 
If you have questions specifically related to your coverage, please contact Pacific Blue Cross at 604.419.2000, toll-free 1-877 PAC BLUE, or see www.pac.bluecross.ca  For all other inquiries, please contact HSA’s benefits advocate Dennis Blatchford at 604.517.0994, toll free 1.800.663.2017, or dblatchford@hsabc.org

PRINTER-FRIENDLY VERSION.

 

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