Employee
Benefits & Services
Bill 102
(Transparent Drug System for Patients Act,
2006)
–
Most of the provisions of this act took effect
in 2006.
However, off-formulary interchangeability became allowed
beginning on April 1, 2007. Prior to
this date, in Ontario, a brand name drug
could only be substituted with a drug that contained the
same active ingredient.
Now, generic interchangeability of drugs with similar
active ingredients is allowed.
Ontario Drug Benefit Program Delists 30 Generics
Thirty
commonly prescribed generic antibiotics
previously
covered under the Ontario Drug Benefit
(ODB)
Program have been delisted. Most of these drugs
were
delisted effective Jan. 15, 2008, while the rest
were
delisted as of Jan. 17, 2008. Among the drugs
no longer
covered by the program are amoxicillin,
penicillin V, cephalexin, cloxacillin and
cefaclor.
The Ontario
government has indicated that, due to
legislated
price limitations, it cannot cover these drugs
at the
increased prices recently announced by generic
drug manufacturers.
Effect on
group benefit plans
This change
will have various effects on benefit
plans, depending on plan design and the
age of plan members covered. However, most Great-West Life
plans will not be affected at all.
For plans
with no plan members aged 65 or over,
there is generally no impact.
However,
for plans based on the ODB formulary, the
newly
delisted drugs are no longer covered since
they are not part of the formulary. Under
these plans, there is the potential for a modest decrease in
claims experience. These plans represent less than
one per cent of plans in Ontario.
Plan members
may experience some inconvenience
if their medication has been delisted and
is no longer covered under
their plan. In this situation, plan members may opt
to:
·
Obtain an equivalent drug at the pharmacy; or
·
Return to the doctor for a
new prescription for a covered drug; or
·
Pay out-of-pocket
For plans that cover plan members aged 65
or over and drugs
requiring a prescription, there may be a small increase in
claims experience, since these plans may now be
responsible for the cost of the delisted drugs.
However, any modest change in claims experience
will likely be mitigated
by pharmacies moving towards drugs that are ODB-eligible
Ontario
Drug Benefit (ODB) makes changes to
payment policies for several antibiotics
Effective January 1, 2008 manufacturers of five classes of
generic molecules announced
increases in their prices. These classes are Amoxicillin,
Penicillin V, Cephalixin, Cloxacillin and
Cefaclor, all
commonly prescribed antibiotics.
As a result, ODB, on January 15, 2008 announced it was
changing the status of several generics
in these five classes to the "Not a Benefit" status. These drugs
are no longer paid for by ODB
for its plans
recipients, although they remain listed for
interchangeability.
While they made
many not a benefit, ODB did keep one generic product of each
molecule in each of these
five class of antibiotics, listed as a general benefit and
eligible for reimbursement under
its plans. The
manufacturer of the product chosen to remain on the ODB
formulary varies by molecule and the generics that
are now “Not a Benefit” show no price difference with those
that were kept as general benefit.
Although
patients always have the option to pay out-of-pocket for a
non-covered drug, we believe
the vast majority of
pharmacies will carry and offer to interchange with the
brand that has remained on the ODB formulary as a
general benefit thus reducing the impact to your plan.
