Low Cost Alternative (LCA) Program
What is a "generic" drug?Generic drugs usually become available after patent protections on the original drug have expired. Generics must contain the same active ingredients (and have similar dissolution characteristics, or bioequivalence) as the originals so they can save patients and insurers significant costs without compromising quality of care. Under PharmaCare, drugs deemed the "lowest cost alternative" are usually (but not always) generics. For more information on bioequivalence, visit Health Canada's bioequivalence website. Are generic drugs as good as brand-name drugs?Yes. They are just as safe and effective. They contain the same active ingredients and are manufactured to the same standards set by Health Canada, and to the same strict regulations established by the Food and Drugs Act. Only minor ingredients like dyes, coatings or binding agents may vary. The real difference is in price – generic drugs cost 30 to 50 per cent less, on average. Why should I care how much drugs cost?In Canada, everyone shares health care costs. Everyone pays for high-priced drugs, whether through the higher taxes needed for provincial drug insurance programs, increased premiums for private insurance, or cuts to our health care system. To maintain our health care system and services, all Canadians need to be aware of the impact that the cost of medications has on the entire health-care system. Who decides which drugs are included in the LCA Program?The decisions are made by PharmaCare. The only reason for PharmaCare listing one product over another is claimed cost – there is no clinical difference between more expensive drugs and their lower-cost alternatives. Because the LCA price is based on PharmaCare claims data, drugs with the same list price do not automatically have the same LCA status. PharmaCare claimed-costs can vary significantly among the available alternatives. How do I get low-cost-alternative drugs?Ask your doctor or pharmacist. You may already be receiving a low-cost-alternative drug. If not, it may be because a generic equivalent of the drug prescribed by your doctor is not yet available. These health professionals can answer questions about generic drugs. If your doctor prescribes a product with partial LCA status, then your pharmacist should inform you that a low-cost alternative is available that will provide the same active ingredient and therapeutic treatment. How will my pharmacist know which products PharmaCare will fully cover?PharmaCare publishes the Low Cost Alternative/Reference Drug Program Booklet containing coverage information on all LCA drugs. Updates to the booklet are published in the PharmaCare Newsletter. If you have any questions about whether a product is covered fully or not, you can ask your pharmacist. What if I want a product that is not a low-cost alternative?You have a choice. Choose either:
However, if a low-cost alternative cannot be obtained due to manufacturer shortages, PharmaCare may temporarily approve full coverage of a partial-benefit product (according to the rules of your PharmaCare plan). What if my doctor writes "no substitution" on my prescription?If the product is not a full benefit, your pharmacist may have to contact your doctor and request a change to the prescription. If your doctor insists on a certain product (and has not requested a Special Authority), you will receive only partial coverage from PharmaCare. I have extended health benefits. Will my private insurer reimburse me for a higher-priced product?Contact your private insurer regarding its reimbursement policies. |
 |
|
|||||||||||||||||||||
