FROM OUR PARTNERS
FROM OUR PARTNERS
▪ epipens and other forms of injectable epinephrine
▪ nitroglycerin products ; and
▪ potassium supplements 5 . Drug Enquiry Tool ( DET )
• The new , expanded Drug Enquiry Tool is available to assist you in discussions with your physician and pharmacist .
FREQUENTLY ASKED QUESTIONS :
Q : Why is TARP ( reference based pricing ) being implemented for these four health states — acid reflux , high blood pressure , anti-inflammatories and migraines ?
A : TARP categories group together drugs that have similar active ingredients used to treat the same medical condition and all are proven equally safe and effective by Health Canada . ARTA is being more efficient by reducing coverage for high cost / low value drugs and allocating these inefficient expenditures to newer high cost effective biologic drugs .
Q : Why are a maximum number of five dispensing fees being introduced for maintenance medications ?
A : Maintenance medications are often prescribed to patients with chronic conditions that can be managed on a long-term basis . In these cases , there is a low likelihood the dosage will change and the medication is usually administered continuously during the course of treatment on a 90- to 100-day cycle . Dispensing fees for these medications will now be limited to five per calendar year ( January 1 – December 31 ) per maintenance medication for covered members under the plan . Capping the number of dispensing fees allows ARTA to ensure extra dispensing fee charges are not being paid to pharmacies for maintenance medications more often than they need to be . After the fifth dispense , the dispensing fee will no longer be covered and will need to be reimbursed out-of-pocket . We suggest you ask your pharmacist how many claims you have made for your particular maintenance medication that may be affected by this change .
Q : What is the rationale behind introduction of the Enhanced Special Authorization approval process for biologic drugs in the five health states of rheumatoid arthritis , multiple sclerosis , Crohn ’ s / colitis , psoriasis and hepatitis C ?
A : The new biologic drugs treating these health states are very expensive . ARTA wants to ensure that first line therapies have been tried before the most expensive drugs are tried . Physicians , specialists and pharmacy care representatives are not responsible for the cost of the drug covered nor the viability of the ARTA drug benefit coverage . ARTA is opening a dialogue with these professionals to gain a more complete understanding of the rationale for the drug coverage recommended and the treatment regimen , before the drug is approved for coverage . ARTA ’ s commitment to covered members is that ARTA strives to provide “ the right drug at the right time , at the right price ,” but not necessarily the most expensive drug every time .
Q : Can you give an example of why the enhanced special authorization process is appropriate ?
A : Hepatitis C is the health state that caused ARTA to institute a more rigorous approval process . The costs for specialty medication prescribed to treat this condition is $ 50,000 to over $ 100,000 when used in combination with other drugs .
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news & views WINTER 2016 | 57