Formulary - Nova Scotia

FormularyCoverTem plateFinal_May2021.pdf

Formulary

August 2024

July 2011 was the last printed publication of

the Nova Scotia Formulary Monthly updates of the Nova Scotia

Formulary are published online and can be

accessed at:

nspharmacare.ca

Copyright ?1996 Nova Scotia Department of Health. All rights reserved. No part of this publication may be reproduced, photocopied, stored on a retrieval system, or transmitted without the express written consent of the publisher.

TABLE OF CONTENTS

INTRODUCTION

How to Use the Formulary Legend

ATC CLASSIFICATION OF DRUGS A - Alimentary Tract and Metabolism B - Blood and Blood Forming Organs C - Cardiovascular System D - Dermatologicals G - Genito-Urinary System & Sex Hormones H - Systemic Hormonal Preparations, Excluding Sex Hormones J - General Antiinfectives, Systemic L - Antineoplastics and Immunomodulating Agents M - Musculo-Skeletal System N - Nervous System P - Antiparasitic Products, Insecticides and Repellents R - Respiratory System S - Sensory Organs V - Various

MISCELLANEOUS

Diabetic Supplies Benefit List Ostomy Supplies Benefit List Compounds

APPENDICES

Appendix I - Abbreviations Appendix II - Abbreviations of Manufacturers' Names Appendix III - Criteria for Coverage of Exception Status Drugs

INTRODUCTION

The Nova Scotia Formulary details which drugs and supplies are benefits under the Nova Scotia Seniors' Pharmacare Program, Family Pharmacare Program, Community Services Pharmacare Programs, Drug Assistance for Cancer Patients, Diabetes Assistance Program and Sensor-based Glucose Monitoring Program.

The Formulary is provided on our website at nspharmacare.ca in PDF.

The ATC Classification System

All medications are classified according to the Anatomical Therapeutic Chemical (ATC) Classification System which is used by the World Health Organization for pharmacoepidemiological purposes and by the Patented Medicine Prices Review Board for pricing purposes.

The ATC Classification System groups chemically similar products according to their site of action and facilitates the comparison of new medicines with previously available medicines. There are fourteen main groups in the ATC system:

A

Alimentary tract and metabolism

B

Blood and blood forming organs

C

Cardiovascular system

D

Dermatologicals

G

Genito-urinary system and sex hormones

H

Systemic hormonal preparations, excluding sex hormones

J

General antiinfectives, systemic

L

Antineoplastic and immunomodulating agents

M

Musculo-skeletal system

N

Nervous system

P

Antiparasitic products, insecticides and repellents

R

Respiratory system

S

Sensory organs

V

Various

Each group is subdivided into anatomical, therapeutic and chemical subgroups as shown in the Legend.

A drug may be given more than one ATC code. If it is available in two or more strengths or formulations with clearly different therapeutic uses, the drug would appear in various categories depending on its different forms. If a drug has more than one clinical indication, the main indication is chosen for the listing of the various brands and strengths of this drug.

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Interchangeability, Maximum Reimbursable Price (MRP) and Pharmacare Reimbursement Price (PRP) The Formulary indicates those products which have been deemed interchangeable by the Nova Scotia Department of Health and Wellness (see the Legend). For generic products that meet the criteria for interchangeability a Maximum Reimbursable Price (MRP) may be applied. MRP is the maximum price established by the Pharmacare Programs for an interchangeable generic drug. MRP is applied to those drugs which are Pharmacare benefits, and have been deemed interchangeable (e.g., brand name drugs and their generic equivalents). The MRP is the maximum amount that the Pharmacare Programs will reimburse providers for one unit (tablet, capsule, millilitre, etc.) of a drug. For each interchangeable, generic drug category, a maximum reimbursable price per unit (e.g., tablet, capsule, millilitre) is determined by calculating a percentage of the cost of the equivalent brand name drug. The percentage of the MRP is reimbursed at 25% of the cost of the manufacturer list price of the equivalent brand drug. Some generic drugs may have exceptions to the MRP formula, and their MRP will also be included in the Reimbursement List. Exemptions to the MRP are available for beneficiaries who have experienced a severe or life threatening reaction with lower cost alternatives. A request must be received from the prescriber detailing the reaction. Providers shall not charge any cost difference between the MRP of the drug and amount reimbursed by the Pharmacare Programs unless the beneficiary requests the higher priced drug. If the beneficiary requests the higher priced drug the extra cost is not counted toward their annual maximum copayment or annual maximum deductible. In addition, a Pharmacare Reimbursement Price (PRP) is the maximum cost assigned to:

- certain groups of drugs that are similar in effect; - specific services for which coverage is established; - certain unit dose and special delivery formats that are also available in less expensive bulk formats; and - certain supplies that are used for the same function. The PRP is the maximum amount the Pharmacare Program reimburses providers for one unit of a drug (tablet, capsule, millilitre, etc.) supply or service. Providers may charge the beneficiary the portion of their AAC that exceeds the PRP. The extra cost is not counted toward the beneficiary's annual maximum copayment or annual maximum deductible. In all pricing categories, except AAC, the Pharmacare Programs will reimburse pharmacies the lesser of the amount submitted, or as applicable, MLP, MRP, or PRP. All Manufacturer List Prices (MLPs) will be updated on a quarterly basis unless otherwise notified directly by the manufacturer.

Prescriber The Formulary provides prescriber codes (see Legend) associated with each benefit under the Pharmacare Programs. These codes indicate which benefits will be reimbursed when prescribed by a specific prescriber.

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