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The Pharmacare Act, Bill C-64, was passed by Canada's House of Commons on June 3, 2024, and currently awaits final approval by the Senate. (1) The legislation promises to provide [...]

BACKGROUND: Policy approaches have been considered to address inconsistent and inequitable prescription drug coverage in Canada, including a national essential medicines list. We sought to explore key factors influencing the acceptability and feasibility of an essential medicines list in Canada. METHODS: We conducted semistructured interviews with decision-makers and other key stakeholders from government or pan-Canadian institutions, civil society and the private sector across Canada. We analyzed data using inductive thematic analysis and by applying Kingdon's Multiple Streams Framework to analyze the emergent themes deductively. RESULTS: We conducted 21 interviews before thematic saturation was achieved. We categorized emergent themes to describe the problem, the essential medicines list policy (including content and process), and politics. There was consensus among participants that prescription drug coverage was an important problem to address. Participants differed in their views on how to define essential medicines and concerns about what would be excluded from an essential medicines list. There was consensus on important features for a process to develop an essential medicines list: an independent decision-making body, use of defined selection criteria based on quality evidence, and clear communication of the purpose of the essential medicines list. Federal government financing and the broader pharmacare model, engagement of various interest groups and changing political agendas emerged as core political factors to consider if developing a Canadian essential medicines list. INTERPRETATION: Although stakeholders' views on the content of a Canadian essential medicines list varied, there was consensus on the process to formulate and implement an essential medicines list or common national formulary, including choosing medicines based on best evidence. Greater understanding is now needed on how patients, clinicians and the public perceive the concept of an essential medicines list., Through Canada's complex system of prescription drug coverage, about 21% of Canadians are covered by public provincial or territorial drug plans, 3% by federal public coverage and 70% by full [...]

Private and public drug benefit plans in Canada use numerous forms of out-of-pocket charges for covered prescription drugs. (1,2) When applied indiscriminately, cost-sharing can reduce patient adherence to medications, even [...]

DOCTORS COULD SEE CHANGES in how they are paid by the Centers for Medicare & Medicaid Services for the drugs they administer in their office, depending on the outcome of [...]

Posted on cmajnews.com on July 10, 2018. Doug Ford has been premier of Ontario for less than two weeks, but his Progressive Conservative party has already made changes that have [...]

Premiums for Medicare prescription drug plans could skyrocket in 2007--if many low-utilizing beneficiaries decide against 2006 PDP enrollment, analysts reported at the recent National Medicare Prescription Drug Congress. If large [...]

Provisions of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) that will take effect on January 1, 2006, could jeopardize access to needed medications for the 6.4 [...]

With the new Medicare drug benefit barely five months away, health plans and other prescription drug plan sponsors are ramping up massive education and advertising campaigns. On January 1, thousands [...]

Uncertainty surrounds many facets of Medicare's prescription drug benefit, as plan-sponsor hopefuls gear up to submit their applications March 23. Drug-only insurance plans bearing partial risk for enrollees' prescription-drug costs [...]

There is agreement about one thing: When it issued final rules for the new Medicare Part D drug benefit, the Centers for Medicare and Medicaid Services did everything it could [...]

After months in flux, Medicare prescription-drug legislation--which Congress may pass this weekend--is complete. Herewith, some details of the conference agreement, focusing on the main event--the prescription-drug benefit itself. * Between [...]

A proposed Trump administration plan for paying for drugs under Medicare Part B has raised red flags for doctors.The Centers for Medicare & Medicaid Services announced Oct. 25 that it [...]

A proposed Trump administration plan for paying for drugs under Medicare Part B has raised red flags for doctors.The Centers for Medicare & Medicaid Services announced Oct. 25 that it [...]

New guidelines from the Centers for Medicare & Medicaid Services (CMS) that increase the number of compendia health insurers rely on to determine whether a drug use is appropriate will [...]

In talking with pharmacy directors and medical directors at health plans around the country, one commonly hears that coverage of a given drug by a plan is at a specific [...]

The annual period in which Medicare beneficiaries can change their prescription drug coverage plan, which begins on November 15, may see more switching than usual. Two related factors are the [...]

On September 30, the Centers for Medicare & Medicaid Services (CMS) extended for 3 more years the waiver that the agency had given Massachusetts to use Medicaid funds to continue [...]

The implementation of a medication therapy management (MTM) program increases the efficiency of pharmacy benefit programs and improves the quality of care for beneficiaries. By engaging clinical pharmacists in medication [...]

Specialty drugs that are typically covered under the medical benefit pose challenges to health insurers looking for ways to implement utilization management (UM) programs because of the limited capabilities of [...]

The CMS is amending its policies to get prescription drug coverage to 'dual eligibles.' The agency promises to process the enrollment of persons who qualify for both Medicare and Medicaid [...]

On May 8, the Centers for Medicare & Medicaid Services (CMS) made public its draft regulations to curb what all sides acknowledge have been abuses in selling Part D and [...]

Byline: Daniel B. Moskowitz, Washington, DC-based journalist The Medicare program overpaid Public Sector Partners (PSP) more than $650,000 in the discount card drug program it sponsored, according to an audit [...]

Five bills are pending in Congress that would require health plans taking part in the Medicare Part D program to reimburse pharmacies for prescription drug claims within 30 days. To [...]

Washington-Medicare Part D, the outpatient prescription drug plan that went into effect on January 1, is having a major impact on community oncology practices as they struggle to deal with [...]

The Maryland Health Care Commission has reduced the drug portion requirement of the basic benefit plan for small businesses to try to encourage a larger number of small businesses to [...]

In a special election this November, Californians will be asked to choose between 2 approaches designed to address the problem of low- and moderate-income residents who cannot afford the medications [...]

Byline: Debi Reissman, PharmD I recently had the opportunity to discuss whether plans should cover OTC medications with several of my colleagues in managed care. Although coverage of OTC agents [...]

Byline: Tami L. Mark, PhD, Ronald J. Ozminkowski, PhD The Medicare prescription drug benefit begins on January 1, 2006; 44 million seniors and disabled persons will be eligible to participate. [...]

The Centers for Medicare & Medicaid Services (CMS) is trying to hammer out the final rules on how the Competitive Acquisition Program (CAP) for Part B drugs will work, but [...]

Byline: Daniel B. Moskowitz, Washington, DC-based journalist Health plans eyeing participation in the new Medicare prescription drug benefit may find out as early as May 6 whether their proposed formularies [...]

Senate Finance Committee Chair Max Baucus (D-MT) and ranking Republican member Chuck Grassley (R-IA) remain upbeat about their chances of marking up legislation in the fall to provide a Medicare [...]

Senate Finance Committee Chair Max Baucus (D-MT) still is working hard to develop legislation that would combine a Medicare prescription drug benefit with program modernizations and revisions but chances seem [...]

Republicans say the Medicare reform principles released by the Bush administration July 12 are the catalyst needed to produce bipartisan agreement on fundamental change including a prescription drug benefit. But [...]