Prescription Drugs (POC 10)

This policy replaces the following VPPM 2 policy: 2.2.19 Prescription Drugs.

Purpose

This policy gives direction on the provision of benefits through Program of Choice (POC) 10 (Prescription Drugs).

Policy

Eligibility

1. Clients who are eligible to receive treatment benefits, including prescription drugs, are outlined under Part 1 of the Veterans Health Care Regulations, 3(1) - 3(10).
2. Clients who are eligible for rehabilitation services under the authorization of a Rehabilitation Plan may be eligible for POC 10 benefits if included in the plan.

General

3. POC 10 benefits are prescribed by health professionals authorized to do so under the laws in force in the province or country where the pharmaceuticals are provided.  The Department establishes a formulary and includes the following:
   1. Drugs which can only be legally dispensed under the authority of a prescription from an authorized prescriber. These drugs are identified by a Drug Identification Number (DIN) or Natural Health Product (NHP);
   2. Drugs which do not require a prescription by law and can be obtained "over the counter". These benefits are identified by a DIN or NHP or a Product Identification Number (PIN);
   3. Extemporaneous compounds contain one or more active ingredients recognized as a benefit by Veterans Affairs Canada (VAC), and do not duplicate commercially available drug products available at a lower cost. These products are identified by a PIN; and,
   4. Non-drug products traditionally obtained through a pharmacy identified by a DIN, NHP or a PIN. Some non-drug products available through the POC 10 may also be available through another POC such as POC 7 Medical Supplies.
4. Health Canada approves drugs for specific indications included in the drug's official product monograph which is part of the Notice of Compliance (NOC). Many off-label drug uses are effective, well documented in the peer-reviewed literature, and widely used. Off-label or unlabeled drug use occurs when a drug is used in a treatment regime or patient population that is not included in the NOC, and a drug is used for an indication other than those specifically included in the NOC. The Department may consider approving off-label or unlabeled drug use when:
   1. The drug is considered medically necessary and there is sufficient evidence available to indicate it has some benefit in treating the client's medical condition;
   2. Two reputable peer-reviewed documents or published studies having validated and uncontested data, support the proposed use for the specific medical condition as safe and effective.

Place of Residence

5. The provision of pharmaceuticals should be applied in a similar manner for all clients regardless of whether the client resides independently in the community or in a long-term care facility.

Generic Drugs

6. Clients are to be dispensed generic pharmaceuticals unless otherwise stated on the prescription and supported with a medical rationale.

Standard, Special Authorization, and Client Formularies

7. Prescription drugs are available when they have been prescribed and have been accepted for inclusion in the Department's standard or special authorization formulary, or an individual client's formulary.

Non-Formulary Products

8. Products that are not included in the Standard Formulary or Special Authorization Formulary can be considered on an individual client basis, based on the specific health needs of the client. These products are called non-formulary products. The authorization of non-formulary products requires an explanation from the authorized prescriber of the client's medical condition and the need for the product and how it will have therapeutic value. Clients are to be reimbursed the cost of obtaining this information (report) up to the rates noted in the VAC schedule.

Prescription Requirements

9. Prescriptions can be written, verbal or electronic in nature and must meet requirements as stipulated by federal and provincial/territorial laws for prescription drugs in the jurisdiction in which they are dispensed. The validity period for a prescription will be no longer than one year from the date the prescription was transcribed.

Extended Supply

10. Clients can receive an extended supply of drugs for a period of up to six months when they have a legitimate reason for needing the quantity requested, such as an extended period of treatment. The request cannot contravene provincial/territorial legislation, and the shelf-life of the drug would not be exceeded.
    
    In addition, the client must be stabilized on the drug (i.e. maintenance therapy) and the prescribing health professional must be confident the client is not at risk by the dispensing of a large quantity of the drug.

Adverse Drug Utilization Evaluation (ADUE) and Quantity Limits

11. The Department can impose quantity limits on a case-by-case basis where a client's use of POC 10 benefits is deemed possibly to be excessive, including situations of adverse drug utilization. In such instances, the Department will request the client provide medical documentation to support a continuation of the benefit.

Over the Counter Drugs

12. Over the counter medications are eligible benefits if:
    1. the benefit is included in the standard, special authorization, or client's formulary; and
    2. the benefit has been prescribed by an authorized prescriber.

References

Veterans Well-being Act

Veterans Health Care Regulations