Reference Drug Program

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About the Reference Drug Program (RDP)

What has Changed?

As of Dec. 1, 2016, PharmaCare coverage of some drugs included in the Reference Drug Program changed.

See the list of drugs for which coverage has changed.

If you are taking one of the drugs, read this page to find out how to get the PharmaCare coverage you need.

The RDP encourages cost-effective prescribing for common medical conditions. It has delivered safe, effective drug treatment at more affordable prices since 1995. Savings from the program help PharmaCare cover new drug treatments for British Columbians.

The RDP groups together drugs that treat the same illness or medical condition with equal effectiveness:

  • The less costly drugs (called “reference” drugs) are eligible for full coverage
  • More costly drugs (called “non-reference” drugs) are eligible for partial coverage, up to a maximum daily cost based on the cost of the reference drug for the RDP categories.

Actual coverage depends on the rules of your PharmaCare plan, including any annual deductible requirement.

All drugs in each of the eight RDP categories are equally safe and effective for treating the medical condition for which they are prescribed.

If you cannot take the fully covered reference drug for a medical reason—such as a drug-to-drug interaction, drug intolerance, or because the medication did not work well for you previously—your doctor, naturopath, or nurse practitioner can submit a Special Authority Request to PharmaCare asking for full coverage of a non-reference drug.

Recent changes to the RDP

PharmaCare recently modernized the RDP. Before Dec. 1, 2016, the RDP included five categories of drugs. It now includes eight. In three existing categories, PharmaCare also revised the drugs that are eligible for full coverage.

The changes were phased in during a six-month transition period. Many patients were pre-identified for continued full coverage of their medication. Prescribers and pharmacists throughout B.C. were informed of the coming changes at the beginning of the transition and given tools to identify patients who rely on PharmaCare coverage and might therefore need to consider switching to an equally safe and effective alternative drug that would be fully covered.  

The changes to the RDP were based on scientific evidence on the safety and effectiveness of the drug treatments.

In modernizing the RDP, the Ministry of Health reviewed the available research, coverage recommendations, and clinical evidence for each RDP category. See the RDP Review Reports.

Was your drug coverage affected?

If you are taking one of the following drugs, your PharmaCare coverage may have been affected by the recent changes.

Please note: The maximum amount PharmaCare reimburses for partially covered RDP drugs changes on a regular basis. As a result of modernization of the RDP, the maximum reimbursement for some partially covered RDP drugs may have decreased when the Modernized RDP came into effect on Dec. 1, 2016.

Drugs for which coverage has changed Used to treat...
  • captopril
  • cilazapril with/without hydrochlorothiazide
  • eprosartan with/without hydrochlorothiazide
  • felodipine
  • irbesartan with/without hydrochlorothiazide
  • olmesartan with/without hydrochlorothiazide
  • quinapril with/without hydrochlorothiazide
  • trandolapril

High blood pressure and heart disease

  • fluvastatin
  • lovastatin
  • pravastatin
  • simvastatin 

High cholesterol drugs
(commonly known as statins) 

  • cimetidine
  • esomeprazole 20 or 40 mg
  • lansoprazole 15 or 30 mg
  • omeprazole 20 mg
  • pantoprazole sodium 40 mg

For significant stomach acid issues, such as acid reflux or ulcer

>> See the full list of RDP categories and drugs.

Even if you are taking one of the drugs above, your coverage may not have been affected because:

  • If you have more complex medical needs, PharmaCare may have pre-approved you for ongoing full coverage of your current medication—For instance, if you are taking:
    • two or more of the drugs listed above, your coverage would not have been affected
    • any of the drugs highlighted in bold above but already have PharmaCare Special Authority coverage for that drug, your coverage would not have been affected
    • specific drugs for heart failure, your coverage may not have been affected
    • any of the drugs above and are under the care of a renal unit for the management of kidney disease, your coverage will not be affected.
  • If you were not pre-identified but cannot take a fully covered reference drug for a medical reason—such as a drug-to-drug interaction, drug intolerance, or because the medication did not work well for you previously—your doctor, naturopath, or nurse practitioner can submit a Special Authority request to PharmaCare asking for full coverage of your current drug. 

Speak to your doctor, naturopath, nurse practitioner, or pharmacist to find out if your coverage was affected.

What happens if your coverage was affected

If your drug coverage was affected by the changes, you may decide to:

  • switch your medication to retain full coverage under PharmaCare, or
  • keep taking your current drug and pay the difference in cost.

If your coverage was affected, any change in cost will be reflected in the payment amount at your pharmacy the next time you refill your prescription or present a new prescription.

It is safe for almost all patients affected to switch to less costly drugs to retain full coverage.

Talk to your doctor, naturopath, nurse practitioner, or pharmacist if you are concerned about keeping full PharmaCare coverage for your drug. They can advise you of your options and help you make a decision that’s right for you.

These health care providers can also makes changes to your prescription for you, if needed.

Information Sheet

For reference, you can print the Modernized Reference Drug Program Information Sheet.

 

Common questions about the RDP



Why was the RDP modernized?

This is the first time the RDP has been significantly updated since it was introduced in 1995. Since then, many new drugs, and generic versions of drugs, have become available. More recently, the price of many generic drugs has been lowered, thanks to B.C.’s Drug Price Regulation and the work of the pan-Canadian Pharmaceutical Alliance.

In light of these changes, PharmaCare reviewed the RDP to make sure it was covering the most cost-effective, safe, and effective medications. Savings from the changes will be reinvested in PharmaCare, allowing it to cover more drugs and supplies.

PharmaCare consulted a wide range of organizations in planning the modernization of the RDP. Please see the stakeholder list for more information.

Which drugs are included in the RDP?

  • Angiotensin converting enzyme inhibitors (ACEIs)—for high blood pressure and heart disease
  • Dihydropyridine calcium channel blockers (CCBs)—for high blood pressure and heart disease
  • Histamine 2 receptor blockers (H2 Blockers)—for significant stomach acid issues, such as acid reflux or ulcers
  • Angiotensin receptor blockers (ARBs)—for high blood pressure and heart disease
  • Proton pump inhibitors (PPIs)— for significant stomach acid issues, such as acid reflux or ulcers
  • HMG-CoA reductase inhibitors (Statins)—for high cholesterol. 

>> See the full list of RDP categories and drugs.

I already have Special Authority approval for my medication. Is this approval still valid?

Yes, if you already have Special Authority for a drug in an RDP category, you will continue to be eligible for full PharmaCare coverage. Please speak to your doctor, naturopath, nurse practitioner, or pharmacistto make sure you are covered.

What if I want to stay on my current drug regardless of cost? Do I have a choice?

Yes, the choice is yours. You may choose to stay on your current drug even if it is not fully covered under the Modernized RDP. You, or your private insurer, would have to pay the extra cost which may range from $37 to $116 a year, depending on the drug.

Does the RDP limit the drugs my care provider can prescribe?

No. The RDP does not prevent your doctor, naturopath, or nurse practitioner from prescribing any specific drug. The program is intended to encourage these health care providers to prescribe a less costly and equally effective drug for you unless there is a medical reason why you need one of the non-reference drugs. If there is a medical reason to prescribe another drug, your health care provider can submit a Special Authority request to PharmaCare asking for full coverage of that drug.

Is the RDP safe? Is it safe to replace one medication with another?

The RDP is based on scientific evidence, which shows less costly drugs in the RDP categories are just as safe and effective as the more expensive drugs. Replacing one drug with another that treats the same condition is called therapeutic substitution. International studies show it is safe for the vast majority of patients.

All the drugs in the RDP are approved for use by Health Canada and meet all medical and safety requirements. Millions of people worldwide take these drugs.

Has the RDP been independently evaluated?

Yes. The RDP and its principles have been reviewed through scientific studies, which showed it is safe for the vast majority of patients to switch to the less costly drugs in the categories. Evidence has also shown that the RDP can save money for the health care system—money that can then be reinvested for other health needs such as new drugs.

See the RDP Review Reports.  

PharmaCare continues to monitor and evaluate the RDP to ensure the program is effective and safe.