Reference Drug Program (RDP)

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The Reference Drug Program (RDP) was modernized Dec 1, 2016.

Three new categories were added, three categories were changed, and two remain unchanged.

For precise drug coverage under the Modernized RDP, see the RDP List of Full and Partial Benefits


On this page…

 

How does the RDP work?

The modernized RDP applies to eight therapeutic classes of drugs. Medical evidence shows that, within each of those categories, the drugs are equally safe and effective.

PharmaCare reviews the cost of the drugs within each category and determines a maximum daily cost it will cover. Fully covered (“reference”) drugs are not subject to the daily maximum; partially covered (“non-reference”) drugs are.

Note: Actual coverage depends on the rules of the patient's PharmaCare plan, including any annual deductible requirement.

Drug coverage under the Modernized RDP

The Modernized RDP came into effect on Dec. 1, 2016, after a six-month transition period during which both former and future RDP full benefit drugs were covered.  The modernized program:

  • added three new categories in which drugs are equally safe and effective, and
  • amended three of the original categories by changing the PharmaCare coverage of specific drugs within those categories, and
  • left two original categories unchanged.

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For specific drug coverage under the Modernized RDP as of Dec. 1, 2016, please refer to the "Modernized RDP Status" (Column G) of the RDP Master Spreadsheet (XLS) or the online version of the Modernized RDP Poster (PDF).

Why is the RDP needed? Who benefits?

The RDP helps PharmaCare save millions of dollars each year. These savings are used to fund important drug treatments for conditions for which fewer treatment options exist. For instance, the RDP has helped to fund new drugs for diabetes and for hepatitis C.

Through the RDP, all B.C. residents benefit from access to a broader range of drug treatments.

How do the changes affect patients?

The change to the Modernized RDP:

Checkmark fully covered many patients for the drugs they were already taking.
Checkmark did not require any patient to change more than one RDP drug.
Checkmark pre-identified and continued full coverage for about 50% of patients taking an RDP drug that would be only partially covered under the Modernized RDP (i.e., patients’ coverage was grandfathered).
Checkmark continued full coverage of RDP drugs for which a patient already had PharmaCare Special Authority approval granted before Jun. 1, 2016.
Checkmark continued to offer patients partial coverage if they chose to stay on their current medication.
Checkmark continued to accept Special Authority requests for full coverage of another drug if a patient had tried all the fully covered medications and could tolerate them.

How to assist patients

To assist patients, prescribers and pharmacists can determine:

  • if a patient is taking a drug affected by modernization,
  • whether the patient has already been granted continued full coverage despite modernization,
  • if not, whether the patient should consider switching drugs to retain eligibility for full coverage, and
  • if the patient chooses to switch, prescribing an appropriate substitute drug or adapting the prescription.

Identifying patients on drugs affected by RDP modernization

Coverage status of the following 17 drugs was affected by RDP Modernization. These drugs were eligible for full coverage but, as of Dec. 1, 2016, are eligible for only partial coverage. Patients still taking one of these drugs may need to consider switching if they rely on PharmaCare coverage.

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, maximum reimbursement for partially covered RDP drugs may have decreased more notably when the Modernized RDP came into effect on Dec. 1, 2016.

Therapeutic Category Drugs that became partial benefits on Dec. 1, 2016

Angiotensin Converting Enzyme Inhibitors (ACEIs)

  • captopril
  • cilazapril with/without hydrochlorothiazide
  • quinapril with/without hydrochlorothiazide
  • trandolapril

Angiotensin Receptor Blockers (ARBs)

  • eprosartan with/without hydrochlorothiazide
  • irbesartan with/without hydrochlorothiazide
  • olmesartan with/without hydrochlorothiazide

Dihydropyridine Calcium Channel Blockers (CCBs)

  • felodipine
Histamine2 Receptor Blockers (HBlockers)
  • cimetidine

Proton Pump Inhibitors (PPIs)

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

HMG-CoA Reductase Inhibitors (Statins) 

  • fluvastatin
  • lovastatin
  • pravastatin
  • simvastatin 

Determining whether a specific patient’s coverage was affected

Many patients taking one of the seventeen drugs above were pre-identified for automatic, ongoing full coverage (via an indefinite Special Authority entered in PharmaNet) beyond Dec. 1, 2016.

>> Please see the list of situations in which a patient’s drug coverage would not have been affected by modernization of the RDP.

>> Refer to the Guide to the Modernized RDP (PDF), Section 4, to find out how to access coverage information for specific patients.

What if a patient cannot take any of the fully covered drugs in a category?

If a patient was not pre-identified for continued full coverage, they may still meet the criteria for Special Authority approval for ongoing coverage if their prescriber requests it.

To review the criteria for Special Authority coverage for a specific RDP drug, look up the drug name on the Special Authority web page or on the RDP List of Full and Partial Benefits.

Is the RDP like the Low Cost Alternative Drug Program?

It's similar but not the same. The Low Cost Alternative Drug Program bases PharmaCare coverage on the price of the lowest cost generic among those drugs that have identical active ingredients. The Reference Drug Program applies to drugs that are not identical but are part of the same therapeutic category and are equally effective in treating the same conditions.

List of Modernized RDP fully and partially covered drugs

See the complete list of fully and partially covered drugs under the Modernized RDP, including links to Special Authority criteria and forms where applicable.

Resources for health professionals

View the RDP Modernization information kit online:

 

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