Dimensión de la catexis en la estructura de género

Public Drug Plans If Yes, for What Type of Program?

British Columbia British Columbia runs a Restricted Claimant Program to reduce problematic medication use. The program limits coverage for patients with identified histories of misuse and/or abuse to medications prescribed by a single practitioner, or dispensed by a single pharmacy. Physicians and pharmacists must communicate this information to the patient.

The program applies only to prescriptions paid for by PharmaCare, and patients may avoid adherence by paying for their own drugs. However, a new dispensing pharmacist would be able to view the patient’s information through the PharmaNet system. The new pharmacist could then ask patients about their reasons for infringing upon the restriction, and engage the beneficiary in a dialogue to encourage compliance.

Pharmacists are not mandated to alert the new physician with whom the patient is double-doctoring. But if the pharmacist chooses to do so, the new doctor could then limit the prescribing of the drug in question or cancel the prescription.

Alberta The Alberta Works Income Support and AISH Health Benefits programs (transferred from Human Services to Alberta Health) that cover persons with disabilities and low-income and unemployed citizens or permanent residents have a restriction policy in place. If clients are identified as high-volume users, their case workers can restrict prescription drug coverage to one pharmacy by having restrictions applied to their Health Benefits Card. Prescribers working with other beneficiaries are encouraged to develop agreements with the patient, and sometimes the pharmacy, whereby the patient assents to limit his or her treatment to one doctor and one pharmacy. Because information regarding dispensing is available to both physicians and pharmacists on Netcare (via the Pharmaceutical Information Network), non-adherence can be checked through the system. Saskatchewan Note: Although there is no program restricting patients to a single pharmacy, pharmacists and physicians

have access to the Pharmaceutical Information Program, which captures prescription information from Saskatchewan pharmacies.

Manitoba Manitoba’s MH is able to use its Drug Programs Information Network to restrict a patient to filling prescriptions at a particular pharmacy. This restriction is initiated at the request of the physician and with the agreement of the patient.

Where the MH is the sole payer for the cost of the prescribed medication for a patient, it has the authority to limit reimbursement to only one pharmacy, with or without the consent of the patient. The pharmacy filling the prescriptions must contact the drug program to “open” the patient’s file before it can begin dispensing for that individual.

Ontario No prescriber or pharmacy designation polices (see Tables 16 and 17)

Quebec In 1985, Programme Alerte was created by OPQ to encourage the appropriate use of drugs. This program identifies patients who are misusing substances that are known to be habit-forming (mainly benzodiazepines and opioids), based on such criteria as visits to multiple pharmacies and multiple physicians, or when habit- forming drug therapy overlaps are found. When a patient has been identified, a warning is sent by a designated OPQ staff member to the pharmacist and neighbouring pharmacies about that patient. When patients visit a pharmacy, they are invited to select one physician and one pharmacy for their drug therapy needs.

New Brunswick As part of the New Brunswick Prescription Drug Program, a report is generated once a month that identifies beneficiaries who have met one or both of the following criteria: used 2 or more physicians or used 2 or more pharmacies. In cases where further investigation is warranted, a 6-month profile is obtained and reviewed on an individual basis. The physician(s) and pharmacies related to each individual case will be contacted if a patient’s profile includes one or more of the following criteria: multiple physicians or pharmacies; duplication of therapy; excess daily dosage; long-term or escalating use; multiple narcotics, controlled drugs, or

benzodiazepines; or high-prescription volumes, dollars, and/or quantities external alerts or requests (pharmacy alerts; individual physician or pharmacy requests).

Under the New Brunswick Prescription Drug Program Drug Utilization Review process, limitations to the access of narcotics, controlled drugs, and benzodiazepines are occasionally placed upon some beneficiaries. When this is necessary, the beneficiary will be restricted to accessing 1 physician and 1 pharmacy in the province. The decision to enact restrictions on a patient is based on reviews and recommendations received from prescribers.

Once the province’s PMP is operational, prescribers will be able to register a Patient Monitoring Agreement within the PMP system. Registration establishes that the patient has agreed to be limited to 1 prescriber and 1 pharmacy. If the individual attempts to fill a prescription from a different prescriber or use a different pharmacy, the system will generate an alert to warn the patient’s care team.

Nova Scotia The decision to designate a single pharmacy to dispense a patient’s medications is determined by physicians in consultation with their patients and, in some cases, with input from the Department of Community Services. In some cases, the NSPMP may offer this as a suggestion to a physician as a strategy to limit misuse, abuse, or diversion. The NSPMP then monitors patient agreements and reports on a weekly basis any patient who receives controlled drugs from a pharmacy or physician outside of the patient’s appointed care team. Newfoundland

and Labrador Beneficiaries restricted to a maximum of 2 pharmacies.

Yukon Territory No prescriber or pharmacy designation polices (see Tables 16 and 17)

NIHB A methodology (via the PMP) identifies NIHB clients who are misusing or are at greater risks of misusing drugs of concern and places the clients under certain restrictions with a view to prevent double-doctoring, by requesting the client to find a sole prescriber for the 4 categories of drugs. If clients or their health care providers cannot follow the PMP process to support the continuation of the drug therapy in question, the NIHB Program reserves the right to refuse coverage.

DND  On rare occasions, if a specific patient demonstrates a behaviour that could be associated with abuse potential, a specific prescriber may be assigned. This decision is made with the involvement of the Senior Medical Authority, the patient’s primary care provider, the pharmacist, and the patient.

AISH = Alberta Assured Income for the Severely Handicapped; DND = Department of National Defence Canadian Armed Forces drug benefit plan; MH = Ministry of Health; NIHB = Health Canada Non-insured Health Benefits Program; NSPMP = Nova Scotia Prescription Monitoring Program; OPQ = L’Ordre des pharmaciens du Québec; PMP = Prescription Monitoring Program.

Source: Unless otherwise referenced, the information was gathered from the 2015 CADTH survey of public drug plans. Survey question: “If you have a program to restrict a patient to a single prescriber or dispenser for accessing opioids, stimulants, or benzodiazepines, or opioid substitution therapy, please describe the program.”