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This version is current as of September 17, 2014.
It has been in effect since December 05, 2013.

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C.C.S.M. c. P115

The Prescription Drugs Cost Assistance Act

HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Manitoba, enacts as follows:

Definitions

1           In this Act

"benefit" means a benefit that may be paid under this Act to an eligible person in respect of the cost of specified drugs; (« prestation »)

"benefit period" means a period specified in the regulations in respect of which benefits may be paid under this Act; (« période d'indemnisation »)

"eligible dependant" when used in respect of an eligible person means a person who is related to or dependant upon the eligible person within classes of eligible dependants as determined under the regulations; (« personne à charge admissible »)

"eligible person" means a person who is within a class of eligible persons as determined under the regulations; (« personne admissible »)

"minister" means the member of the Executive Council charged by the Lieutenant Governor in Council with the administration of this Act; (« ministre »)

"monitored drug" means a specified drug, or a class of specified drugs, designated in the regulations as a monitored drug; (« médicament contrôlé »)

"product agreement" means an agreement between the government and one or more manufacturers or distributors of a drug that relates wholly or partly to the price or supply of a drug that is, or may be eligible to be, either or both of the following:

(a) designated as an interchangeable product under legislation governing the profession of pharmacy,

(b) specified in a regulation made under clause 9(1.1)(a); (« accord d'approvisionnement »)

"specified drug" means a drug or other item that is specified in the regulations; (« médicament couvert »)

S.M. 1994, c. 1, s. 2; S.M. 2011, c. 4, s. 2; S.M. 2013, c. 53, s. 8.

Authority for payment of benefits

2(1)        The government may pay to an eligible person, in accordance with the regulations, a benefit in respect of the cost incurred by the eligible person in a benefit period for the purchase of specified drugs for his or her own use or the use of his or her eligible dependants.

Payments to persons on behalf of eligible persons

2(2)        Benefits may be paid under this Act to a person, including an insurer of an eligible person, who has incurred the cost for specified drugs purchased by the eligible person.

S.M. 1994, c. 1, s. 3.

Maximum benefit

3           The benefits paid to an eligible person under this Act in respect of any benefit period shall not exceed the cost incurred by the eligible person in that benefit period for the purchase of specified drugs for use by the eligible person or the use of his or her eligible dependants.

S.M. 1994, c. 1, s. 4.

Advisory committees

3.1(1)      The minister may establish one or more advisory committees to provide the minister with advice and recommendations respecting the administration or enforcement of this Act and its regulations.

Terms of reference

3.1(2)      The minister may determine the terms of reference and the procedures of an advisory committee.

S.M. 2011, c. 4, s. 4.

False or misleading information

4           Every person who provides or allows to be provided false or misleading information for the purpose of obtaining a benefit is guilty of an offence and is liable, on summary conviction,

(a) in the case of an individual, to a fine of not more than $5,000.; and

(b) in the case of a corporation, to a fine of not more than $50,000.

S.M. 1994, c. 1, s. 5.

Forfeiture of rights

5           An individual who is convicted of an offence under section 4 forfeits any right to receive benefits in respect of the benefit period to which the offence relates and in respect of the next following benefit period, in addition to any penalty imposed under that section.

S.M. 1994, c. 1, s. 6.

False prescriptions

6           Every person who gives or issues a prescription for a specified drug for an eligible person or an eligible dependant knowing that the specified drug is intended to be used by or for another person is guilty of an offence and liable, on summary conviction, to a fine of not more than $5,000.

S.M. 1994, c. 1, s. 7.

False dispensing

7           Every person who dispenses a specified drug for an eligible person or an eligible dependant knowing that the specified drug is intended to be used by another person is guilty of an offence and liable, on summary conviction, to a fine of not more than $5,000.

S.M. 1994, c. 1, s. 8.

False receipt

8           Every person who issues a receipt, or submits a claim for benefits on behalf of an eligible person,

(a) for the cost of a specified drug, without dispensing the specified drug; or

(b) for the cost of a specified drug, in excess of the amount actually paid for the specified drug;

is guilty of an offence and is liable, on summary conviction, in the case of an individual to a fine of not more than $5,000. and in the case of a corporation to a fine of not more than $50,000.

S.M. 1994, c. 1, s. 9.

"Registration certificate" defined

8.1(1)      In this section, "registration certificate" means a registration certificate issued to a person under section 40 of The Health Services Insurance Act.

Inspection of registration certificate

8.1(2)      A purchaser of a specified drug who holds a registration certificate shall, upon being requested to do so, present the registration certificate to the pharmacist for inspection and, where the specified drug is being purchased for the purchaser's dependant who also holds a registration certificate, the purchaser shall in addition so present that registration certificate for inspection.

Refusal to present certificate

8.1(3)      Where a purchaser of a specified drug refuses to comply with subsection (2), the pharmacist shall refuse to fill the prescription unless and until the purchaser complies.

S.M. 1994, c. 1, s. 10.

Regulations by LG in C

9(1)        For the purposes of carrying out the provisions of this Act according to their intent, the Lieutenant Governor in Council may make regulations ancillary thereto and not inconsistent therewith; and every regulation or order made under, and in accordance with the authority granted by, this section has the force of law and, without restricting the generality of the foregoing, the Lieutenant Governor in Council may make regulations

(a) specifying benefit periods in which benefits may be paid under this Act;

(b) determining classes of persons who are eligible persons to whom benefits may be paid under this Act in respect of costs incurred by them for the purchase of specified drugs for use by them and their eligible dependants;

(c) determining classes of dependants who are eligible dependants of eligible persons;

(d) specifying benefits that may be paid to eligible persons in respect of any benefit period or prescribing methods for determining the amount of benefits that may be paid;

(e) and (f) [repealed] S.M. 1994, c. 1, s. 11;

(g) prescribing the information to be provided by a person claiming benefits under this Act;

(g.1) prescribing conditions, including the payment of fees, to be met by manufacturers of drugs and other items in order for those drugs or other items to be considered for specification under clause (1.1)(a);

(h) authorizing benefits to be paid, in prescribed circumstances, to persons, including insurers of eligible persons, who have incurred the cost for specified drugs purchased by eligible persons and prescribing terms and conditions under which the authority is granted and under which payment of the benefits to the person or insurer is authorized.

Regulations by minister

9(1.1)      The minister may make regulations

(a) specifying drugs and other items in respect of the cost of which benefits may be paid;

(a.1) not yet proclaimed;

(a.2) designating a specified drug, or a class of specified drugs, as a monitored drug, including, without limitation, designating a specified drug that is a controlled substance as defined in the Controlled Drugs and Substances Act (Canada) as a monitored drug;

(a.3) removing a drug or other item from a regulation made under clause (a) or (a.2);

(b) prescribing procedures for claiming and paying benefits, including limiting the time within which claims for benefits may be made;

(c) requiring any specified document used under this Act or the regulations to be in a form acceptable to the minister;

(d) specifying persons, purposes and conditions for the purposes of clause 10(5)(j);

(e) prescribing fees payable for information provided from its records by the branch of the government administering this Act under the minister.

Reference to lists of drugs

9(2)        Specified drugs may be specified under the regulations by reference to any pharmacopoeia, formulary or other list of drugs, published or printed for any other purpose and by any other person, either with or without variation, modification or amendment and with or without additions thereto or deletions therefrom.

9(3)        [Repealed] S.M. 1994, c. 1, s. 11.

Notice not required

9(4)        Subject to subsection (5), a regulation may be made under subsection (1.1) at any time without prior notice to anyone.

Notice requirement — product agreement

9(5)        Subsection (4) does not relieve the minister of any notice requirement set out in a product agreement.

S.M. 1993, c. 48, s. 31; S.M. 1994, c. 1, s. 11; S.M. 1998, c. 15, s. 2; S.M. 2011, c. 4, s. 5; S.M. 2013, c. 53, s. 9.

Verification of information

10(1)       For the purpose of verifying any information on the basis of which a claim for benefits is made, the minister, or any person authorized in writing by the minister for the purpose, may request any medical practitioner, dentist, pharmacist, optometrist, registered nurse or midwife to produce records relating to the prescription or dispensing of specified drugs for the purpose of making copies, photographs or extracts of or from the records, and the production of records by the medical practitioner, dentist, pharmacist, optometrist, registered nurse or midwife upon such a request shall not, in any matter, be considered as a breach of confidence between the medical practitioner, dentist, pharmacist, optometrist, registered nurse or midwife and any patient or client.

Order by justice

10(2)       Where, upon a request made under subsection (1), a medical practitioner, dentist, pharmacist, optometrist, registered nurse or midwife refuses to produce records relating to the prescription or dispensing of specified drugs, the minister, or any person authorized in writing by the minister for the purposes of subsection (1), may apply ex parte to a justice for an order requiring the medical practitioner, dentist, pharmacist, optometrist, registered nurse or midwife to produce the records as requested under subsection (1) for the purposes of subsection (1), and the justice, if satisfied on the evidence that it is reasonably necessary for the administration of this Act that the request be complied with, may make such an order.

Inspection of records

10(2.1)     The minister may appoint inspectors who may, at any reasonable time and upon presentation of identification,

(a) enter any of the following places:

(i) the office of a medical practitioner, dentist, pharmacist, optometrist, registered nurse or midwife,

(ii) the office of a group of health care professionals, including, without limitation, any described in subclause (i),

(iii) a hospital, surgical facility or other health care facility in which records relating to specified drugs are kept; and

(b) require the production of, examine, audit and make copies of any records, including medical or clinical records, kept in that place that relate to specified drugs.

Use of data processing system and copying equipment

10(2.2)     In carrying out an inspection or examination under this section, an inspector may

(a) use a data processing system at the place where the records are kept to examine any data contained in or available to the system;

(b) reproduce, in the form of a print-out or other intelligible output, any record from the data contained in or available to a data processing system at the place; and

(c) use any copying equipment at the place to make copies of any record or document.

Assistance to inspectors

10(2.3)     A medical practitioner, dentist, pharmacist, optometrist, registered nurse, midwife and any other person who has custody or control of a record must give an inspector all reasonable assistance to enable the inspector to carry out his or her duties and must furnish to the inspector any information the inspector may reasonably require.

Warrant by justice

10(2.4)     A justice who is satisfied by information on oath that an inspector has been prevented from exercising his or her powers under this section may issue a warrant authorizing the inspector and any other person named in the warrant to exercise those powers.

Use of records produced

10(3)       Any records produced under this section, or any copies, photographs or extracts of or from records produced under this section may be used in respect of any action or proceeding for the enforcement or due administration of this Act but are not admissible by reason of being produced under this section, in any action or matter not related to the enforcement or administration of this Act.

Information confidential

10(4)       Except as permitted under this section, no person shall

(a) knowingly allow any other person to inspect, or to have access to, any record obtained under subsection (1), (2) or (2.1), or any copy, photograph or extract of or from such a record; or

(b) knowingly communicate or allow to be communicated, to any other person, information obtained under or in the course of the administration and enforcement of this Act.

Exceptions

10(5)       Subsection (4) does not prohibit the disclosure of information obtained under or in the course of the administration and enforcement of this Act

(a) to the person who is the subject of the information;

(b) with the informed, written consent of the person who is the subject of the information, given at the time the disclosure is sought to be made;

(c) where the person who is the subject of the information is under the age of 14 years, with the informed, written consent of the parent or legal guardian of the person, given at the time the disclosure is sought to be made;

(d) where the person who is the subject of the information is 14 years of age or over but is not mentally competent to give the consent required under clause (b), with the informed, written consent of the person entitled to make medical treatment decisions on his or her behalf under The Mental Health Act;

(e) to a health care professional engaged in the direct care of the person who is the subject of the information, where it is not reasonably possible to obtain the consent required under clause (b), (c) or (d) and, in the opinion of the minister or a person authorized by the minister, the disclosure would clearly benefit the person who is the subject of the information;

(f) to persons charged with the administration and enforcement of this Act, or of any other Act of the Legislature or of another province of Canada or of Canada relating to the subject matter of this Act;

(f.1) subject to subsection (5.1), to the members of an advisory committee established under section 3.1;

(g) to a pharmacist, or to a person authorized to practise medicine, registered nursing, dentistry, optometry or midwifery or another health care profession and in that capacity to prescribe, dispense or administer drugs or devices, for the purpose of enabling the pharmacist or person to dispense a drug or device safely;

(g.1) subject to subsection (5.1), to a regulatory body governing a profession that has authority to prescribe or dispense a monitored drug, for the purpose of the regulatory body monitoring or reviewing

(i) the patterns of its members' prescribing or dispensing practices relating to monitored drugs, or

(ii) the utilization of monitored drugs by patients or clients of its members,

with a view to identifying patterns or trends that might indicate inappropriate or fraudulent prescribing or dispensing, or abuse or misuse, of monitored drugs;

(h) subject to subsection (5.1), to a regulatory body governing a profession mentioned in clause (g), for the purpose of the regulatory body auditing or investigating a member, including an investigation for disciplinary purposes, in relation to inappropriate or fraudulent prescribing or dispensing, or abuse or misuse, of a monitored drug or other specified drug;

(i) where the information is in statistical form and does not contain the name of, or other means of identifying, the person who is the subject of the information; or

(j) to any person specified in the regulations, for the purpose and subject to the conditions there set out.

Limit on disclosure of identifying information re patient

10(5.1)     The disclosure of personal health information, as defined in The Personal Health Information Act, about a patient or client, or of other information that could reasonably be expected to identify a patient or client, is not authorized

(a) under clause (5)(f.1) or (g.1); or

(b) under clause (5)(h), except to the extent the information is necessary to carry out the audit or investigation.

Restriction on further disclosure

10(6)       A person to whom information is disclosed under this section shall not disclose it or allow it to be disclosed to any other person, unless it is to be used for the purpose for which it was originally disclosed or for any of the other purposes set out in subsection (5).

Offence and penalty

10(7)       A person who discloses information in breach of this section, or who knowingly and without authorization obtains access to information obtained under this Act, is guilty of an offence and is liable on summary conviction, in the case of an individual, to a fine of not more than $5,000. and, in the case of a corporation, to a fine of not more than $50,000.

S.M. 1994, c. 1, s. 12; S.M. 1998, c. 15, s. 3; S.M. 2005, c. 38, s. 11; S.M. 2008, c. 13, s. 11; S.M. 2010, c. 33, s. 52; S.M. 2011, c. 4, s. 6.

Referral to a professional regulatory body

10.1(1)     If the minister believes, based on advice from an advisory committee established under section 3.1, that the prescribing or dispensing practices of a member of a profession that has authority to prescribe or dispense a drug or other item may be inappropriate or not in accordance with generally accepted prescribing or dispensing practices, the minister may refer the matter, or make a complaint about the matter, to the regulatory body governing the person's profession.

Matter deemed a complaint under governing Act

10.1(2)     A referral or complaint under subsection (1) is deemed to be a complaint under the legislation that governs the profession.

S.M. 2011, c. 4, s. 7.

Additional information from claimant

11          Where a person claims a benefit on the basis of information furnished, the minister may require proof of that information and may require further information, in addition to any proof or information required under the regulations, before authorizing payment of the benefit.

S.M. 1994, c. 1, s. 13.

Benefits not liable to attachment

12          No amount payable as a benefit to an eligible person is liable to execution, seizure or attachment in any proceeding or under any Act of the Legislature.

S.M. 1994, c. 1, s. 14.

Recovery of benefits

13          Where, after paying a benefit to a person, it is determined

(a) that the benefit was paid in error;

(b) that the information on the basis of which the benefit was paid was false or inaccurate; or

(c) that the person was or has become disentitled to receive the benefit for any reason;

the minister, on behalf of the Crown, may recover the amount of the benefit from the person by action in a court of competent jurisdiction or by way of set-off against future benefits payable to the person.

S.M. 1994, c. 1, s. 14.

Limitation period

14          Proceedings in respect of an offence under this Act or the regulations may be commenced within two years after the minister receives knowledge of the commission of the offence, but not afterwards.

S.M. 1994, c. 1, s. 14.

Minister may delegate

15          The minister may, in writing, delegate to any person any duty, power or function conferred or imposed on the minister by this Act or the regulations, except the power to make regulations.

S.M. 1998, c. 15, s. 4.

Agreements

16          The minister may enter into agreements with any person or group of persons, or with the government of any jurisdiction, as the minister considers necessary for the purposes of this Act.

S.M. 2011, c. 4, s. 8.

 

 


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