Frequently asked questions
Who does the DBL publications apply to?
What does the DBL publications contain?
What do the abbreviations and bolding in the listings
mean?
What do the prices in the DBL publications
mean?
What is an LCA?
Why are some prices bolded?
How do I find out if a particular prescription drug
or product is covered by the DBL publications?
How does the Special Authorization process work?
How do I find out the status of my Special Authorization
request?
Are there other medications that are restricted
as benefits?
What should I do if the medication I am interested in
is not listed in the DBL publications ?
How are drug products approved for inclusion in
the DBL publications?
How often are there product changes to the DBL publications?
How is Alberta Blue Cross involved with the DBL publications?
How can I obtain a copy of the DBL publications?
Who do I contact if I have more questions about the DBL publications?
For questions about the Alberta Human Services Drug Benefit Supplement (HSDBS) click here.
Who does the DBL publications apply to?
The DBL publications provide information about eligible prescription
drugs and products available to Albertans who are covered under programs
sponsored by the Alberta Government and administered by Alberta Blue Cross.
These programs include:
- Alberta Blue Cross (Group 1) offered by Alberta Health.
- Alberta Blue Cross Coverage for Seniors (Group 66) provided to all Alberta senior citizens (65 years of age or older) and those on the Alberta Widows' Pension Plan (Group 66A) offered by Alberta Health.
- Drug coverage provided to individuals approved by Alberta Health for Palliative Coverage. (For these individuals the Palliative Coverage Drug Benefit Supplement must also be considered).
- Drug coverage provided to Alberta Human Services clients. (For these clients
the Alberta Human Services Drug Benefit Supplement
must
also be considered).
What do the DBL publications contain?
The DBL publications are organized into two main parts, policies
and guidelines and eligible product listings.
The Policies
and Guidelines (Section
1) include information on program and price policies (e.g., drug review process
and Least Cost Alternative) in addition to common guidelines adhered to in
the DBL publications.
Four components contribute to the eligible product listings. These are: Special Authorization (Section
3 ),
Optional Special Authorization (Section
3a), Rare Diseases Drug Coverage Program (Section
4 ), and
the regular Listing
of Benefits under
Alberta government-sponsored drug programs. Special Authorization drugs include
drug products that are eligible under Alberta government sponsored drug programs
when specific criteria for coverage are met. The regular benefits are eligible
drug products that do not require special authorization although there may
be restrictions.
The DBL publications are designed to be used primarily
by health professionals, especially pharmacists and physicians. Specific
drug product information is provided, including product name (ingredient,
strength and dosage form), Drug Identification Number (DIN), manufacturer/distributor
of the product, and pricing information. The pricing information in the DBL publications
reflect the drug material per unit cost only and does not reflect the dispensing
fees claimed by your pharmacist. The product listings are generally organized
by "pharmacologic-therapeutic classification" (PTC) classifaction
as seen in the Listing
of Benefits .
Although the special authorization listing and Monthly Updates list products
by active ingredient grouping.
What do the abbreviations and bolding in the listings mean?
These are explained in the Legend in
the DBL publications.
What do the prices in the DBL publications mean?
The prices listed in the DBL publications are based on the manufacturers'
responses to Alberta Price Confirmation for the period of time during which
the DBL publications are effective. The pricing information in
the DBL publications reflect the drug material per unit cost only
and does not reflect the dispensing fee claimed by your pharmacist. It
is presented for information purposes only.
If the medication you are interested in is within an "interchangeable" grouping
of medications (with the same active ingredients, dosage and form), the
program may pay only up to the Least Cost Alternative (LCA) price, if one
has been established for that grouping. In these cases, the LCA price appears
in bold text. For more information, see Price
Policy .
In some cases, Maximum Allowable Cost (MAC) pricing is established for
a specific drug product or selected group of interchangeable drug products.
MAC pricing appears in bold italic type in the second column from the right
(after the manufacturer code). For more information, see Price
Policy.
What is an LCA?
The Least Cost Alternative (LCA) price is the lowest unit cost established
for a drug product within a set of interchangeable drug products. LCA prices
appear in bold type in the DBL publications. The LCA price policy
is applied to selected interchangeable groups as identified in the List.
The Alberta government-sponsored drug programs, which follow the LCA price
policy, will pay the Actual Acquisition Cost (AAC) of the drug material
to a maximum of the LCA price.
Why are some prices bolded?
The bolded prices represent the Least Cost Alternative (LCA) price.
The Least Cost Alternative (LCA) price is the lowest unit cost established
for a drug product within a set of interchangeable drug products. The LCA
price policy is applied to selected interchangeable groups as identified
in the DBL publications . The Alberta government-sponsored drug
programs, which follow the LCA price policy, will pay the Actual Acquisition
Cost (AAC) of the drug material to a maximum of the LCA price.
How do I find out if a particular prescription drug or product is covered
by the DBL publications?
To confirm the spelling of the product go to the Alphabetical
List of Pharmaceutical Products .
Once spelling is confirmed, proceed to search the ADBLif
your computer can handle this large file, or search the appropriate part
of the DBL publication:
Section
3 - Criteria
for Special Authorization of Select Drug Products, or
Section
3a -
Criteria for Optional Special Authorization of Select Drug Products,
or Section
4 -
Rare Diseases Drug Coverage Program, or
Listing
of Benefits by Pharmacologic-Therapeutic classification.
Refer to tips for searching PDF documents.
Prescription drug benefits for those covered under Alberta Human Services programs are found by searching both the Alberta Human Services Drug Benefit Supplement (HSDBS) and the Alberta Drug Benefit List (ADBL).
If you do not find the drug product in one of these locations, check the online version of the DBL publications by clicking here for any Updates to the ADBL that have been issued since the last Monthly Update.
How does the Special Authorization process work?
If your physician has prescribed a medication that is covered only
through Special
Authorization ,
your physician must complete the appropriate drug Special
Authorization Request form and fax or mail that form to Alberta
Blue Cross for review. Information regarding the status of a special authorization
request will be ready within three working days of Alberta Blue Cross receiving
the request from the physician.
How do I find out the status of my Special Authorization request?
Call Alberta Blue Cross Customer Services at 780-498-8000 (Edmonton
and area), 403-234-9666 (Calgary) or 1-800-661-6995 (toll-free from anywhere
else in Canada) to confirm the status (approval, pending more information,
denial) of the Special Authorization request.
If you go to your pharmacist, he or she may be able to tell you if it has been approved—if not it may still be in the process of being assessed. If more information is required for further assessment of the request, this will be communicated directly to your physician. If the request is declined, Alberta Blue Cross will send a letter to your physician and to you, the patient.
Are there other medications that are restricted as benefits?
Yes. Some selected devices or drug products are eligible benefits with
limits or restrictions in the DBL publications. For these
products, a "Restricted Benefit" or "Limited Restriced Benefit" comment
is displayed in the DBL publications after the ingredient name
or specific strength of the ingredient which explains the limits or restriction.
For more information, refer to Restricted
Benefits of
the DBL publications .
What should I do if the medication I am interested in is not listed
in the DBL publications?
If the drug product is not listed anywhere in the ADBL or
its components: Section
3 -Criteria
for Special Authorization of Select Drug Products, Section
3a Criteria
for Optional Special Authorization of Select Drug Products, (Section
4 -
Rare Diseases Drug Coverage Program, or or Listing
of Benefits by Pharmacologic-Therapeutic Classification , or Updates
to the ADBL), it generally will not be provided as a benefit
under the applicable government-sponsored drug program. In these cases
the patient pays the complete cost of the medication or can contact his
or her physician for an alternative medication that is a benefit.
How are drug products approved for inclusion on the DBL publications
?
The Alberta
Health Expert Committee on Drug Evaluation and Therapeutics makes
recommendations on the ADBL. The Minister of Health makes the final decisions on changes after reviewing the recommendations
of the Expert Committee and Alberta Health. Check the Drug
Review Process section
of the ADBL for more information.
How often are there product changes to the DBL publications?
The DBL publications are published annually, effective April 1, with normally scheduled monthly Updates.
How is Alberta Blue Cross involved with the DBL publications?
Alberta Blue Cross administers the prescription drug benefit programs
sponsored by Alberta Health and Alberta Human Services and prepares the DBL.
How can I obtain a copy of the DBL publications?
You can view and print the DBL publications in Acrobat Portable
Document Format (PDF). You will need to download Acrobat
Reader which is available free of charge from the Adobe web site. For more
information on using Adobe Acrobat, please refer to the tips on
this site. The documents vary in length.
Printed versions of the DBL publications, including supplements and Updates, are available from Alberta Blue Cross at the address shown below.
Costs are:
Binder and contents: $42.00 ($40.00 + $2.00 G.S.T.)
Contents only: $36.75 ($35.00 + $1.75 G.S.T.)
A cheque or money order must accompany the request for additional copies.
Alberta Blue Cross
10009 108 Street NW
Edmonton AB T5J 3C5
Who do I contact if I have more questions about the DBL publications
?
Call Alberta Blue Cross Customer Services at 780-498-8000 (Edmonton
and area), 403-234-9666 (Calgary) or 1-800-661-6995 (toll-free from anywhere
else in Alberta). Pharmacy service providers may call Alberta Blue Cross
pharmacy services representatives at 780-498-8370 (Edmonton and area),
403-294-4041 (Calgary and area) or 1-800-361-9632 toll free.
OR
Simply e-mail Alberta Blue Cross.
Note: Information pertaining to Albertans covered under Alberta Human Services sponsored prescription drug programs is located on the Alberta Human Services web site.
NOTICE:
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL (iDBL), and any such changes to the Interactive DBL (iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.
