Claiming magistral formulas
Many patients complain to their physicians that magistral formulas are not covered by their insurance. This is a problem stemming from the manner in which they are claimed by the pharmacist.
Each ingredient must be covered by the insurance in question
Check that all ingredients are included on the patient’s insurance list.
Refer to the RAMQ list. Private insurers must cover at least the ingredients covered by the Régime Général d’Assurance Médicament (RGAM).
Use “name brand” ingredients
The RAMQ’s Liste de médicaments has two magistral product sections: PRODUITS POUR MÉDICAMENT MAGISTRAL and VÉHICULES, SOLVANTS OU ADJUVANTS.
These sections contain ingredients that do not have a listed unit price (e.g.: soft paraffin).
When no price is indicated, the pharmacist may purchase the product of his/her choice. The product thus obtained is then considered insured and the price payable by the Régie is the pharmacist’s cost price. For example, the DIN for Soft Paraffin (yellow) can be used to claim VaselineMD on a prescription. Here is a simplified list of proctology magistral ingredients covered by the RAMQ:
- Hydrocortisone (1% or higher), glyceryl trinitrate, nifedipine and diltiazem
A few important points: for all proctology magistral formulas:
- Use Soft Paraffin as a generic brand ingredient in place of Vaseline
- Use products with a DIN covered by the RAMQ for active ingredients:
- Soft Paraffin (Yellow): 00902683
- Hydrocortisone: 00900761
- Nitroglycerin (ointment): 01926454
- Diltiazem (two 300 mg capsules in 29.4 g of ointment): 02231057
- Nifedipine (capsules*) 00725110
* Certain pharmacies enter the ingredient as a capsule when the preparation is made using powder.
A quantity of 50 g or less is considered a Class 1 magistral formula that can be prepared by a pharmacy.
Magistral formulas that have a petroleum jelly base have a shelf life of 12 months (or 25% of the expiration date for the ingredient expiring the earliest). Avoid systematically entering 30 days as the expiration date.
These formulas must be applied inside the anal canal.