Can formulary coverage criteria go in footnotes?

[kshulist]

Hi there,

I'm looking for some clarity on this PAAB advisory on formulary coverage statements: https://www.paab.ca/resources/provincial-formulary-coverage-statements/

My question is whether formulary criteria (in the case where coverage is restricted) can go in a footnote as long as the body copy indicates "restrictions exist"?

The advisory says "If the manufacturer elects to include coverage codes within the APS, the codes must be accompanied by the corresponding coverage criteria (e.g. inclusion/exclusion criteria), definitions, and notes where applicable. These elements may be included in a footnote."

But I am unclear whether "these elements" (e.g., coverage criteria) can go in a footnote only if the manufacturer elects to use coverage codes, or in all cases?

Thanks so much!

[Jennifer Carroll]

Good Morning @kshulist

Yes, coverage criteria can be relegated to footnotes so long as the APS presentation indicates that coverage restrictions apply (in prominent body copy within the claim or proximal to it). The reader should also be aware of these footnotes. This can be done via a prominent statement near the claim similar to “please see footnote * for coverage criteria”.

[kshulist]

@jennifer-carroll Thank you for clearing that up!