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HESA Committee Report

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APPENDIX A: OVERVIEW OF PROVINCIAL AND TERRITORIAL PRESCRIPTION DRUG COVERAGE PLANS

 

This appendix provides an overview publicly funded prescription drug coverage plans offered by Canada’s provinces and territories, including prescription drug coverage plans for the general population, seniors, children, individuals with low income, individuals with chronic diseases or those facing high drug costs as referred to in part one of this report. The tables below were compiled using information from Appendix H: Provincial Drug Plans Overview, in the Office of the Parliamentary Budget Officer’s report entitled Federal Cost of a National Pharmacare Program;, Appendix A: Public Drug Plan Design in the Patented Medicine Prices Review Board’s report NPDUIS Compass Rx: Annual Public Drug Plan Expenditure Report 2012/13; and various provincial and territorial government websites. 

Table 1– Characteristics of Publicly Funded Drug Plans for the General Population under 65 Years of Age

Jurisdiction

Plan Name

Eligibility

Premium

Fixed Copayment

Co-insurance

Deductible

Max. Out-of-Pocket Payments

Alberta

Non-Group Coverage

AB residents

Monthly premium

Single: $63.50

Family: $118

Billed quarterly

X

30% of Rx costs

X

$25 per Rx

British Columbia

PharmaCare

BC residents 

X

X

After deductible, 30% of Rx costs

0-3% annual of net family income

2-4% of net annual family income

After Family Maximum is reached, PharmaCare pays 100% of eligible costs for remainder of year

Saskatchewan

Special Support Program

SK residents

X

X

Before deductible, varies with income and monthly drug expenditures

After deductible, 35% of Rx cost

3.4% of net family income,

paid semi-annually

X

Manitoba

Pharmacare Program

MB residents whose prescriptions are not covered by other provincial or federal plans

X

X

X

2.97-6.73% of net income, , min. of $100

N/A

Ontario

Trillium Drug Program

ON residents with no/limited private insurance,  who do not qualify for the Ontario Drug Benefit

X

After deductible, $2 per Rx

X

3–4% of annual net income,

paid quarterly

X

Quebec

Public Prescription Drug Insurance Plan

Individuals not eligible for private insurance

Annual premium $0-$667, varies with income

X

After deductible, 34.8% of Rx costs

$19.45 monthly

Monthly: $88.83

Annual: $1029

Newfoundland & Labrador

Assurance Plan

NL residents

X

X

Rate = (capped based upon family income*/total drug expenditure of family

X

5-10% annual net income, varies with income

Nova Scotia

Family Pharmacare

NS residents not receiving other provincial drug coverage

X

X

20% of Rx costs

1-20% annual of net income

6-35% of net income

New Brunswick

New Brunswick Drug Plan

NB residents with no/limited private insurance

Monthly premium $16.67-166.67 varies with income

or

Annual premium of $200-$2000, varies with income

X

30% of Rx costs to a max. of $5-$30 per Rx, varies with income

X

X

Prince Edward Island

Generic Drug Program

PE residents under 65 years of age with no private insurance

X

X

X

X

Max of $19.95 per generic drug

 

 

Table 2 – Characteristics of Publicly Funded Catastrophic Drug Coverage Plans

 

Plan Name

Eligibility

Premium

Fixed Copayment

Co-insurance

Deductible

Max. OOP

British Columbia

Fair PharmaCare- Enhanced Assistance

BC residents

X

X

X

X

1.3%-3.2% of net family income

Saskatchewan

Extended Benefits and Drug Plan

Determined by the Ministry of Health

X

Calculated using total family income and actual benefit drug costs

X

X

3.4% of total adjusted family income

Manitoba

Pharmacare

MB residents

X

X

X

X

3.05%-6.90% of adjusted total family income

Ontario

Trillium Drug Program

ON resident

X

After deductible, $2 per Rx

X

X

3%-4% of household income after taxes

Newfoundland & Labrador

Assurance Plan

NL resident

X

X

X

X

5-10% of annual net income

Nova Scotia

Family Pharmacare

NS residents not receiving other provincial drug coverage

X

X

X

X

Varying percentage of total adjusted family income

Prince Edward Island

Catastrophic Drug Program

PE residents

X

X

X

X

3%-12% of net income, varies with income

 

 

Table 3 – Characteristics of Publicly Funded Drug Plans for Seniors

 

Plan Name

Eligibility

Premium

Fixed Copayment

Co-insurance

Deductible

Max. OOP

Alberta

Coverage for Seniors

AB residents over 65 years of age

X

X

30% of Rx costs

x

$25 Max. PER Rx

British Columbia

Fair Pharmacare

BC residents over 65 years of age

X

X

After deductible, 25% of Rx costs

0% - 2% of net income

1.25%-3% annual of net income

Saskatchewan

Seniors’ Drug Plan

SK residents over 65 years of age

X

Max. $20 per Rx

X

X

(Deductibles exist for GIS recipient)

N/A

Ontario

Ontario Drug Benefit Program

ON residents over 65 years of age

X

$2 per Rx if income <$19,300 (single),

<$32,300 (couple)

Otherwise Max. $6.11 per Rx

X

$0 if income <$19,300 (single),

<$32,300 (couple)

Otherwise $100

N/A

Quebec

Public Prescription Drug Insurance Plan

QC residents over 65 years of age who are not eligible for private insurance

Annually $0-$667, varies with income

X

After deductible, 34% of the Rx costs

$18 monthly

No GIS Monthly: $88.83 Annual: $1,066

1%-93% of GIS Monthly: $52.56 Annual: $632

94%-100% of GIS $0

Newfoundland & Labrador

65 Plus Plan

NL residents over 65 years of age & receiving OAS & GIS

X

Max $6 of dispensing fee per Rx

X

X

X

Nova Scotia

Seniors’ Pharmacare

NS residents over 65 years of age with no prescription drug coverage

Annually $0-$424, varies with income

X

30% of Rx costs

X

Annual limit including premium and copayment of $382-$806, varies with income

New Brunswick

Seniors Program

NB residents over 65 years of age receiving/qualified for GIS

X

GIS recipient: Max. $9.05 per Rx,otherwise varies by income

X

X

Annual limit for GIS recipient: $500, otherwise, no max.

 

Medavie Blue Cross Seniors Prescription Drug Program

NB residents over 65 years of age not eligible for NB Seniors Program/has no private insurance

$115 monthly

Up to $15 per Rx

 

 

 

Prince Edward Island

Seniors Drug Cost Assistance Program

PE residents over 65 years of age

X

Max. $8.25 per Rx + pharmacy professional fee up to $7.69

X

X

X

Yukon

Pharmacare

YT residents over 65 years of age or over 60 years of age and married to someone over 65 years of age

X

X

X

X

N/A

Northwest Territories

Extended Health Benefits Seniors Program

“Non-Aboriginal and Non-Indigenous Métis”

NT resident over 60 years of age

X

X

X

X

X

Nunavut

Extended Health Benefit

Non-Indigenous NU residents over 65 years of age

Unclear

X

X

Unclear

Unclear

 

 

Table 4 – Characteristics of Publicly Funded Drug Plans for Children

 

Plan Name

Eligibility

Premium

Fixed Copayment

Co-insurance

Deductible

Max. OOP

Alberta

Alberta Child Health Benefit

Children under 18 years of age or up to 20 years of age, if they live at home and are attending high school up to grade 12

X

Unclear

X

X

X

British Columbia

Children At Home Program (Plan F)

BC children with severe disabilities

X

X

0%

X

X

Saskatchewan

Children’s Drug Plan

Children under 14 years of age

X

$25 per Rx

X

X

X

Ontario

OHIP+: Children and Youth Pharmacare

(Beginning 1 January 2018)

Children under 24 yearsof age with OHIP coverage

X

X

0%

X

X

Quebec

Prescription Drug Insurance

Children under 18 years of age or under 25 years of age who are single, living with their parents and enrolled in full time studies

 

X

X

X

X

$0

Nova Scotia

Low Income Pharmacare for Children

NS families receiving the Nova Scotia Child Benefit

X

$5 per Rx

X

X

X

New Brunswick

Plan G (Special needs children and children in the care of the Minister of Social Development)

Children in care of the Minister of Social Development

X

X

0%

X

N/A

 

Plan F (Social Development Clients)

Low income families

Unclear

$2 per Rx for children <18 years

X

Unclear

$250 per family unit annually

Prince Edward Island

Family Health Benefit Drug Program

Low income families with at least 1 child  under 19 years of age or under 25 years of age who is a full-time student

X

Pharmacy professional fee

Varies with income and number of children

X

X

Yukon

Children’s Drug & Optical Program

Families with limited income with at least one child under 18 years of age

X

X

X

Varies with income

Annual max. of  $250 per child and $500 per family

 

 

Table 5 – Characteristics of Publicly Funded Chronic and High-Cost Diseases Drug Plans

 

Plan Name

Eligibility

Premium

Fixed Copayment

Co-insurance

Deductible

Max. OOP

Alberta

Specialized High Cost Drug Program

AB residents

X

X

X

X

X

 

Outpatient Cancer Drug Benefit Program

AB residents

X

X

0%

X

X

 

Palliative Care Coverage Program

AB residents

X

30% to a maximum of $25

X

X

Maximum lifetime payment of $1000

 

Diabetic Supply Coverage

AB residents

X

X

0% up to a maximum of $600 annually

X

X

British Columbia

Cystic Fibrosis (Plan P)

BC residents registered with provincial cystic fibrosis clinic

X

X

0%

X

X

 

BC Palliative Care Drug Plan

BC residents

X

X

0%

X

X

Saskatchewan

Insulin Pump Program

SK residents under 25 years of age with type 1 diabetes

X

X

X

X

X

 

Palliative Care Drug Coverage

SK palliative care patients

X

X

0%

X

X

Newfoundland & Labrador

Select Needs Plan

NL residents with Cystic Fibrosis or Growth Hormone Deficiency

X

X

0%

X

X

Nova Scotia

Drug Assistance for Cancer Patients

NS cancer patients with limited income and no drug coverage beyond Family Pharmacare

X

X

0%

X

X

 

Palliative Care Drug Program

NS palliative care patients

X

X

0%

X

X

New Brunswick

New Brunswick Drugs for Rare Diseases Plan

NB resident

X

X

X

X

X

Prince Edward Island

AIDS/HIV Drug Program

PE resident who is HIV positive or diagnosed with AIDS

X

X

0%

X

X

 

Cystic Fibrosis Drug Program

PE residents with Cystic Fibrosis

X

X

0%

X

X

 

Diabetes Drug Program

PE residents with Diabetes

X

$10.00 /10 mL vial or $20.00/ 5 x 3 mL cartridges of insulin; $11.00 per oral medication prescription; for 100 test strips monthly

X

X

X

 

Erythropoietin Drug Program

PE residents diagnosed with chronic renal failure or receiving kidney dialysis

X

X

0%

X

X

 

High Cost Drug Program

PE residents diagnosed with approved medical condition

X

Varies with household income, + pharmacy fee

0%

X

X

Yukon

Chronic Disease Program

YT residents with a chronic disease that is not covered by public/private plan

Unclear

Unclear

Unclear

First $250 per year

$500 a year per family

Northwest Territories

Extended Health Benefits for Specific Disease Conditions

NT resident with specific diseases

X

X

X

X

N/A

Nunavut

Extended Health Benefit Specified Conditions

Non-Indigenous NU residents with chronic disease

X

X

X

X

N/A

 

 

Table 6 – Characteristics of Publicly Funded Drug Plans for Individuals with Low Incomes or receiving Social Assistance

 

Plan Name

Eligibility

Premium

Fixed Copayment

Co-insurance

Deductible

Max. OOP

Alberta

Alberta Adult Health Benefit

AB residents with low income or receiving social assistance

X

X

X

X

N/A

British Columbia

Pharmacare Recipients of B.C. Income Assistance (Plan C)

BC residents receiving income assistance

X

X

X

X

N/A

Saskatchewan

Supplementary Health Program

Determined by Ministry of Social Services

X

Up to $2 per Rx for adults, depending on status

X

X

X

Manitoba

Employment & Income Assistance

MB residents receiving income support

X

X

X

X

N/A

Quebec

Public  Prescription Drug Insurance Plan

QC residents receiving 94%-100% of GIS

X

X

X

X

X

Newfoundland & Labrador

Foundation Plan

NL residents receiving income support

X

X

X

X

N/A

 

Access Plan

Families and individuals with low incomes

X

X

20%-70% of total Rx costs, varies with income

X

X

Nova Scotia

Pharmacare Benefits

Families and individuals with low incomes

X

$5 per Rx

X

X

X

New Brunswick

Plan E (Adults in Licensed Residential Facilities)

NB residents who reside in a licensed adult residential facility

Unclear

$4 per Rx

X

Unclear

$250 annually

 

Plan F (Social Development Clients)

NB residents with valid health card issued by the Department of Social Development

Unclear

$4 per Rx for adults >18 years

X

Unclear

$250 per family unit annually

Prince Edward Island

Financial Assistance Drug Program

PE residents approved under Social Assistance Act

X

X

X

X

N/A

Sources: Tables prepared by the Library of Parliament using data obtained from Office of the Parliamentary Budget Officer, Appendix H: Provincial Drug Plans Overview, in Federal Cost of  a National Pharmacare Program, Ottawa, 28 September 2017, p. 73-77; Patented Medicine Prices Review Board, Appendix A: “Public Drug Plan Design” - Saskatchewan, in NPDUIS Compass Rx: Annual Public Drug Plan Expenditure Report 2012/13, 1st ed., 1 September 2015; and various provincial and territorial government websites.