Provincial Programs
Overview
Health Premiums
When Coverage Begins
Length of Coverage
Outside Canada
What is Covered
Drug
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Albertans are responsible for the cost of prescription drugs provided to them outside hospitals, auxiliary hospitals and nursing homes. Prescription Drugs for Seniors Drug coverage for Seniors is available to all Albertans 65 years of age and older and their dependants. To qualify, one must be 65 years of age or older, or be the spouse or adult interdependent partner of a person 65 years of age or older, be a resident of Alberta, be registered with the Alberta Health Care Insurance Plan and have not opted out of the plan, and must have submitted proof of age to either Alberta Health and Wellness or to Alberta Seniors and Community Supports. Eligible Albertans pay 30% of the cost, to a maximum of $25, for each drug prescribed. Individuals are responsible for additional costs related to the choice of more expensive brand-name drugs instead of an equivalent generic drug. Proposed changes to seniors' drug plan, scheduled to take effe t on July 1, 2010, has been delayed.
Alberta Blue Cross Non-group Coverage As of July 2010, premium rates are $63.50 (single) and $118 (family). *Subsidized premium rates are available based on an individual's prior year income tax return. Premiums are currently set at: Regular Coverage $41.00 (single) or $82.00 (family), with quarterly bill rates set at $123.00 (single) and $246.00 (family). Beginning July 2010, premium rates will be increased to $63.50 (single) and $118 (family). *subsidized premium rates are available based on an individual's prior year income tax return. The prescription drug benefits of Non-group coverage are as follows: Co-payment is 30% to a maximum of $25 unless drugs are not listed in the Alberta Health and Wellness Drug Benefit List, an individual chooses a more expensive brand of drug than the lowest-cost or generic brand, or if the brand of drug costs more than the maximum cost set by Alberta Health and Wellness Other Alberta Employment and Immigration contracts with Alberta Blue Cross to offer health benefits, including prescription drugs, for the following client groups:
Additional Coverage Other mechanisms employed by Alberta Health and Wellness to provide coverage for prescription drugs include:
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Fair PharmaCare Program All BC residents currently receiving MSP benefits are eligible to apply for Fair Pharmacare, which is income-based. Residents are responsible for the full cost of prescription drugs until prescribed deductibles have been reached. Maximum annual costs are also prescribed. PharmaCare will pay 70% of your family's eligible costs for the rest of the year after an income-based deductible is reached and until the family maximum is exhausted. For those born in 1939 or earlier, PharmaCare will pay 75% of eligible costs for the rest of the year, after an income-based deductible is reached. Deductible and maximum amounts are based on income bands rather than individual/family income, and range from 2/3% to 2-4% respectively, depending on the income band. PharmaCare sets a maximum cost that it will recognize for eligible prescription drugs and medical supplies and for a dispensing fee. Individuals are responsible for additional costs. Other Drug Programs Permanent Residents of Licensed Residential Care Facilities (Plan B) - PharmaCare covers the full cost of eligible prescription drugs and designated medical supplies for permanent residents of licensed residential care facilities in B.C. Recipients of B.C. Income Assistance (Plan C) - 100% coverage of eligible prescription costs for B.C. residents receiving medical benefits and income assistance through the Ministry of Housing and Social Development. Cystic Fibrosis (Plan D) - Individuals with cystic fibrosis who are registered with a provincial cystic fibrosis clinic receive digestive enzymes free of charge through Plan D. Children in the At Home Program (Plan F) - provides community-based, family-style care for severely handicapped children who would otherwise become reliant on institutional care. Children receiving full benefits or medical benefits through the program qualify for full coverage of eligible prescription drugs and designated medical supplies. No-Charge Psychiatric Medication Plan (Plan G) - available to individuals of any age who are registered with a mental health services centre and who demonstrate clinical and financial need. The plan provides coverage of certain psychiatric medications. Registration and approval is required. BC Palliative Care Benefits Program supports BC residents of any age who have reached the end stage of a life-threatening disease or illness and who wish to receive palliative care at home. B.C. Centre for Excellence in HIV/ AIDS-available to HIV-positive persons living in British Columbia for receipt of antiretroviral drugs free of charge when enrolled with the centre. |
Pharmacare is an income-based program available to all Manitobans, regardless of age. Coverage is based on total family income and the amount paid for eligible prescription drugs. An annual deductible is assigned based on these factors and ranges from 2.69% up to a maximum of $15,000, to 6.08% on total income above $75,000. Other programs are available for social assistance recipients, residents of long-term care facilities and the terminally ill. |
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The NB Prescription Drug Program provides benefits to a number of eligible beneficiary groups. Eligible groups include:
Plan A-Seniors - available to those age 65 and over who receive the federal GIS or qualify based on an annual income as follows:
Beneficiaries receiving the GIS are required to pay a co-payment of $9.05 for each prescription, up to a maximum of $250 in one calendar year. Beneficiaries who qualify based on their total annual income are required to pay a co-payment of $16 per prescription with no yearly co-payment maximum. Individuals must be registered with New Brunswick Medicare in accordance with the Medical Services Payment Act. An application package is automatically sent to every New Brunswick resident 60 days before their 65th birthday and must be completed and forwarded to the program in order for coverage to be considered. For those whose income level disqualifies them from participating in the NB Prescription Drug Program, a Medavie Blue Cross Seniors' Drug Plan is available with premiums payable at a rate of $105 per month. |
The Prescription Drug Program provides financial assistance in the purchase of eligible prescription medications and has five branches.
The NLPDP also provides 100% coverage for disease-specific medications and supplies for patients with Cystic Fibrosis and Growth Hormone Deficiency. |
Alberta Blue Cross administers the following programs on behalf of the Government of the NWT:
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Nova Scotia provides assistance to eligible residents through various programs to help pay for prescribed medications and supplies listed in the Nova Scotia Formulary including:
Seniors' Pharmacare Program - available to eligible residents age 65 and over who do not have drug coverage through Veterans Affairs Canada, Non-Insured Health Benefits, Nova Scotia Family Pharmacare or any other public or private drug plan. The plan covers certain prescribed drugs and supplies listed as benefits under the Nova Scotia Formulary. Seniors are responsible for an annual income-based maximum $424 premium and a copayment of 30% of the total cost of each prescription. The annual maximum copayment is $382. Seniors are responsible for additional costs incurred when the purchase of brand name drugs are more expensive than generic, when the drug or supply prescribed is more than the maximum amount the program will pay, when prescribed costs are more than the maximum amount Seniors' Pharmacare will pay, or the drug prescribed is not covered by the plan. |
Seniors and persons with chronic illness may obtain some coverage for drugs and medical supplies through the Extended Health Program. Inuits are eligible for coverage through Health Canada. No coverage is provided for non-Inuits.
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Ontario's drug benefit programs provide reimbursement for the cost of pharmaceutical products listed on the provincial drug formulary. Coverage is provided through the following programs: Trillium Drug Program Drug Benefits for Ontarians with a valid Health Card for certain expensive outpatient drugs used to treat specific diseases or conditions Special Drugs Program Drug benefits for Ontarians with a valid Health Card for certain expensive outpatient drugs used to treat specific diseases or conditions. New Drug Funding Program for Cancer Care Drug Benefits for newer, intravenous drugs, typically administered in hospitals and cancer care facilities. The Ministry provides about 75% of the overall funding for intravenous cancer drugs in Ontario and hospitals fund the remaining 25% through their operating budgets. Ontario Drug Benefit (ODB) Program Drug benefits for Ontarians aged 65 and older, residents of long-term care homes and homes for special care, recipients of professional home services and social assistance and recipients of the Trillium Drug Program. ODB eligible recipients may be asked to pay some portion of their prescription drug product cost as follows:
The benefit year for all ODB recipients starts on August 1 and ends on July 31 of the following year. An Exceptional Access Program also exists to review funding requests for drugs not listed on the Formulary. |
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Effective September 1, 2010, the co-payment will be reduced to $8.25. The Seniors Program pays the full cost for eligible prescriptions minus the co-payment and the senior must also pay the dispensing fee. The Family Health Benefit program assists lower income families with the cost of prescription drugs. Families with at least one child under age 18 with a total annual income less than $24,800 are eligible to participate. |
All residents must be covered by a private drug plan or the public drug plan. Those eligible for coverage under a private plan must join that plan and private plan benefits cannot be less than the minimums set by the public plan. The Public Prescription Drug Insurance Plan is intended for persons age 65 and over, recipients of last-resort financial assistance and other holders of a claim slip, persons who are not eligible for a private plan, or the children of persons covered by the public plan. It covers drugs obtained on prescription in Québec and dispensed by a pharmacist. The drugs covered are listed on the provincial List of Medications. Public plan participants must pay an annual income-based premium, which is collected every year by the Ministère du Revenu du Québec when income tax returns are filed. Premium rates are revised annually in July. The current annual rate (July 2010-June 2011) varies depending on net family income and indicated below: Adults age 18 to 64 not eligible for a private plan
Persons age 65 or over: No GIS
Persons age 65 or over: 1-93% GIS
Holders of claim slips issued by the Minister, persons age 65 or over receiving 94%-100% of GIS, children of persons insured under the public plan who are under age 18 and children of persons insured under the public plan who are age 18-25, full-time students, without a spouse and living with their parents, are exempt from monthly deductibles, monthly co-insurance, monthly contribution maximums and/or related obligations when filing income tax returns. |
Coverage provided to eligible Saskatchewan residents for listed drugs prescribed outside Saskatchewan hospitals. Saskatchewan Health lists these covered drugs in the Saskatchewan Formulary. Eligible persons include those in receipt of Supplementary Health Program benefits, a maximum of $2.00 per covered prescription is paid by the individual. Special benefits are available through the Saskatchewan Aids to Independent Living (SAIL) program (coverage is limited to people registered with SAIL's Paraplegia, Cystic Fibrosis or End Stage Renal Disease programs), Emergency Prescription Drug Assistance, for those who require immediate treatment and are unable to cover their share of the cost; and a Palliative Care Drug Program (PCDP) for patients whose life expectancy is measured in terms of months. Seniors' Drug Plan - persons resident in Saskatchewan aged 65 and older pay no more than $15 per prescription (inclusive of dispensing fees) for drugs listed under the Saskatchewan Formulary, including drugs under Exception Drug Status. Seniors receiving either Saskatchewan Income Plan or federal Guaranteed Income Supplement have a $100 or $200 semi-annual deductible applied. Seniors benefiting from coverage will pay either the Special Support co-payment or the $15 per prescription cost, whichever is lower, while seniors whose drug costs or diabetic supplies exceed 3.4 per cent of total family income may be eligible for additional assistance (lower deductibles and/or co-payment schemes based on income and drug costs). |
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Pharmacare eligibility:
Pharmacare pays total costs of lowest priced generics of all prescription drugs listed in the Yukon Pharmacare Formulary, including the dispensing fee. Certain non-prescription drugs and goods are also covered by the program such as:
Children's Drug Program Provides assistance to low income families for prescription drugs for children. |