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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, 1^st ed., 1 September 2015; and various provincial and territorial government websites.