Canada's Pharmacare patchwork: the digested read

We're still no closer to a fair and comprehensive national drug plan.
Comparing our current provincial plans shows none are
truly ready for primetime

By Abe Konigsberg

Part of the problem boils down to semantics — how do we define catastrophic costs? Well, if we peg it at 4 to 5% of household income, as did healthcare consulting firm Applied Management, then a lot of Canadians fall within the catastrophic bracket. And indeed most provincial drug plans have chasmic cracks between which many citizens fall. For instance, an article entitled "Who's the fairest of them all?" recently published in Longwoods Review found that nearly a fifth of Newfoundland seniors are in the catastrophic bracket of drug buyers, while 12.1% of non-seniors in Nova Scotia are in a like situation. Even the much ballyhooed Quebec Pharmacare plan leaves 7% of seniors paying 4.5% or more of their annual income for drugs.

At the Council of the Federation meeting in July the premiers decided to think big and agreed upon a comprehensive national pharmacare plan — with Ottawa footing the bill. Left-leaning greenhorn federal Health Minister Ujjal Dosanjh was at the helm and it looked for a moment like they had a workable deal on the table. But then the trail went cold.

Coming up with a solution ought to take a load off doctors leery about writing expensive but appropriate scripts for impecunious patients. Canadian patients as a whole coughed up $16 billion for prescription drugs in 2003.

Link to pdf for a breakdown of public pharmacare options currently available in each province. Who's the fairest? You be the judge.

• Fair Pharmacare www.healthservices.gov.bc.ca/pha rme • Alberta Health and Wellness supplementary health plans (administered by Alberta Blue Cross) www.health.gov.ab.ca/ahcip/prescription • The Saskatchewan Drug Plan www.health.gov.sk.ca/ps_drug_plan • Manitoba Pharmacare Program www.gov.mb.ca/health/pharmacare • Ontario Drug Benefit www.health.gov.on.ca/english/publ ic/program/drugs/drugs_mn.html • The Public Prescription Drug Insurance Plan www.ramq.gouv.qc.ca/en/citoyens /assurancemedicaments • New Brunswick Prescription Drug Program www.gnb.ca/0212/intro-e.asp • Nova Scotia Pharmacare www.gov.ns.ca/health/pharmacare • PEI Drug Cost Assistance Formulary www.gov.pe.ca/infopei/index.php3 ?number=45156 • Newfoundland and Labrador Prescription Drug Program (NLPDP) www.gov.nl.ca/health/nlpdp • Yes, but they must pay 30% of the drug’s cost, plus a 2-3% deductible. Those making >$30,000 a year could spend up to 4% of their net income before the maximum contribution kicks in. • Yes, but everyone except seniors and Social Assistance recipients must pay a quarterly premium which ranges from $61.50-$123. Plus there is a co-payment of 30% for each script. • Not for high income earners but the ‘working poor’ who qualify for Family Health Benefits can opt in. • Yes, with three deductible categories: households with annual incomes of <$15,000, those earning >$15,000 and Social Assistance recipients. • Yes, for families who have hefty drug tabs. • Absolutely, everyone is compelled to opt in if you don’t have private drug coverage. • Only seniors and Social Assistance recipients. But change could be afoot. The premier’s 2004-2008 health plan states: “Savings from non-clinical efficiencies directed to new catastrophic drug program.“ • There’s no coverage for the nonsenior general public, apart from Social Assistance recipients. • Apart from seniors, families on low incomes are eligible. • Only seniors who receive Guaranteed Income Supplements and non-seniors on Social Assistance are eligible. • A new scheme makes income, not age, the deciding factor for how much coverage one receives. There’s a clause that lets people born before 1940 keep their current plan which has a lower maximum contribution ceiling. • There’s no annual maximum contribution, except for Social Assistance recipients. • It requires beneficiaries to pay a premium which varies depending on age and income. • The deductible is equal to the maximum annual contribution. The plan would be most useful to those with catastrophic drug expenses. • There’s no premium but the deductible is relatively high, but after paying it co-payments are low (between $2.00-$6.11). • Generally, the most comprehensive public plan and the most complicated — it’s the only plan that entails premiums, deductibles and co-payments. • There’s a rather nasty gap in coverage for seniors who have an income above $17,198 — they must pay a premium of $58 a month, plus a copay of $15 per script. • All seniors pay between $3 and $30 per script in co-payments. Wealthier seniors also must pay a premium relative to their income. • Regardless of income, all seniors pay $10 per script plus a ‘professional fee’ between $4 and $8. There is no maximum annual contribution. • This is the only provincial plan that does not offer coverage to a segment of the senior citizenry. • Full coverage • Yes. They pay $2 per script up to a maximum of $72 a year. • Yes. They pay $2 per script with no annual maximum. • Yes. Full coverage. • Yes. $2 per script, a fee which pharmacies may choose to waive. • Yes. Full coverage. • Yes. $4 per script for those over 18 years of age, those younger pay half. The annual maximum is $250 per family. • Yes. $5 per script with no annual maximum. • Full coverage, but recipients need to go to the provincial pharmacy. • Yes. Full coverage. For further information, please see “Who’s the Fairest of Them All? Which Provincial Pharmacare Model Would Best Protect Canadians Against Catastrophic Drug Costs.” Longwoods Review Vol 2 No 3 2004.