PDF (312 kB, 30 pages)PRB 09-06E
Karin Phillips
Social Affairs Division
1 September 2009
PDF (312 kB, 30 pages)
Catastrophic drug coverage is defined as the provision of a general level of coverage that protects individuals from drug expenses that threaten their financial security or cause “undue financial hardship.”(1) The level of hardship can be set either as a fixed dollar figure, or as a percentage of personal or family income.(2)
In 2002, one study estimated that approximately 11% of Canadians faced the risk of experiencing high prescription drug costs because they either lacked or had insufficient drug coverage.(3) In a 2007 international study, 6% of Canadian adults said that their families had out of-pocket expenses of more than $1,000 for prescription drugs per year, a higher percentage of respondents than all of the other seven countries surveyed, except for the United States.(4) Another 2008 international survey further revealed that this proportion rose to 17% for Canadians suffering from a chronic illness, such as diabetes or arthritis.(5)
Both the Senate Standing Committee on Social Affairs, Science and Technology, chaired by Senator Michael Kirby, in its October 2002 final report on the state of the health care system in Canada (Kirby Senate Committee),(6) and the Commission on the Future of Health Care in Canada, led by Roy Romanow (Romanow Commission), in its November 2002 final report(7) recommended the establishment of a “national” or federal/provincial/territorial catastrophic drug insurance plan. In 2003, Canada’s first ministers agreed to take measures to ensure that all Canadians have reasonable access to catastrophic drug coverage.(8) In support of this commitment, the federal government invested $16 billion in a five-year (2003–2004 to 2007–2008) Health Reform Fund to provide provinces and territories with more money to improve health care in a number of ways, including by expanding the provision of catastrophic drug coverage.(9)
Since then, two provinces and one territory have introduced catastrophic drug coverage programs, thereby presumably reducing the percentage of Canadians currently at risk of experiencing financial hardship as a result of high drug costs.(10) Meanwhile, in 2004, as part of a National Pharmaceuticals Strategy, the first ministers also established a federal/provincial/territorial ministerial task force to develop, assess and cost options for national catastrophic drug coverage.(11)
Despite this progress, some Canadians still lack access to catastrophic drug coverage. This paper provides an overview of catastrophic drug coverage in Canada and current challenges facing the system, and it examines the potential for creating a national catastrophic drug coverage plan, as envisioned by the first ministers.
Unlike most countries that are members of the Organisation for Economic Co operation and Development (OECD), Canada does not have a national catastrophic drug coverage system, nor does it have a national universal prescription drug coverage plan.(12) Instead, a “patchwork” of public and private drug insurance plans exists.(13) In total, there are 19 publicly funded drug plans in Canada: ten provincial, three territorial and six federal. These programs complement the more than 1,000 private drug insurance programs offered by employers, unions and professional associations across the country.(14) These plans vary significantly in terms of eligibility, benefit payment structures and drug formularies.
This mixture of private and public drug plans can be explained by jurisdictional divisions with respect to health care and limitations imposed by the Canada Health Act, as well as the unanticipated rapid rise in costs and use of out-of-hospital prescription drugs over the past 20 years. Under the 1867 Constitution, provinces and territories have primary responsibility for the administration and delivery of health services to Canadians, while the federal government is responsible for the delivery of health care to specific subpopulation groups.(15) Provision of health care in Canada is also based upon the Canada Health Act, which establishes five principles that provinces and territories must uphold in order to receive federal funding for health care: public administration, comprehensiveness, universality, portability and accessibility.(16)
Though the Canada Health Act provides for public coverage of physician services and hospital care, the only pharmaceuticals it covers are those used while in the hospital.(17) Out-of-hospital prescription drugs were left beyond the purview of the Canada Health Act, because historically they had played a limited role in the provision of health care, and their costs were not considered a significant financial burden to Canadians.(18) The omission of out-of-hospital prescription drugs from the Canada Health Act meant that any public provision of drug coverage outside of the hospital setting would remain the sole responsibility of the provinces and territories.(19) It also meant that prescription drug coverage was not considered medically necessary, but rather a fringe benefit offered by employers in the private sector.
However, this situation began to change as early as the 1970s, when provincial governments started to recognize that the rising costs of prescription drugs could constitute an increasing financial burden on those with low or fixed incomes.(20) As a result, they began offering drug coverage to certain sectors of the population, including social assistance recipients and seniors. By the 1990s, some provincial governments had acknowledged that all sectors of the population were at risk of experiencing financial hardship due to rising drug costs and therefore introduced universal catastrophic drug coverage plans.
As part of its obligations to particular subpopulations, the federal government also began providing drug coverage to First Nations and Inuit, veterans, federal inmates, members of the Canadian Forces and the RCMP, refugee claimants and federal public service employees.(21)
Details regarding the levels of coverage offered by private, provincial and territorial, and federal drug plans against severe drug costs are outlined in the sections below.
Private plans offered by employers, unions and professional associations are a significant source of drug coverage in Canada, providing approximately 60% of Canadians with some degree of protection from catastrophic drug costs.(22) Of those enrolled in private sector programs, 55% have plans that protect against catastrophic drug costs, either through the provision of a cap on overall drug expenses, or through their coverage of 100% of total drug costs. The remaining 45% have plans that provide substantial but incomplete coverage, commonly reimbursing 80% of drug costs, once a deductible is reached.
It is important to note that private sector plans are the voluntary initiatives of plan sponsors, but they can be regulated by the provinces and territories.(23) In Quebec, prescription drug coverage is mandatory, and private plans are required to provide minimum coverage standards that are equivalent to those offered by the provincial public plan. This regulation allows the province is able to ensure that 100% of its residents have protection against catastrophic drug costs through both public and private programs.(24)
The federal government administers prescription drug coverage plans for specific population groups that do not otherwise have access to private drug plans, or plans offered by provincial or territorial governments. These programs are managed by the following departments: Health Canada for First Nations and Inuit; Veterans Affairs Canada for veterans and regular and retired members of the Royal Canadian Mounted Police; Correctional Service of Canada for federal offenders; Citizenship and Immigration Canada for refugee claimants, Convention refugees, and persons detained by the department for immigration purposes;(25) and the Department of National Defence for members of the Canadian Forces. Altogether, these federal plans cover approximately 1 million eligible clients at a cost totalling $594 million in 2007–2008.
As an employer, the federal government also provides drug coverage to its public service employees through the Public Service Health Care Plan managed by the Treasury Board of Canada Secretariat and administered by private insurer Sun Life Financial.
Beneficiaries of federal plans are well protected from catastrophic drug costs through the provision either of 100% coverage or of partial coverage with out-of-pocket expenses capped at $3,000 per year for federal public service employees. Full details regarding the six federal government drug programs can be found in Appendix A.
Drug plans offered by provincial and territorial governments provide catastrophic drug coverage to those who have only partial coverage through their private plans, have no coverage, or belong to population subgroups that are likely to experience high drug costs relative to income, such as seniors. These programs offer catastrophic drug coverage to approximately 25% of the Canadian population.(26)
The programs fall into two main categories: universal drug coverage plans and targeted drug coverage plans. Universal programs provide catastrophic drug coverage to all sectors of the population by placing a protective cap on drug costs, as either a percentage of income or a fixed dollar amount. Seven provinces and two territories(27) offer universal programs with varying benefit payment structures (premiums, deductibles, and co-payments),(28) as well as caps on payments. Table 1 outlines the annual upper payment limit provided by each of these programs as protection against catastrophic drug costs.(29)
| Province/Territory | Catastrophic Drug Coverage |
|---|---|
| British Columbia | 2–4% of net family income(30) |
| Saskatchewan | 3.4% of total adjusted family income(31) |
| Manitoba | 2.69%–6.08% of total adjusted family income(32) |
| Ontario | 4% of net family income(33) |
| Quebec | $954(34) |
| Nova Scotia | Varying percentage of total adjusted income family income(35) |
| Newfoundland and Labrador | 5,7.5 or 10% of net family income(36) |
| Northwest Territories | 5% of total family income(37) |
| Nunavut | 100% coverage(38) |
It is important to note that Alberta also provides a universal drug coverage program for its residents. The program caps out-of-pocket expenses at $25 per prescription. However, it does not provide an overall cap to protect against high drug costs, but instead limits its payout to $25,000 per year.(39) However, coverage for those who have expenses that exceed this amount is considered on a case-by-case basis. Prince Edward Island, New Brunswick and Yukon do not have universal programs.
As an alternative or supplement to universal programs, provinces and territories also offer catastrophic drug programs targeted to the needs of seniors and those on social assistance or with specific diseases. Most provinces and territories cover 100% of drug costs for people with specific diseases that require high-cost prescription drugs, though the types of diseases covered vary by province and territory. Programs for persons on social assistance and low-income seniors either require minimal co-payments, or they cover the full costs of drugs. Higher-income seniors tend to face higher premiums, deductibles and co-payments, though these amounts are usually capped. For full details regarding both targeted and universal programs by province and territory, see Appendix B.
Although more jurisdictions have made prescription drugs more accessible and affordable to their residents in the last few years, the system is still inequitable. One study has shown that the Canadians who are most likely to be underinsured or to have no insurance at all are those who are young (between the ages of 18 and 34), receive low to middle incomes, or work part-time.(40) There also remains a significant amount of regional disparity in catastrophic drug coverage: Prince Edward Island, New Brunswick and Yukon are still without universal catastrophic drug coverage programs.
Meanwhile, the levels of coverage offered by existing programs vary significantly from one province to the next. For example, a person whose annual household income is $14,000 per year and whose drug costs to treat her or his hypothyroidism and hyperlipidemia total $807 annually would pay $490 a year under Saskatchewan’s Special Support Program, but only $375 under Ontario’s Trillium Drug Program.(41)
Some point out that the mix of public and private coverage in Canada fails to reflect the fact that, owing to changes in medical practice, out-of-hospital prescription drugs have become an integral part of the health care system.(42) Acute conditions that used to be treated in hospital are now treated at home because of advances in technology and drug therapy. For example, new medications for peptic ulcers have eliminated the need for surgery to remove the ulcers.(43) Similarly, such chronic conditions as asthma and high blood pressure are treated through prescription medications.
Consequently, critics argue that prescription drug coverage can no longer be considered a “fringe benefit” offered by employers, but rather constitutes a significant part of Canada’s health care system.(44) They claim that, as a result, prescription drug coverage should be incorporated into the Canada Health Act. Those who hold this belief contend that the country is falling short of the ideal of having all prescription drugs covered under a national drug plan. However, as recommended by the Romanow Commission, the creation of a national catastrophic drug coverage plan could be seen as a first step towards the establishment of a universal pharmacare program.(45)
Furthermore, the increased use of prescription medications to treat illnesses has meant that there has been a rise in the amount that Canadians spend on those drugs. Out-of-pocket expenses for prescription drugs increased by 6.8% per annum for Canadian households between 2000 and 2007.(46) The rapid rise in costs coupled with the aging of the population is bound to lead to an increase in the proportion of Canadians facing catastrophic drug costs.
Finally, some studies have demonstrated that increased out-of-pocket costs for prescription drugs have resulted in negative health outcomes. For example, one researcher found that patients 65 or older were less likely to fill their prescriptions when they had to pay for them. This in turn resulted in increases in their rates of hospital admissions, emergency care and visits to physicians. These results have led health policy researchers to argue that prescription drugs need to be considered medically necessary under the Canada Health Act.(47)
In response to the challenges associated with prescription drug coverage in Canada, policy makers have developed two main options to extend the provision of catastrophic drug coverage to all Canadians.
The first option is to increase federal funding to the provinces and territories to develop new catastrophic drug programs and expand existing drug plans. This was done through the $16-billion Health Reform Fund as part of the 2003 First Ministers’ Accord on Health Care Renewal.(48) Since then, some provinces and territories have used the fund to expand catastrophic drug coverage programs available to their residents. Provinces with catastrophic drug coverage plans, such as British Columbia and Saskatchewan, have used the federal funds to broaden their drug formularies, providing increased coverage for blood products, cancer drugs and supplies for diabetics.(49)
Meanwhile, in 2007, Newfoundland and Labrador introduced a universal catastrophic drug program, while Nova Scotia and the Northwest Territories followed suit in 2008. These initiatives however, were not a direct product of the 2003 Accord or the Health Reform Fund, but rather independent initiatives by the provinces and territories in response to internal needs.(50)
Despite this progress, many Canadians still do not have catastrophic drug coverage,(51) – as noted by the Health Council of Canada, the body responsible for reviewing the implementation of the First Ministers’ Accord on Health Care Renewal – because two provinces and one territory have not yet established universal catastrophic drug plans. The Health Council explained that this lack of progress was due to the absence of accountability in the health care renewal process. Though provinces and territories received increased funding through the Health Reform Fund to expand catastrophic drug coverage, they faced few reporting requirements and did not have to reach any measurable objectives or outcomes.(52)
There have also been several proposals for a national catastrophic prescription drug plan, in which costs would be shared by federal, provincial and territorial governments. In 2002, the Romanow Commission recommended the establishment of a federal Catastrophic Drug Transfer, which would reimburse 50% of the costs of provincial and territorial drug insurance plans, above a threshold of $1,500 per person per year.(53) The commission estimated that, based on 2001 figures, the annual cost of the proposed transfer would total between $749 million and $1.01 billion.(54)
The Kirby Senate Committee proposed instead that the federal government reimburse provincial and territorial drug plans for 90% of drug costs for persons with total expenses exceeding $5,000 per year.(55) The proposal also called for the equivalent reimbursement of private plans. To receive funding, both provincial and private plans would have to cap costs paid by clients at 3% of income, or $1,500, whichever was less. The committee estimated that its plan would cost $500 million in its first year.(56)
Finally, the federal/provincial/territorial ministerial task force on the National Pharmaceuticals Strategy proposed two main options with four variations for a national catastrophic drug coverage plan. The variations for each of the main options and the cost of the option with or without the maintenance of private plan coverage are outlined in Table 2.
| Catastrophic Drug Coverage Options | Variations | Estimated Costs |
|---|---|---|
| Variable percentage of family income (0,3,6,9%) | With private plan | $7.8 billion |
| Without private plan | $10.3 billion | |
| Fixed percentage of family income (4.3%) | With private plan | $6.6 billion |
| Without private plan | $9.4 billion |
Source: Federal/Provincial/Territorial Ministerial Task Force on the National Pharmaceuticals Strategy, National Pharmaceuticals Strategy Progress Report, June 2006, p. 31.
According to research that evaluated the long-term costs and benefits of some of these proposals, the federal costs of the Kirby proposal would be higher than those of Romanow’s proposed transfer.(57) This is due to the higher cost-sharing rate under the Kirby proposal and the rapidly rising cost of drugs (assumed to increase at their current average annual rate, which ranges from 6.5% to 9.5%).
The research showed that, as the population ages, a larger proportion of Canadians experiencing drug costs would qualify both for Romanow’s proposal (with its lower $1,500 threshold for reimbursement) and for Kirby’s (with its higher threshold of $5,000), and that the increase in the cost of drugs and the cost-sharing arrangements in each proposal would determine which plan would be more costly for the federal government. For example, a 9.5% rise in drug costs by 2035 would result in the federal government’s paying 41% of total prescription drug costs in Canada under the Kirby plan, with its reimbursement rate of 90% of costs covered by provincial and territorial drug insurance plans. It would pay only 23.5% of the costs under the Romanow proposal, which, with its lower reimbursement rate of 50%, would shift much of the expense burden to other payers, including provincial governments and private plans. Conversely, if prescription drug costs rise at a lower rate of 6.5%, the proportion of drug costs paid by the federal government in 2035 would be 17.5% under the Kirby plan, with its higher reimbursement threshold of $5,000, and 35% under the Romanow plan.
The long-term costs of the options proposed by the federal/provincial/territorial ministerial task force have yet to be analyzed, principally because the two options given did not specify how the costs would be shared between federal, provincial and territorial governments.(58) However, in its report, the ministerial task force recommended analyzing and costing a fixed 5% of income threshold above which Canadians would be eligible for catastrophic drug coverage. The task force stated that this threshold would be easier to communicate and not create a substantial difference in cost from the estimates for the 4.3% threshold – the average of the maximum income percentage thresholds of the four income-based public drug plans in Canada – used in its initial calculations.(59) The report also suggested that further studies needed to be done to determine the costs associated with extending coverage to those currently not covered by either a public or a private plan.(60)
In a September 2008 meeting on the National Pharmaceuticals Strategy, provincial and territorial health ministers reaffirmed their commitment to extending catastrophic drug coverage to all Canadians. They further agreed that they would pursue a funding formula for national catastrophic drug coverage that would have on average an income threshold of 5%.(61) The costs, estimated at $5.03 billion annually in 2006, would be divided equally between the provinces or territories and the federal government.(62) However, according to the provinces and territories, inability to agree on this cost-sharing arrangement is delaying any further progress.(63) The Health Council of Canada notes that unless this political impasse is overcome, “the National Pharmaceuticals Strategy will remain largely a prescription unfilled.”(64)
| Department | Program | Population Group | Level of Coverage |
|---|---|---|---|
| Health Canada | Non-Insured Health Benefits Program(1) | First Nations and Inuit | The program provides full coverage to those who do not have access to either private or provincial and territorial drug plans. |
| Treasury Board of Canada Secretariat, administered by Sun Life Financial | Public Service Health Care Plan(2) | Federal public service employees and their dependants | The program provides catastrophic drug coverage whereby members pay 20% of drug costs up to a maximum of $3,000 per year. |
| Veterans Affairs Canada, administered by Blue Cross | VAC Health Care Benefits Program(3) | Qualified veterans Current and former serving members of the RCMP |
Group A clients receive full prescription drug coverage for medical conditions resulting from duty. Group B clients receive full prescription drug coverage for regular and high-cost drug expenses, if they are not covered by a private or provincial plan. |
| Department of National Defence | Health Care Benefits(4) | Canadian Forces | The program provides full coverage for all prescription drugs. |
| Citizenship and Immigration Canada, administered by Funds Administrative Service Inc. | Interim Federal Health Program(5) | Refugee protection claimants, Convention refugees and those detained by the department for immigration purposes | The program provides full coverage for essential generic or low-cost alternative drugs. |
| Correctional Service Canada | Health Services(6) | Federal inmates | The program provides full coverage for all prescribed and dispensed drugs. |
| Province/Territory | Program | Benefits Payment Structure | Catastrophic Coverage |
|---|---|---|---|
| British Columbia | Fair Pharmacare | An income-tested deductible(1) (2% to 3% of total net income) is levied. Seniors pay 25% of each prescribed drug, once the deductible is reached. Non-seniors pay 30% of each prescribed drug, once the deductible is reached. Social assistance recipients and those with particular medical conditions(2) do not have to pay a deductible or make co-payments.(3) |
The program provides complete coverage of all prescription drug costs, once members have reached spending limits of 2% to 4% of net family income.(4) Those on social assistance or with particular medical conditions have 100% coverage. |
| Alberta | Prescription Drug Program | There is a quarterly premium(5) based on income. Non-seniors pay 30% of each prescribed drug to a maximum of $25. In 2010, low-income seniors will no longer have to pay for drug coverage, while other seniors will have to pay a premium with a co-payment of 20% to a maximum of $15 per prescription.(6) |
The program is limited to covering a maximum of $25,000 in prescription drug costs. Coverage beyond this maximum is considered on a case-by-case basis. Complete drug coverage is provided for persons with high-cost diseases such as cancer, HIV/AIDS and cystic fibrosis and for persons with severe handicaps. By 2010, catastrophic drug coverage will be introduced for rare genetic diseases.(7) |
| Saskatchewan | Special Support Program(8) | Co-payment is determined by the amount that family drug costs exceed 3.4% of adjusted family income.(9) | Out-of-pocket expenses are capped at 3.4% of adjusted family income. |
| Manitoba | Pharmacare Program | An income-tested deductible, ranging from 2.69% to 6.08% of adjusted total family income is levied.(10) | 100% of costs are covered, once the deductible has been reached. |
| Ontario | Trillium Drug Program(11) | There is an income-tested deductible of not more than 4% of total household net income. | Once the deductible has been reached, members pay $2 per prescription. |
| Quebec | Public Prescription Drug Insurance Plan(12) | An annual premium, ranging from $0 to $585 per adult based upon net income, is levied. There is a monthly deductible of $14.95. Once the deductible is reached, there is a co-payment of 32% of prescription costs. Low-income seniors and those on social assistance do not pay premiums or deductibles, or make co payments. |
The maximum annual payment is $954. Low-income seniors and those receiving social assistance do not pay for coverage. |
| Nova Scotia | Family Pharmacare Program(13) | An annual deductible, based upon total adjusted family income, is levied.(14) Users co-pay 20% per prescription. |
Co-payments are capped at a percentage of total adjusted family income.(15) |
| Newfoundland and Labrador |
Assurance Plan(16) | Co-payments depend upon income levels and drug costs. | Payments are capped at 5%, 7.5% or 10% of net family income. |
| Northwest Territories |
Catastrophic Drug Costs Program(17) for non-Aboriginal residents who experience high drug costs(18) | Users pay a maximum annual co-payment of $3,000. | Co-payments are capped at 5% of total family income. |
| Nunavut | Extended Health Benefits Policy for Métis and non-Aboriginals, or any resident who has no coverage or exhausted third party coverage(19) | No co-payments | This program provides 100% coverage. |
| Province/Territory | Program | Population Group | Benefits Payment Structure |
Catastrophic Coverage |
|---|---|---|---|---|
| Ontario | Special Drug Programs | Persons with specific conditions, including cystic fibrosis, HIV, renal disease and schizophrenia(1) | No deductible(2) or co-payment is charged.(3) | The program provides 100% coverage. |
| New Brunswick | Prescription Drug Program | Persons with specific conditions, including HIV, multiple sclerosis and cystic fibrosis(4) | There is a registration fee of $50 per year. Users co-pay 20% of each prescription to a maximum of $20. |
Co-payments are capped at $500 per year. |
| Nova Scotia | Diabetes Assistance Program | Persons with diabetes(5) | An annual family deductible, adjusted for income and size, is charged. Users must co-pay 20% of prescription costs. |
There is no cap on co-payments. |
| Drug Assistance for Cancer Patients | Low-income persons with cancer(6) | No co-payments are required. | The program provides 100% coverage. | |
| Prince Edward Island |
High Cost Drug Program | Persons with specific high-cost conditions, such as multiple sclerosis, renal failure, sexually transmitted diseases and diabetes.(7) | Co-payments are based on family income. Users must pay the dispensing fee. |
There is no cap on co-payments. |
| Northwest Territories |
Extended Benefits for Specific Diseases/Conditions |
Non-Aboriginals and Métis with specific diseases/conditions such as HIV and diabetes (8) | No payments are required. | The program provides 100% coverage. |
| Yukon | Chronic Disease Program(9) | Persons with a broad range of diseases or conditions, such as HIV and arthritis | An annual deductible, ranging from $250 to $500, is charged. | The maximum payment is $500 per family. |
| Province/Territory | Program | Population Group | Benefits Payment Structure |
Catastrophic Coverage |
|---|---|---|---|---|
| Saskatchewan | Family Health Benefits Program Income Supplements Program |
Low-income seniors and families(1) | The semi-annual deductible(2) is between $100 and $200. A co-payment(3) of 35% of prescription drug costs is levied. |
The program is available through the Special Support Program.(4) |
| Ontario | Drug Benefit Program(5) | Seniors Social assistance recipients |
Low-income seniors and social assistance recipients co-pay $2 per prescription. Higher-income seniors pay a $100 deductible and a $6.11 co-payment. |
Co-payment for each prescription is limited to either $2 or $6.11. |
| New Brunswick | Prescription Drug Program | Low-income seniors(6) | Seniors receiving the Guaranteed Income Supplement (GIS) co-pay $9.05 per prescription. Other low-income seniors co-pay $15 per prescription. |
Seniors receiving GIS pay a maximum of $250 per year. There is no annual maximum for low-income seniors not receiving the Guaranteed Income Supplement. |
| Persons on social assistance | There is a $4 co-payment per prescription. | The maximum payment is $250 per year. | ||
| Nova Scotia | Seniors’ Pharmacare Program(7) | Seniors | An annual premium(8) is based on income. Users co-pay 30% for each prescription. Annual premiums are capped at $424. |
Co-payments are capped at $382. |
| Pharmacare(9) (through the Department of Community Services) | Persons on social assistance and their children Persons with disabilities Children in the care of child welfare |
No payments are required. | The program provides 100% coverage. | |
| Prince Edward Island |
Pharmacy Programs | Low-income families with children(10) | Users pay only the dispensing fee per prescription. | There is no cap on co-payments. |
| Seniors(11) | Users co-pay $11 per prescription and the dispensing fee. | There is no cap on co-payments. | ||
| Persons receiving social assistance(12) | No payment is required. | The program provides 100% coverage. | ||
| Newfoundland and Labrador |
Prescription Drug Program (13) | Persons receiving social assistance | No payment is required. | The program provides 100% coverage. |
| Low-income seniors(14) | Users must pay the dispensing fee. | There is no cap on the payment of dispensing fees. | ||
| Low-income families and individuals(15) | Co-payments range from 20% to 70% of costs, depending upon income levels.(16) | There is no cap on co-payments. | ||
| Northwest Territories |
Supplementary Health Benefits Program(17) | Low-income non-Aboriginal residents | Program currently under review. | Program currently under review. |
| Métis Benefits Program(18) | Métis | No payment is required. | The program provides 100% coverage. | |
| Seniors Benefits Program(19) | Non-Aboriginal seniors | No payment is required. | The program provides 100% coverage. | |
| Yukon | Pharmacare(20) | Non-Aboriginal seniors | No payment is required. | The program provides 100% coverage. |
| Children’s Drug and Optical Program(21) | Low-income families with children | An annual deductible of $250 per child and $500 per family is charged. | The maximum payment is $500 per family. |
PDF (96 kB, 2 pages),
Canadian Healthcare Manager, April 2005, p. 16. PDF (1.22 MB, 36 pages), January 2009, p. 9. PDF (1.14 MB, 392 pages) October 2002. PDF (2.33 MB, 392 pages), November 2002. PDF (29 kB, 11 pages), 5 February 2003. PDF (674 kB, 89 pages), OECD Health Working Papers,
No. 24, DELSA/HEA/WD/HWP(2006)4, 15 February 2007, p. 18. PDF (256 kB, 37 pages), November 2006, p. 5. PDF (146 kB, 27 pages), 2008. PDF (98 kB, 6 pages), November 2009. PDF (140 kB, 2 pages) PDF (57 kB, 17 pages), November 2007. PDF (1.47 MB, 156 pages), 2008, p. 60. PDF (125 kB, 9 pages), December 2004, p. 4; and Government of British Columbia, Ministry of Health Services,
Federal Funding in British Columbia 2003/04: Health Reform Fund – Primary Health Care – Diagnostic and Medical Equipment Fund,
PDF (272 kB, 48 pages) pp. 12–13. PDF (1.7 MB, 20 pages), January 2009, p. 7. PDF (113 kB, 20 pages), April 2008. PDF (922 kB, 4 pages), May 2009. PDF (98 kB, 6 pages), April 2009. PDF (98 kB, 6 pages), April 2009. PDF (140 kB, 2 pages). It is important to note that the Catastrophic Drug Costs Program is under review until April 2010. Therefore, these numbers are subject to change. Northwest Territories Health and Social Services, “
Supplementary Health Benefits Program.” PDF (57 kB, 17 pages), November 2007. PDF (65 kB, 7 pages), December 2008. PDF (44 kB, 6 pages), February 2008. PDF (110 kB, 2 pages).