A public drug plan is a government-subsidized plan designed to help certain groups of people access prescription drugs. Traditionally, government drug plans were targeted to those who did not have access to an insurance drug plan. Today they help a range of different people in different situations. Public drug plans do not always offer “automatic” enrollment. Many programs require you to apply and may not offer 100% coverage.
Federal Drug Plans
The federal government provides drug plans for certain groups that fall under its mandate for health care responsibility:
- Veterans (VAC)
- registered First Nations & Inuit (NIHB)
- active members of the RCMP
- active members of the military
- inmates in federal correctional facilities
- certain groups of refugees (IFH)
This represents about 3% of all drug plans in Canada (Source: CIHI Prescribed Drug Spending in Canada). Each plan has its own administration and a list of drugs it covers. These plans typically cover drugs at 100% but may impose limits on quantities or other restrictions.
If you have a federal drug plan, the oncology drug access navigator may provide some basic information about drugs that are covered on your plan but will work in tandem with your pharmacist to process any requests to the plan for coverage or for prior authorization. If you are in the military, this will be the pharmacist at your assigned base.
For more information on the federal plans, or to check the list of drugs covered on certain plans, go to the Government of Canada website.
Provincial Drug Plans
Each provincial government has enacted different drug plans over the years. Each plan was created to respond to specific needs for specific groups of people. Approximately 24% of Canadians rely on a provincial public drug plan as their sole source of drug coverage (Source: CIHI Prescribed Drug Spending in Canada). Provincial drug plans are only available to residents of the province with a valid provincial Health Card number.
Each province has different programs, with different eligibility criteria, fee structures, and processes. They also differ in the drugs they cover. However, there are some common types of programs:
Types of Provincial Public Drug Plans
These plans are targeted to persons age 65 and over who do not have access to an insurance plan. In NS and NB, eligible residents are sent an enrollment package a few months before their 65th birthday, and enrollment is voluntary. In PEI, all eligible residents are automatically enrolled in the seniors plan the month they turn 65. In NL, only residents who receive the Guaranteed Income Supplement (GIS) are eligible. The NL Prescription Drug Program is notified by Service Canada that a senior is in receipt of the GIS, and upon notification the eligible person is sent a letter and information form to complete.
Every province offers help with the cost of prescription drugs for those on provincial government income assistance programs & provincial disability support programs. There are also some provincial drug plans for those who are not on income assistance programs but who can demonstrate a family income under a specified amount.
Family or General Coverage Plans
In recent years, the provincial governments have responded to calls for programs that address the needs of those who aren’t over 65 and who don’t qualify for low income drug plans. These are individuals and families who lack insurance (or enough insurance) to cover their prescription drug costs. These plans do not provide 100% coverage. They are designed to ease the burden of out-of-pocket prescription costs. Some require a premium or fee to be paid up front, with coverage kicking in once the premium is paid. Others require the person/family to first satisfy a deductible by paying for prescriptions until that amount is met.
High Cost or Specific Drug Plans
These plans target specific “high cost” drugs that are needed for treatment and supportive drugs that are needed for specific situations (most commonly, anti-rejection after bone marrow or solid organ transplant). Some provinces provide a high cost drug plan that ensures patients have quick access with no cost to certain drugs. Other provinces require a person to submit income information or proof of payment and the costs are instead cost-shared. Every province is different in their approach and the types of drugs they cover.
There are a range of other measures that the provincial governments use to help ensure provincial residents have access to the prescription drugs they need at certain points in their care. These include drugs provided as part of government home care programs, palliative care programs, drug addiction programs, mental health programs, and nursing home care. Access to these programs is usually through the doctor or nurse in that provincial program. A health professional in that provincial program or facility will discuss your eligibility for drug coverage and provide an application if required.
Want to learn more? Click below on the provincial program that best suits your situation as a cancer patient. This is not a complete listing of all provincial programs, but the ones most frequently used by patients in cancer care in Atlantic Canada.
Low-Income Drug Plans
Nova Scotia Community Services Pharmacare
Nova Scotia Low-Income Pharmacare for Children
Nova Scotia Drug Assistance for Cancer Patients
New Brunswick Social Development
Prince Edward Island Financial Assistance Drug Program
Prince Edward Island Family Health Benefit Drug Program
Newfoundland and Labrador Foundation Plan
*Nova Scotia has a high cost drug program that is operated out of the QEII Health Sciences Centre pharmacy in Halifax. The information on the drugs covered through that program is not published on-line. For cancer patients, coverage is limited to specific anti-rejection drugs post-transplant and a drug to prevent neutropenia. Patients must meet certain clinical qualifying criteria to access the drugs on this program, and referrals are made by the prescribing oncologist or hematologist. Drugs are dispensed directly from the hospital pharmacy and patients are charged a dispensing fee. For more information, contact your oncology drug access navigator.