What’s Not Covered: Canadian Prescription Drug Insurance
On my way flying up to Vancouver, my seatmates and I had gotten on the subject of health care services not covered by the Canadian health care system. The item that raised the greatest concern for me was pharmaceutical coverage.
My understanding of the situation was pretty hazy so I decided to take a trip to the Urban Fare Market downstairs from our condo to talk to the pharmacist. Well, I didn't actually take it up with the pharmacist since he looked perpetually harried, as is so often the case with pharmacists. But there was an employee who turned out to be a 4th year pharmacy student doing some sort of internship and he seemed to have plenty of time to answer my questions.
I had come away with the impression from my friends on the plane that people got their prescription drug coverage through private insurance purchased either by individuals or employers. That turned out to be partially correct. But my pharmacy intern friend told me there is, in fact, a government program in British Columbia called PharmaCare that provides some prescription drug coverage based on income.
At this point, the intern stepped out from behind the desk, took me aside and gave me a quick education about the Canadian health care system...
There isn't just one Canadian health plan. Each province has a different health care plan. They are all a part of Canadian Medicare, which stipulates a few general requirements all the provincial plans must fulfill. In British Columbia, all legal residents are covered by the Medical Services Plan (MSP), which covers all medically necessary care provided by doctors and hospitals. There are premiums for everyone who makes more than $22,000 but no deductibles or co-payments.
Everyone who is covered by the Medical Services Plan is also covered by PharmaCare. For folks who earn less than $15,000 per year, all their prescriptions are free. For everyone else, there is a deductible based on income, which must be met before the government starts covering 70% of the price of medications.
After folks have spent a certain amount out-of-pocket, medications are 100% covered. The amount a person has to spend before the 100% coverage kicks in is also based on a person's income.
For example, an individual or family with a net income of $50,000 has a deductible of $1500. After they spend $1500, their prescriptions are reimbursed at 70%. Once they have spent a total of $2000, the government covers 100% of their prescription costs.
This is where the private insurance may come in. Some employers provide private insurance that picks up the out-of-pocket expenditures. Evidently, this was the situation for the folks I met on the plane. And sometimes individuals decide to purchase private insurance on their own. Depending on the plan, private insurance may also cover other services not picked up by the Medical Services Plan such as physical therapy, chiropractic, and dental services.
Now this brings up the question whether folks who don't have private insurance can end up unable to afford the prescriptions they need. This is a scenario that is not terribly uncommon in the U.S.
I asked my pharmacy student buddy whether people come into the pharmacy who can't afford to buy their meds. His answer was yes. He said if the problem is that the prescription is for an expensive, non-covered medication, the person could qualify for Special Authority coverage. If somebody is just waiting for his or her next paycheck, the pharmacy can advance some medication. And of course, many prescription drugs are far less expensive in Canada. However, he said that even in Canada, there are prescriptions that can cost $1000 or more.
At last my intern friend had to get back to work. But I’m going to continue enquiring about the prescription drug situation. It appears that even in Canada, the pharmaceutical industry scores on this one.