Do Canadians pay for their prescription drugs?

[ailsagirl]

I was never clear on this.

Thanks!

[domlaw]

1. "Do Canadians pay for their prescription drugs?"

Yes we do. In Quebec we are more heavily subsidized than say Ontario, but overall drugs are relatively inexpensive (I live in the Ottawa / Hull area).

Also, most jobs after three months provide full benefits. I've never had a job that didn't.

[ailsagirl]

2. Thanks for the post, domlaw.

I just read that prescription drugs are not paid for by socialized
medicine. So does that mean Canadians have to pay the full price?
I know that Lipitor (for high cholesterol) is over $100 (American)
for a 30-day supply. Would it cost that much in Canada?

Yikes

:hi:

[domlaw]

3. socialized medicine

Well that all depends on your income. For example if you are on assistance then it's all free (dentist, doctor, medicine, special needs etc.)

If you are employed, the majority of employers cover Dentist / Medicines. Again I'm talking from my own experience that nearly all my employers have covered this, no questions asked.

Of course all of your medical needs are covered. if, for example, you are hospitalized then its all free.

Going to the doctor = free
Going to hospital = free
Clinic = free (sometimes a surcharge of $10.00 for a doctors note for work.)

In Quebec my son has full dental care until 12 = free

In other words, if you are sick then you will not go into debt to cover your medical needs. I have never met anyone who has had this happen, we actually do feel for you guys.

[ailsagirl]

6. What if you're unemployed??

Hey, you're a newbie! Welcome to DU!!

:hi:

Do unemployed Canadians qualify for prescription benefits?

[domlaw]

9. Short answer yes

I think you show your EI slip and it's free.

[ailsagirl]

11. That's pretty cool!! Not like HERE :=(

Never have we had such a "government"-- I don't even
have to check the ramifications of any bill that's signed
into law because I know that if the repugs are for it,
it's bad news for the country.

Really unbelievable.

Do Canadians realize how screwed up things are down here??
And how unhappy most of the population is?

:(

[iverglas]

19. actually, no ;)

Pharmacare arrangements vary from province to province.

As I understand it (a quick Google), seniors in BC pay a maximum co-pay of $25 per prescription, $275 annual cap. In Ontario, it's $2 per prescription, $100 annual cap. I believe people with "drug cards" -- people on social assistance or the working poor up to some level -- pay the same co-pay. Many pharmacies in Ontario, like my local independent guy in a low-income neighbourhood, don't charge the co-pay.

A person on unemployment benefits would qualify if their income was below the cut-off for a drug card, but they would have to apply for and receive the card.

I'm self-employed, high income. No drug benefits. For me to buy into a private plan, even if I could find one, would cost more than it's worth. Mind you, with the co-vivant having just started on insulin ...

People employed with major employers generally have the kind of supplemental insurance coverage described here, i.e. have the option of buying in; it's usually paid 50-50 by the employer and employee. It will cover dental, eyeglasses, drugs and a certain number of pyschotherapy sessions, for example.

My co-vivant is also on Lipitor, but gets samples from his doc at the community clinic where we choose to be patients (rather than going to a doc in private practice), I suspect because most of her clients have drug cards, and others have supplemental private insurance through their jobs. So I don't know what it would cost otherwise. Possibly what you said, but I don't imagine quite that much.

Here's a rather technical article about prescription drug policy in Canada:
http://www.expressnews.ualberta.ca/article.cfm?id=4737

... our enormous neighbour to the south is further muddying the waters when it comes to pharmacare. The U.S. industry lobby group PhRMA has funded a million-dollar lobbying campaign to "change the Canadian health-care system." This means they want to raise the price of prescription drugs in Canada to those of the U.S. Frankly, Canadians' access to medications is in enough trouble without U.S. interference. Our policymakers need to show some intestinal fortitude on this issue. There is a principle worth defending here: the preservation of the Canadian approach to health care, characterized by a strong belief in the rights and interests of patients.

One reason that NAFTA is a subject of concern is that it could very well prevent Canada from implementing a national pharmacare program, thereby ousting USAmerican insurance companies from the prescription drug insurance market. Those companies would have standing to challenge Canada's legislation.

An article in the Canadian Medical Association Journal about the lack of attention to pharmacare, and particularly the need for catastrophic out-patient drug coverage. (If you're in the hospital, your drugs are free; if you're taking an expensive anti-cancer drug at home, say, you pay for it.)
http://www.cmaj.ca/cgi/content/full/171/6/565

One gaping hole in Canadian medicare is the lack of universal public insurance for outpatient drugs. The benefits of prescription drugs are undeniable, but their full potential, as Roy Romanow noted in the report of his Royal Commission, will be realized only once they are fully integrated into the health care system in a way that ensures their appropriate utilization.

Still, because prescription drugs are almost always considerably cheaper in Canada (as a result of the govt's negotiations with the pharmaceutical companies), the issue isn't a big one for most people.

Another commentary, from the Canadian Cancer Society:
http://www.bc.cancer.ca/ccs/internet/standard/0,2939,3278_335421_363674_langId-en,00.html

Aha -- finally: a paper prepared for Health Canada on the subject. This is its summary of existing provisions (I've never had them at all straight in my own head, you see).
http://www.hc-sc.gc.ca/iacb-dgiac/arad-draa/english/rmdd/wpapers/pharma02.html

Even though the Canada Health Act does not require the provinces to offer coverage of pharmaceuticals (except for patients in hospital), all provinces have plans that pay for the drugs of individuals receiving social assistance, and all but two have plans that cover every individual older than age 65. (The exceptions are New Brunswick and Newfoundland, whose plans only cover senior citizens with income low enough to qualify for the guaranteed income supplement.)

In addition to the plans that cover all senior citizens and social assistance recipients, the western provinces, Ontario and Quebec have at least some type of coverage that is available to all citizens, although in some cases with very high deductible provisions. Among this group, Quebec is unique in that it has a plan under which pharmaceutical insurance is mandatory. However, those who are eligible for private group insurance through their employer do not have to enroll in the public plan (indeed, are not allowed to do so).

<I'm in Ontario, and frankly I had no idea that Ontario offered such a plan to anyone other than seniors and low-income people.>

Most of the provincial/territorial plans are tax-financed, although there are some exceptions. In Quebec, those insured under the public plan have to pay an annual premium, determined on the basis of net income, that varies from $0 to $350 per adult per year. The premium is collected annually through the provincial/territorial income tax system.

Alberta offers an extended health benefits plan, which includes drugs for those not covered by plans for seniors and social assistance recipients, at a three-month premium of $123 per family. In both cases, premium subsidies apply to those with low income. In Nova Scotia, seniors must pay a premium of $215, while seniors in New Brunswick who do not qualify for low-income coverage have to pay a monthly premium of $58 per person.

Most plans have either deductibles or some type of co-insurance or co-payment provision; several provinces have both. In many cases, deductibles and stop-loss provisions14 differ by categories of beneficiaries, or are computed according to the beneficiaries' income (e.g. Manitoba, Ontario's Trillium plan). In some cases, the deductibles and co-insurance provisions of the residual plans for people who do not have low incomes are so high that the plan may be best characterized as catastrophe insurance. Thus, the standard deductible in Saskatchewan's residual plan is $850 per six months, and there is a co-insurance provision of 35 percent of the cost of each prescription thereafter. In B.C., the corresponding plan has an annual deductible of $600, followed by co-insurance of 30 percent, with an annual patient payment ceiling of $2,000. The public plan in Quebec has a smaller cost-sharing element: a three-monthly deductible of $25 per adult, and then co-insurance of 25 percent of the prescription cost, up to a total ceiling of $187.50 per three months (lower for those with low income). In the Maritime provinces, there are no deductibles, though some co-payments apply.

[CHIMO]

21. Just A note

In Alberta seniors have a Blue Cross plan that requires a one third payment for the equivalent drug. With a small yearly deductible.
So the additional coverage may be there but from what I am seeing here the overall plans are nowhere near what Ont. and Que. are offering.

And to bring to the attention of many, there are many self employed or contractors who get no assistance from the customer. In addition to part timers.

I guess in summary there is no Canada medicare plan. There is a minimum obligation from the province to meet the requirements for maintaining the federal funding.

[iverglas]

22. and another ;)

So the additional coverage may be there but from what I am seeing here the overall plans are nowhere near what Ont. and Que. are offering.

Ontario doesn't offer shit, actually -- except the fairly good coverage for seniors (universal, not means-tested) and social assistance recipients / working poor. Of course, there used to be no co-pay at all (it's $2 now), until Mikey Harris both slashed social assistance benefits and imposed the $2 co-pay.

http://www.health.gov.on.ca/english/public/pub/drugs/trillium.html

You can apply to the Trillium Drug Program if:

- your private insurance does not cover 100% of your prescription drug costs;
- you have valid Ontario Health Insurance (OHIP); and
- you are not eligible for drug coverage under the Ontario Drug Benefit (ODB) Program.

... The program has a deductible that is based on income and family size. Each year starting August 1, you must pay your drug costs up to your deductible level before you are eligible for drug coverage. The program runs from August 1 of one year to July 31 of the following year.

On August 1, 1999, the annual up-front deductible previously paid by Trillium recipients changed to a deductible that is paid in four installments over the Trillium program year (August 1 to July 31 of the following year). For example, a family with an annual deductible of $500, will pay $125 for prescriptions purchased at the start of each quarter on August 1, November 1, February 1, and May 1. After the deductible is paid in each quarter, the family will receive benefits for that quarter, and may be asked to pay up to $2 per prescription each time they purchase a covered drug product.

Now, I've never been much of a prescription drug user ... the odd penicillin for ear infections ... so $500 strikes me as a lot. With the c.v. on insulin now, it looks like that will cost about $600 a year. I could save $100, I suppose. Except that my deductible would be way higher than $500, I have no doubt. (Can't find any info on line about income / deductible level.)

Oh look! A guide to provincial drug coverage plans:
http://www.drugcoverage.ca/content/content.asp?ContentTypeID=27&LanguageID=1

Example:
http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/AttachDocsPublish/014-S46850E-87~10/$File/trillium_bookE_.pdf

Household income $50,001 - $50,005
Deductibles
Family of 1 --- $1881
Family of 2 --- $1761
Family of 3 --- $1711
Family of 4+ -- $1761

That is, a family of 4 earning $50,000 a year must spend more than $1761 on prescription drugs in a year before getting any benefits.

For a family of 4 earning $100,000, it's $3,889.

So while I gather it's free to enrol, it's really no use to anyone who does not have extraordinary expenses. Who spends $3,000 a year on prescription drugs?? It's some coverage of really unusual expenses for some people, but it's no use to average people with prescriptions worth a few hundred dollars a year, even.

[CHIMO]

23. Thanks

For the O look! reference.

My comment was on seniors.

Found the basic prescription coverage. Don't know if this is for each trip to the pharmacy or on a yearly basis.

"You will be asked to pay 30 per cent of the cost, to a maximum of $25, for each drug prescribed. If you choose a more expensive brand name drug instead of an equivalent generic drug, you will be asked to pay the additional cost."

As I understand it additional Blue Cross coverage costs, are similar to what one would expect, high unless one has extraordinary requirements.

[tocqueville]

13. In countries like France, Sweden it's called social security

(not to be mixed with American social security)

basically it works like this :

when you go to a doctor you are reimbursed (repayed) 70-80%

when you buy prescription medecine it's the same.

In some cases like long time illness and non curable illness you are reimbursed 100% (diabetes for example).

when you have a low level of income (under $800 a month) everything is free.

Abortion is not covered in France, but in Sweden. Contraception is reimbursed in both countries and pratically free for teenagers, even abortion pills.

Hospital is free. But extras can be paid for rooms etc...

Dentistery and to some extent correction glasses are reimbursed too.

Cosmetic surgery is not repayed, unless for damages caused by accidents or by causing severe mental stress.

Private insurances pay normally for the difference between social security and a 100% coverage. They cost about $30 a month and are specially intresting to cover dentistry and glasses.

All this is financed by taxes, both on income an on employers (social charges as part of the wage)

The system is in deficit today so the government has to pump in extra money. The cause is unemployment and the fact that the number of eldelerly is increasing compare to the number of productives. France, Norway, Sweden have the longest life span in the world and the baby boomers are already creating a big problem (even they have been paying all their life for the system's funding).

Nobody wants to change this system anyway. Everybody is trying to make it more efficient to minimize the deficit.

[sandnsea]

14. Reimbursed?

Does that mean you have to have the money up front to pay? How much is a doctor's visit as compared to, say, an inexpensive meal? Like here it would be $15 meal to a $60 doctor bill. It would be hard for working people to come up wtih the $60 if they had to wait for it to be reimbursed. OTOH, it would address the problem of people going to the doctor for a cold.

[tocqueville]

16. it means repaid

a doctor's visit cost $20 ($30 for a specialist)

in reality everybody have a chip card. When the visit is over (doctor, pharmacy) you put the card in the machine and only pay for the difference. Since the chip card contains - for most of us - the data for the private insurance too, normally you don't pay anything.

For more complicated procedures (hospital, several visits etc..) some paper work can be done (it exists always in parallell to the chip card) but normally you have your money back within 3-4 days wired on your bank account.

But this is only for people having more normal incomes.

As I told you for everybody under $800 they have access to the CMU (Universal Medicine Coverage) and there there is NO money exchange for all medical treatment. Just show your card and fetch your pills. They only ask every year to justify your low income by showing your tax form.

Another aspect of the coverage is that the days you are sick are reimbursed too to a rate of 80%. But this goes through your employer.
A carency of 3 days is taken though, so that abuse (being often "sick" a shorter time) is not a good idea.

[sandnsea]

18. That's interesting

Health care is free for families on welfare and some other situations here too. I live in Oregon and we have more coverage for low income people, but there have been alot of cut backs. Still, the problem here are the lower income working people. Make too much to qualify for the govt health plan, but not enough to pay for insurance or medical care. Which led to my reimbursement question. People here would likely object to that for the reason I did, not helpful if people don't have the money up front to pay. Although $20 isn't much, but then again, that's what a doctor's visit cost not too many years ago anyway.

Of course, if the plan you describe were proposed here, we'd also have it called a DLC sell-out to the insurance companies and worthless because it's not completely free to everybody, like they have in the rest of the world. *sigh*

It sounds like a good plan to me, I haven't been to the doctor in 12 years.

[CanuckAmok]

29. One other issue is on drug patents.

The patent laws on pharmaseuticals are different than in the US. I don't know the details, but you can often get a generic eqivilent of an expensive drug for far less than the cost of the name-brand.

It has something to do with the length of time the drug has been on the market, and stuff like that.

I used to need an ear medicine which was $60/10ml, or $12/10ml for the generic.

[Ksec]

4. must be nice

Its nice to see corporatism hasnt taken over Canada.

[ailsagirl]

7. Let's hope it never does. So far, so good (I think)

Canada continues to be progressive, thank God.

Canada rocks!!

:yourock:

[domlaw]

8. Yes all thanks to Tommy Douglas

http://en.wikipedia.org/wiki/Tommy_Douglas


Sad to say there is no statue or any memorial for this guy in Ottawa. He was a great great man.

Oh and for a little trivia he is the grandfather of actor Kiefer Sutherland.

[ailsagirl]

10. Then he was a Scot, I'm assuming? (at least, his lineage)

I'll check out the link-- thanks

ailsa

[domlaw]

15. Well he was born in Scotland

And he was a minister. I think alot of his values came from being sick when he was young and almost dying because of a lack of funds.

We just voted on our greatest canadian and well I think we picked right:

http://www.cbc.ca/greatest/top_ten/nominee/douglas-tommy.html

Of course my vote would have been:

http://www.cbc.ca/greatest/top_ten/nominee/trudeau-pierre.html

but then again some Canadians don't really like the guy.

Oh and as a side note not one conservative (unless you count Don Cherry) in the top 10.

Short story: When my mother first saw and heard Don Cherry she calmly remarked to me that it was nice of Hockey Night in Canada to give mentally challenged people a job. (I didn't bother to correct her)



(edited for spelling)

[iverglas]

20. no statue or memorial ...

but it seems the CBC will be rerunning "The Greatest Canadian" once a month for the rest of time ...

;)

(For our USAmerican friends, Tommy Douglas beat out the other nine front-runners for the title of "the Greatest Canadian" in a multi-week TV series on CBC television, by on-line poll of the viewers.)
http://www.cbc.ca/greatest/

[CHIMO]

5. Short Answer

Is yes.

Anything that happens in a hospital is free.(Exceptions are private romm....)

Visits to the doctor are free as well as the tests prescribed by the doctor.(Unless one wants to hurry up and move to the front of the line with a private test.)

The Canadian plan is one where the federal government provides a certain amount of funds to the provincial government and the provincial government promises to deliver health care to a certain standard. If they do not comply then they loose some of that funding. Essentially health falls under the provincial government.
Thus different provinces have slightly different twists to things and things like dental, eye exams, glasses and prescriptions are paid by the individual.
When one can't afford a prescription and there are no more safety nets, then they just show up at emerg all the time and wait for a solution.

[CHIMO]

17. Oops

Meant to say no.

[Ksec]

12. Its a crime what repubs are doing to healthcare in the US

Only the wealthy can afford decent healthcare now. The rest of us get sick and die because of their roadblocks and their corporate whoring.

If I would get sick there's no way I could afford chemo or surgery. No way.

Compassionate conservatives at work here.

Congrats to Canada and its citizens. You people should take a bow.

[ironflange]

24. Mrs Ironflange is a teacher, so we have an Rx plan

We get about 2/3 of the cost back. That's a lot, when you consider she and I are clinically depressed and both kids are bipolar, how the hell did that happen? Believe me, it's no fun around here when everyone gets the sulks, but that doesn't happen much any more, thanks to Tegritol, Risperdal, Celexa, Paxil, Effexor, Trazodone, EEEK!

[Logiola]

25. one really bad thing with canada health care

if you want one, you have to pay for a tv in your hospital room.. another reason to close the whole system down... (phones are free)

[dancing kali]

26. In my experience with the BC health care system...

Our family physicians are a married couple who have a small clinic near by. The take care of everything except things that require a specialist and I have never gotten a bill for our "preventative health care", x-rays, mammograms, or any other basic mundane health needs.

We get some extended health care benefits through our employers as well as a dental plan. I believe the extended benefits will get us some extra coverage for long term health care issues and includes mental health care (although that may be an employer benefit and not a provincial one).

I can have 18 visits to Physio a year before I have to pay for the treatments and anything after that I pay some portion of the cost and then turn the receipts into the benefits office at work and I get the money back. 18 visits to Physio is more than enough to deal with most common sports and dance related injuries... most of the time I've gotten away with less visits. The most I've ever had to fork out was $20/visit. The same has applied to my visits to the Chiropractor. From what I understand visits to the Therapist work the same way.

Dentist visits - if you are a child, braces are covered... if you are an adult getting braces (like my husband did) you have to pay for them. We get x number of visits per year and then pay 20% of the cost... in my case about $9 per visit... $14 when I had my wisdom teeth pulled.

Glasses - I think both of us can get a pair/year but we have to pay and then turn in receipts to get the money back. Our lens prescriptions aren't changing yearly so we don't worry about this every year. I have lightweight, flexible Silhouette frames with fully loaded lenses (non-glare, scratch resistant, shatter resistant, photo-grey, transition lens) and I got reimbursed for them but then had to pay out for my contacts because I got them a couple of months later (if I had waited a year I could have gotten reimbursed for them as well).

Drugs - I pay at the pharmacy and turn in the receipts. While I was on the happy pills for three years (Effexor) I paid about $150 for a two month supply. Each time I got the money back.

In short, my experience has been that whenever I have had to pay out of pocket, the amount is generally trivial in most cases and when I have had to pay out a lot of money I get it back quickly. From speaking with my folks in the States... we definitely have cheaper drugs and health care here. However, since our insurance is dealt with through our employers I don't have to deal directly with anyone. We just fill out forms and turn in receipts at work... someone else gets to do the grunt work. So I can't really say how it works for someone who has to deal directly with the Provincial bureaucracy.

In answer to your question... yes, I pay for my prescriptions but I get the money back.

[achtung_circus]

27. M y plan only pays 80%

and I pay up front then get reimbursed. It takes a couple of days.

[CanuckAmok]

28. My union plan just introduced a credit-card sort of thing.

We used to pay up front and get reimbursed, but now the pharmacist just swipes the card, and I pay the 20% balance. It's pretty convenient.