Pages

August 26, 2013

The Scope of Public Pharmacare in BC and Quebec

written by Josie  Newman


Although most of the Western provinces offer some form of income-based public pharmacare, British Columbia has the best program. Quebec is unique in that it is the only Canadian province with mandatory pharmacare, but its drug prices are unnecessarily high due to the government's failure to monitor prices charged by drug manufacturers.    

British Columbia


Similar in scope to Ontario's income-based Trillium plan, British Columbia has a Fair Pharmacare Program which covers 70% of prescription drug costs for residents born after 1939. But unlike Ontario's generous pharmacare for seniors, those British Columbians who are born before 1939 are eligible for Enhanced Fair PharmaCare which only covers 75% of costs.

photo from www.techvibs.com
Everyone enrolled in Fair Pharmacare has 70% of their prescription costs covered, but those who pay deductibles pay full prescription costs until they have paid their annual deductible. After that, they are covered for 70% of costs until they reach the maximum payment for their income level at which point they are covered for 100% of costs.

Families or individuals who make less than $15,000 annually pay no deductibles and are eligible for 100% coverage once they have paid 2% of their net family income on prescriptions. Those who earn between $15,000 and $30,000 pay deductibles equivalent to 2% of their net family income and are eligible for 100% coverage once they have spent 3% of their income on both deductibles and prescriptions, while those who earn more than $30,000 pay deductibles equivalent to 3% of their net income and receive 100% coverage once they have spent 4% of their income on both drugs and deductibles.  

Seniors covered by Enhanced Fair PharmaCare pay smaller deductibles and lower percentages of their incomes than others. For example, those who earn less than $33,000 pay no deductible and a maximum of 1.25% of their net income while those who earn between $33,000 and $50,000 pay a family deductible of 1% of net income and maximum prescription and deductible costs of 2% of net income. However, their pharmaceutical and other health needs are usually much greater than younger people's so BC's Enhanced Fair Pharmacare is not comprehensive enough for the poorest seniors, those who earn less than $50,000.          

Increased assistance is available to those whose family income has decreased by 10% in the past year or if one's spouse has become a resident in long-term care. In addition, there are nine other specialized drug programs available, including Permanent Residents of Licensed Residential Care Facilities, Recipients of BC Low Income Assistance, Cystic Fibrosis, Children in the At Home Program, No Charge Psychiatric Medication Plan, Medication Management Services, BC Palliative Care Drug Plan, Nicotine Replacement Therapy, and Anti-Retroviral Medication for HIV/AIDS.


Quebec

Quebec's public prescription drug insurance, part of Regie de l'assurance maladie Quebec, is mandatory for those Quebeckers who aren't eligible for private insurance through their employer, union or professional organization, as well as for seniors over 65 and social assistance recipients. Children 18 and under as well as those 18 to 25 if they are full-time students, unmarried and live with their parents, are automatically covered if their parents receive public insurance.

Conversely, if a Quebec employer offers private insurance, eligible employees must join that plan and must get prescription drug coverage through the plan. So, unlike any other Canadian province, in Quebec it is mandatory for all residents to have prescription drug coverage! 
photo from  www.rsc.org
But people using public pharmacare, other than the pensioned elderly and those on social assistance, must pay annual premiums to a maximum of $607 to the government whether they purchase prescriptions or not. Though this may seem unfair, it ensures that everyone in Quebec receives pharmacare coverage regardless of income.       

There are many critics of Quebec's system, though, because private insurance providers don't negotiate prices with drug companies, resulting in needlessly high drug prices. Everyone suffers because those on public insurance must pay the same high prices which means general public resources are depleted more quickly than if fair price negotiations took place with pharmaceutical companies.     

Both public and privately insured Quebeckers pay deductibles when purchasing prescriptions at the pharmacy, although those on public pharmacare pay monthly while those covered privately usually pay annually. Although Quebeckers aged 18 to 64 on public pharmacare as well as seniors not receiving Quebec's public pension, called the Guaranteed Income Supplement, shoulder 32% of the cost of their prescriptions after the deductible is paid, the maximum monthly amount they will pay for their drugs is $82.66. The maximum annual amount they pay for deductibles and premiums combined is $992.  

Although consumers sometimes have to pay further costs for certain drugs because there is a discrepancy between the price charged by the drug manufacturer and the amount public health insurance will immediately reimburse, they will eventually be reimbursed for 100% of those costs. There are more than 7,000 drugs covered under Quebec's List of Medications , almost twice as many as Ontario's Drug Formulary! People with specific health conditions may be eligible for exceptional medications based on their doctor's referral and approval of the Regie de l'assurance maladie Quebec.   


1 comment: