CBC News Indepth: Health Care

INDEPTH: HEALTH CARE
Pharmacare FAQs
CBC News Online | September 13, 2004

What is pharmacare?

Simply put, it's government help to pay the cost of your prescription drugs. The reality, however, is far from simple.

There has never been a national strategy to help Canadians cover the cost of prescription drugs. The coverage you have depends on the province you live in. Some provinces call their drug coverage plans "pharmacare." Some don't.

The programs that do exist are mainly aimed at seniors or people whose incomes are below a certain level and who don't have extended health coverage.

In A Fix for a Generation: the Paul Martin Plan for Better Health Care, pharmacare is described as "coverage for prescription drugs in situations where expenses are catastrophic to personal or family finances."

Prime Minister Martin says his objective is "to agree with provinces and territories on a national pharmaceuticals strategy by 2006. That would be followed by appropriate legislation and supported by a federal funding contribution, the size of which will be determined once the strategy is agreed."

That means even with a quick agreement, a national pharmacare program could be years away.

How much would it cost?

The fastest-growing component of the cost of delivering health care is prescription drugs – even with what Americans call cheap Canadian prescription drugs.

For instance, in 1998, Manitoba spent $62 million to help just over 56,000 families cover the cost of their drugs. In 2003, the province's tab was $172 million for 87,000 families.

The cost of a national program has been estimated at from $7 billion to $12 billion a year, depending on how generous the benefits are.

In Britain, everyone over the age of 60, children and pregnant women get all their medication for free under a national pharmacare program. Everyone else pays $15 per prescription. The program costs the government $21 billion a year.

The plan works by giving people less choice. Patients won't necessarily get the latest drugs. In the UK, only 15 per cent of the latest drugs are being prescribed by doctors. In Canada, it's 26 per cent – one of the highest rates in the world.

The pharmaceutical industry argues that doctors have the right to prescribe what they think is best for their patients. Britons who want the latest drugs can have them – but they'll have to pick up the extra cost, if they're not covered by private insurance.

Martin has said his campaign promise was to establish a pharmacare system that would cover costs that are "catastrophic" to family finances. According to the Canadian Oxford Dictionary, a catastrophe is a "great and usually sudden disaster."

Why should Ottawa pay?

Proponents of a national pharmacare program argue it makes financial sense. They say having Ottawa as the single buyer of drugs would help reduce costs because one enormous purchaser can buy more cheaply than 13 smaller ones (the provinces and territories).

As well, a national program would mean your benefits would be the same whether you lived in Nova Scotia or the Yukon.

A pharmacare program may also be a natural fit for the federal government since it's responsible for many related areas, such as patent protection and drug testing.

The provinces and territories say if Ottawa picks up the tab for prescription drug programs, they would have more money available to improve access to other services.

What would it mean for me?

It should mean that you won't have to sell your house to pay for your medicine if you develop rheumatoid arthritis and have to take Remicade for the rest of your life – at a cost of more than $26,000 a year. It's covered in Manitoba – if you qualify for Pharmacare – but not necessarily in Alberta.

What does pharmacare cost now?

Again, it depends on where you live.

If you're a resident of Alberta, you can join one of several plans the province has set up with its partner, Blue Cross. If you're 65 or older, there are no premiums, but you'll be responsible for 30 per cent of the cost of each prescription filled, to a maximum of $25 per prescription. If you're under 65, you're buying the equivalent of private extended health care coverage.

If you live in the Yukon, pharmacare is free if you're 65 or older – or at least 60 and married to someone who is 65 or older.

Live in Nova Scotia? Then seniors pay a premium of $32.50 per month and face co-payments of 33 per cent to a maximum of $30 per prescription. The co-payments are capped at $350 a year.

In Ontario, drug coverage is mainly for seniors. Recipients are responsible for the first $100 of prescription drugs each year. They may also have to pay up to $6.11 per prescription.

In British Columbia, the Fair Pharmacare Program is not limited to seniors. The cost to you depends on family income. Once you reach your deductible, which could be more than $1,000, the program covers 70 per cent of the cost of each prescription. But the amount you pay each year is capped – depending on your income. After that level is reached, the plan pays all prescription costs.

In Quebec, when you file your provincial tax return, you'll pay a premium for drug coverage – unless you're covered by a plan where you work. Premiums for the provincial plan range from nothing to $494 per year, depending on your income. Seniors who receive the maximum Guaranteed Income Supplement and people on welfare pay nothing.

Again, proponents of a national pharmacare plan argue it will greatly simplify the process.

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