Stitching the gaps in the Canadian public drug coverage patchwork?: a review of provincial pharmacare policy changes from 2000 to 2010

Abstract

Objectives: To describe recent changes and identify emergent trends in public drug benefit policies in Canada from 2000 to 2010.

Methods: For each province, we tracked pharmacare design (namely eligibility, premiums, and patient cost-sharing) over time for three beneficiary groups: social assistance recipients, seniors, and the general non-senior population. We assess which plan designs are emerging as a national standard, where the gaps in public coverage remain, and implications for progress towards national pharmacare.

Results: Expansion of public drug coverage has been limited. For social assistance recipients, first-dollar coverage is the standard. Seniors coverage remains varied, though means testing of eligibility or cost-sharing is common. Seniors benefits were significantly expanded in only one province. As of 2010, six provinces have embraced age irrelevant catastrophic income-based coverage, in some, resulting in the elimination of seniors drug benefits.

Conclusions: Universal income-based catastrophic coverage appears to be emerging as an implicit national standard for provincial pharmacare. However, due to the variation and high level of patient cost-sharing required under these programs, convergence on this model does not equate to substantial progress towards expanding coverage or reducing interprovincial disparities. Leverage of federal spending power to promote standards for public drug coverage is necessary to uniformly protect Canadians against high drug costs.

Conflict of interest statement

Conflict of Interest

The authors have no conflicts of interest to declare.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Cost sharing structure for social assistance beneficiaries by province, 2000–2010. Notes: AB: Co-payment of $2.00 for the first three prescriptions per month was eliminated in May 2004. QB: Deductibles and co-insurance for all welfare recipients were eliminated on July 1, 2007.

Figure 2

Cost sharing structure for seniors (>=65) by province, 2000–2010. Notes: BC: Fair Pharmacare was introduced in May 2003, replacing both the Universal Plan (Plan E) and the Seniors Plan (Plan A). SK: The Senior’s Drug Plan was introduced on July 1, 2007. The plan required seniors to pay a $15 co-payment for all drugs listed on the SK formulary. As of July 1, 2008, an income-based eligibility test was introduced. Only seniors with a reported income that is less than the limit for the federal age credit are eligible (individual net income less than $75,480 in 2010). QB: As of July 1, 2005, all patient cost sharing was removed for seniors receiving the maximum GIS. As of July 1, 2007, cost sharing was removed for seniors receiving 94 to 99% of the GIS. NL: The 65Plus Plan covers only seniors eligible for both old age security and the GIS (individual net income less than $15,888 required to qualify for the GIS in 2011). The universal catastrophic Assurance Plan was introduced on October 31, 2007.

Figure 3

Cost sharing structure for the general non-senior population by province, 2000–2010. Notes: BC: Fair Pharmacare was introduced in May 2003, replacing both the Universal Plan (Plan E) and the Seniors Plan (Plan A). NS: Nova Scotia Family Pharmacare was introduced on March 1, 2008. NL: The Assurance Plan was introduced on October 31, 2007.