There are many sources for payment of drugs both public and private. Most provinces have special programs for those without any coverage (i.e. Trillium plan in Ontario). Click on the link to your province under the Drug Coverage by province section to find out what is available to you. Many hospitals have Drug Access Navigators, Pharmacists, Social Workers or Physicians who can help you find out what is available for you. You should be informed about access of your drug and what it might cost before you agree to treatment.
Publicly Funded Prescription Drug Insurance Coverage
Under the Canada Health Act, prescription drugs given in Canadian hospitals are provided at no cost to the patient.
Outside of the hospital setting, provincial and territorial governments are responsible for the administration of their own publicly funded drug plans. The public drug plans determine what prescriptions drugs are listed and under what conditions for their eligible recipients.
Most Canadians have some access to insurance coverage for prescription drugs through a patchwork of public and/or private insurance plans. The federal, provincial and territorial governments offer varying levels of coverage and decide who is covered and what the patient and plan pays. The publicly funded drug programs generally provide drug plan coverage for those most in need, based on age, income, and medical condition. Many Canadians and their family members have drug coverage linked to employment and some Canadians may have no effective drug coverage and pay the full cost of prescription drugs.
The CanCertainty Coalition is the united voice of 35 Canadian patient groups, cancer health charities and caregiver organizations working with oncologists and cancer care professionals to improve the price and accessibility of take home cancer treatment in Ontario, New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland https://www.cancertaintyforall.ca . These provinces do not provide take home cancer drugs. Patients must access their own funding.
Drug Coverage by Province
In Canada, the provinces and territories actually decide which therapies are available and funded to their residents. Each province and territory offers a drug benefit plan for eligible persons. Some are income-based universal programs. Most have specific programs for citizens that may need increased coverage, including seniors, persons on social assistance, and persons with diseases or conditions that have high drug costs. For more details, please contact your provincial or territorial health care ministry or click on the relevant link below.
Differences in Quebec
In Quebec, drug coverage is different from other provinces. By law, all Quebec residents must have either public or private insurance coverage for prescription drugs.
Employers, unions, associations and professional organizations can give their employees or members access to a private plan as part of a benefits package.
The public plan is administered by the Régie de l’assurance maladie du Québec, and covers residents who do not have access to a private plan, including:
- People not eligible for a private plan (self-employed workers, for example)
- People aged 65 and over
- People receiving financial assistance from the government
- Children of residents covered by the public plan
Federal government coverage
The federal government also provides drug coverage to certain groups of people:
- First Nations living on reserves
- Inmates in federal penitentiaries
- Military personnel
- Royal Canada Mounted Police employees
- Some recent immigrants
Private Supplemental insurance
Depending on your income, age and other factors such as whether you have a chronic illness, the drug coverage you receive from your provincial or territorial government may not be enough to pay for all or even most of the prescription medications you need. This is where supplemental insurance can add an extra layer of protection. You can buy supplemental insurance as part of a group (through your employer, union or alumni association, for example) or individually. Provinces may offer supplemental insurance programs (i.e Trillium in Ontario).
Once you have checked your province’s drug plan to see whether you have any coverage, you can decide whether it makes sense for you to buy supplemental insurance.
Special Access Programme (SAP)
When all other sources for coverage have failed, the Special Access Programme (SAP) provides access to nonmarketed drugs for doctors treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable. The SAP authorizes a manufacturer to sell a drug that cannot otherwise be sold or distributed in Canada. Drugs considered for release by the SAP include pharmaceutical, biologic, and radio-pharmaceutical products not approved for sale in Canada.