Pharmacare plans in Canada shifting burden onto patients

Nova Scotia's move to a seniors' pharmacare program based on income is ashifttoward a British Columbia and Manitoba model whererich subsidizepoor, and away fromthe flatter fees typically charged inAtlantic Canada.

Canada has an fragmented approach to pharmacare for seniors. Details are complicated and varybetween provinces.

But Nova Scotia's latest move to increase premiums for its richest registrants is part of a general trend to deal with an ever-more expensive drug system, Carleton Universitypublic policy associate professor Marc-AndrGagnon said in an interview.

"One of the trends we're seeing in all provinces is this cost-shifting onto the shoulders of patients, first and foremost," Gagnon said.

"What we're seeing is increased premiums, increased co-pays or deductibles."

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As of April, individual Nova Scotia seniorsmaking more than $75,000will pay annual premiums of up to $1,200, nearly three times the current cap of$424. Couples making$100,000 or morewill pay $2,400.

"For anyone it's problematic if you ask them to pay more for the same type of coverage," Gagnon said.

Income-based plans the trend

Nova Scotia's changes bring the province closer to income-based plans in British Columbia and Manitoba, where drug coverage is for all ages andannual fees are similar to Nova Scotia's premiums.

Manitobabases its payments on income and a deductible rate, taking into account pension splitting and how many dependants there are in a family.

For instance, a couplethat makes $24,000 annually and has no children under 18pays $1,065 per year. After that, all prescriptions costs are covered.

By comparison,a couple that makes $100,000 a year pays $6,730. It drops to $6,326.20 if they have two children.

In British Columbia, there is a slight discount for seniors born in 1939 or earlier.

Annual fees are slightly less than in Manitoba;around $500 per year for families making $24,000 and around $3,000 for families making $100,000 or more.

Quebechas a premiumsimilar to Nova Scotia that can go up to $640 for the highest income bracket.

At-the-counterfees

Meanwhile, almost half of Canadian provinces have no deductible or premiums for seniors,including New Brunswick, Newfoundland, Prince Edward Island, Saskatchewan and Alberta.

Several of those provinces, including New Brunswick and Newfoundland, only cover low income seniors. In P.E.I., Saskatchewanand Alberta, everyone age 65 or olderis eligible, regardless of income.

Most seniors who qualify in those provinces are charged only a small fee ranging from $6 to $25at the pharmacy counter.

At-the-counter pharmacy costs:

• New Brunswick$15 to a maximum of $500 per year
• Prince Edward Island $15.94 for each prescription
• Newfoundland Up to$6maximum
• Quebec 34 per cent of the prescription cost,capped at $51.83 monthly
• Manitoba Completely covered after deductible
• Saskatchewan Maximum of $20 per prescription
• Ontario Up to $6.11 after a $100 deductible for most seniors
• Alberta 30 per cent of the prescription cost up to $25
• British Columbia Between 25 and 30 per cent of prescription cost
• Nova Scotia20 per cent of prescription cost to a maximum of $382 per year

Ontariohas a flat fee, known there as a deductible, of $100 for most seniors, with some ability to lower thatfor the poorest seniors.

Small fixes not sustainable

Gagnonand others say aCanada-wide system a national pharmacareplan would be more consistent and helpthe countrynegotiate for cheaper drug prices as a single unit.

It may also help people rely less on private drug coverage to make up the gap, Gagnon said, which also contributes to diluting provincial power to negotiate on drug costs.

"That would make things more sustainable," Gagnon said.

"In the end the problem is the same. We have a very inefficient system in terms of drug coverage that's costing way toomuch. Somebody have to pay for that and, yes, we end up making richer people pay."