Cost of Medication

• A variety of medicines are available for most problems.
• Ask your doctor and pharmacist about the cost and advantages of different medicines, especially if you have limited coverage.
• Most doctors are happy to discuss the cost of treatment with you.
• If you use an internet pharmacy be very careful. Only accredited internet pharmacies are safe.

• Be aware that the sample pack of medicine you may receive from your doctor as a “starter dose” are usually for newer medicines.
• Newer medicines are usually more costly than older ones. They are often no more effective.
• Some newer medicines are not covered by insurance plans.
• Starting with a sample pack may lead to taking a more costly medicine over time.
• Switching to a less costly medicine is possible, but this takes time. There is a risk of having more symptoms while you switch.
• It is usually less expensive to pay for a medicine from the start, rather than beginning on a more expensive medicine with a sample pack.
• Ask your doctor about long term cost if you are considering using a sample package.

• Your pharmacy has a record of the medicines that you take and can help with information about them.

• Pharmacies charge a dispensing fee for each prescription. This pays for the pharmacy services, including keeping records, making up the prescription, and providing advice about the medicine, other medicines you take, and your health.
• Dispensing fees and mark-ups vary between pharmacies.

• Once you have taken a medicine for a while, are on a stable dose, and find it helpful, you can reduce the cost of the dispensing fee by asking your doctor to write a prescription covering a longer period if possible.
• Usually the longest period supported by insurance plans is about three months (90 to 100 days).
• The dispensing fee is usually the same whether you get a prescription for three weeks or three months.
• If your doctor or pharmacist is reluctant to provide prescriptions for three months at a time, discuss this with your doctor.

• Brand name drugs are produced by the company that developed that drug and are generally more costly.
• Once a drug has been available for a number of years, it may be sold by a generic brand company.
• Generic brands have the same composition for the active ingredient but may have different components for other ingredients (like colouring or binding agents).
• Generic brands are generally less costly.
• If you are concerned about the medicine having a different colour or appearance discuss this with your pharmacist or doctor.
• Some insurance plans will cover only the cost of the generic drug if one is available. Some plans will pay for the brand name drug if you have a form completed by your doctor.

• The provincial drug plan and private insurance plans may cover part or all of your medication costs.
• All Canadian provinces and territories have public plans that cover some of the costs of medicines for qualified persons.
• You have to make an application to be included in the plan. Your pharmacy will have information about this.
• Provincial and private plans usually have a deductible that you must pay before your coverage starts. Some plans have a maximum dispensing fee that they will cover. You pay the remainder.
• Most medicines are covered by insurance, but newer medicines may not be.
• Your doctor or pharmacist will be able to tell you if a medicine is covered by your insurance plan. You can also check with the insurance plan.
• Insurance plans can be complicated. Most plans have a phone number you can call for more information.

• Many families have coverage for medicines through supplementary health insurance plans offered through work or school. Many plans require you to pay a portion of the total prescription cost or a set deductible amount.
• Dependents and unmarried young adults may be covered by a parent’s plan until age 21 or until age 25 if they are full-time students.
• Some plans only cover the generic form of a drug if a generic is available.
• Some newer medicines may not be covered.
• Coverage differs from plan to plan. It is wise to check the plan brochure or the information on the plan’s website to find the details. You may also phone for more information.

• Some employers provide these accounts, which cover a range of health services, including medication costs not covered by other insurance. If you have a plan, check what is covered and the amount.

• A Health Canada plan covers prescription drug expenses for First Nations people that are not covered by other plans.
• The plan covers the best priced alternative for prescription drugs.
• Most drugs are covered – a pharmacist or doctor will have information about what drugs are covered.

• All Canadian provinces and territories have public plans that cover some of the costs of medications for qualified persons.
• Manitoba’s Pharmacare plan will pay 100 percent of eligible prescription drug expenses after the family pays a yearly deductible amount.
• The deductible depends on total family income as declared on income tax forms.
• As examples, with a total family income of $20,000, the yearly deductible is $273; for $30,000 it is $774; and for $40,000 it is $1,284. The minimum deductible is $100. If a family has high medication costs and the deductible is a financial problem, arrangements can be made to pay the deductible in monthly installments. After they turn 18, young adults are considered to be on their own and their eligibility is calculated based on their income and drug expenses.
• Details about the plan are available on the Manitoba Health website, http://www.gov.mb.ca/health/pharmacare/ or through pharmacies.

• Health care spending accounts: Some employers provide these accounts, which cover a wide range of health services, including medication costs not covered by other insurance.
• If you have a plan, be sure to check what is covered and the amount of coverage.
• As an example only, one widely-used plan in Manitoba covers 80 percent of the first $375 of eligible medication expenses and 50 percent of the next $300 to a maximum of $450 per calendar year (for the whole family). Unmarried dependent children up to age 21 and up to age 25 if they are full time students are covered. Children who became disabled before age 21 (or before age 25 if in full time studies) may be covered for a longer period. This may vary from plan to plan.

• All Canadian provinces and territories have public plans that cover some of the costs of medications for qualified persons.
• In Ontario, the Trillium Drug Program covers persons who have high prescription drug costs relative to household income, and may cover amounts not covered by private insurance plans. There is a deductible amount that depends on household income and household size. Deductible amounts are paid in four installments over the program year.
• Applications for the Trillium Program are available at local pharmacies or on the Ontario government website, http://www.health.gov.on.ca/en/public/programs/drugs/programs/odb/opdp_trillium.aspx
• Another plan, the Ontario Drug Benefit Program, http://www.health.gov.on.ca/en/public/programs/drugs/programs/odb/odb.aspx pays most of the cost of drugs for persons over 65 years old, or in long term care, or receiving home care, or those receiving social assistance.
• If a medicine is not covered under the provincial programs, your doctor may apply on your behalf for the Exceptional Access Program, http://www.health.gov.on.ca/en/pro/programs/drugs/eap_mn.aspx to see if this medicine will be covered in your situation. All approved prescribed drugs are covered.
• Details about the plan are available on Ontario’s Ministry of Health and Long-Term Care website, http://www.health.gov.on.ca/en/public/programs/drugs/programs/programs.aspx or through pharmacies.

Health Care Spending Accounts

• Some employers provide these accounts, which cover a wide range of health services, including medication costs not covered by other insurance.
• If you have a plan, be sure to check what is covered and the amount of coverage.

• As an example only, one widely-used plan in Ontario covers 80 percent of the first $375 of eligible medication expenses and 50 percent of the next $300 to a maximum of $450 per calendar year (for the whole family). Unmarried dependent children up to age 21 and up to age 25 if they are full time students are covered. Children who became disabled before age 21 (or before age 25 if in full time studies) may be covered for a longer period. This may vary from plan to plan.