Prescription Medications Covered Under Canadian Health Plans

Prescription Medications Under Canadian Health Plans

Medications are a very big part of total health spending in Canada and many Canadians rely upon their prescriptions to manage their health. This detailed article looks at prescribed medications that Canadian health plans often include. It also talks about the medications that these health plans do not cover. Here’s what you need to know about prescription medications under Canadian Health Plans.

Various Health Insurances

Canadian health insurance is mainly of two categories: employee benefits (i.e., “group insurance”) and individual health insurance (i.e., “personal” health insurance).

By and large, most provinces do not cover prescription medications unless there is some pharmacare program – such as in BC, where above a certain threshold based on your annual income, there is coverage for medications. But below that threshold, you are responsible for your meds.

Many group benefit plans in Canada will provide medication coverage, but many Canadians are not lucky enough to be under these plans. A few personal health insurance plans like Flexcare from Manulife Financial prescription drugs outside a hospital setting. In a hospital when you are admitted for care, your medications are fully covered.

Permanently Covered Prescription Drugs

For most extended health plans in Canada, a prescribed drug:

1. That a physician, dentist or psychiatrist has prescribed
2. It must be an essential remedy.
3. Must have a linked DIN (Drug Identification Number), except for medical marijuana (Sun Life declared its plans to add medical marijuana to its group benefits plans in February 2018).

Every medication that fulfills these conditions is not covered. It does not cover lifestyle drugs such as smoking cessation aids, fertility, weight loss, and contraceptive pills.

Some commonly prescribed drugs that every health insurance plan covers are:

• Insulin for diabetics
• Medicines for regulating high cholesterol levels
• Medications for mental healthcare – such as Lithium
• High blood pressure (hypertension) medicines

Prescription Drugs that are ‘Perhaps Covered’

Based on its type, health insurance may cover these medicines:

• New drugs permitted for everyday usage (i.e., fresh from clinical testing)
• Lifestyle drugs like smoking cessation kits, birth-control, and fertility drugs
• Branded medicines, in case of a corresponding generic medicine
• Personal health insurance plans do not cover clinical marijuana. Nevertheless, a few employees benefit plans that provide insurance support in cases that prescribe marijuana for pain relief. This pain relief may be for MS, cancer, rheumatoid arthritis, and other severe conditions.

Important: To get a specific prescription drug covered by a health insurance plan, you must get in touch with the insurance company.

DIN Numbers for Canada

A DIN (Drug Identification Number) is an 8-digit registration number allocated by Health Canada to every drug for sale in Canada. It also covers prescription drugs.

A DIN comprises particulars about the pharmaceutical company, the medicine name, active contents, etc.

No Individual Health Insurance Covers these Prescription Drugs in Canada

Private health insurance does not include the following prescription drugs:

• Over-the-counter drugs (without a prescription).
• Drugs used in hospitals (except provincial healthcare plan).
• Prescription drugs without a DIN number.

Oral Contraceptives

A usual employee benefits plan includes oral contraceptives.

Some individual health insurance plans differ in the case of contraceptive drugs. By and large, the cheaper, lower-edge plans do not include contraceptive medicines. Whereas, the “deluxe” or “enhanced” methods have provisions to cover oral contraceptives.

At present, “birth control patch” drugs do not fall under any health insurance plans.

Fertility Remedies

Usually, health insurance plans do not cover fertility remedies or drugs. They do not depend on the health insurance you have (group versus individual).

It includes issue health insurance plans that do not include any fertility medicines.

It is imperative to know that for insurance companies, infertility is an “underlying condition”. Therefore, any infertility issues discussed with your doctor previously fall under your medical history. It, the insurance company can access when they are underwriting.

Simply put, you can only insure your fertility drugs if you have never discussed infertility with your doctor.

Note: In some cases, fertility treatments are costlier than fertility medications. However, insurances only cover fertility drugs, not treatments.

Smoking Cessation Aids

Lifestyle drugs cover smoking cessation drugs and may have an employee benefits plan insurance.

In the case of group insurance, you need to contact your advisor at the insurance company to check whether your health plan covers smoking cessation aids.

Not many individual medical coverage plans offer inclusion for smoking cessation aids. In any case, the Personal Health Insurance (PHI) plan from Sun Life incorporates smoking cessation aids.

Other Lifestyle Medications

There are other lifestyle drugs (in addition to the ones already referenced) that no provincial healthcare plan or private health insurance plan supports. A few of them include drugs for male impotence (Viagra and Cialis) and weight reduction drugs.

Get Covered for Extended Healthcare in Canada

The bottom line for Canadians residing in Canada is to get an extended health plan to cover prescription medicines, which can be quite expensive. You can get a quote for the Manulife Follow-Me or Health plans via our website.