9- Drug insurance

Drug insurance²⁹

Quebec

In general, any person residing in Quebec must be covered by basic medical insurance, either through a private insurance plan (often available through an employer) or through the government plan.³⁰

Under the government drug insurance plan, the maximum payable includes an annual premium, a deductible and a co-insurance portion.

The annual premium takes account of a taxpayer’s ability to pay and has to be paid with the tax return. The premiums have to be taken into consideration for those who have to make tax instalments. These amounts are reviewed on July 1 of each year.

The following table summarizes the maximum amounts payable for the various components of the government program:

When the maximum monthly contribution is reached, the person no longer pays for drug purchases for the rest of the month.

The following persons do not have to pay any premium or any other amount:

• Children of persons insured under the government program under 18 years of age or from age 18 to 25 who do not have a spouse, who are enrolled in full-time studies and who are living at home;
• Persons aged 65 or older who receive almost the total maximum GIS (between 94% and 100%);
• Certain persons with a functional impairment that has existed since before the person was 18 who does not have a spouse, who lives with their parents or their tutor and who does not have access to a private insurance plan and does not receive social assistance benefits;
• Last-resort assistance recipients (social assistance).

The premium, deductible and co-insurance payments made by taxpayers who purchase prescription drugs qualify as medical expenses for both federal and provincial purposes. For federal purposes, in view of the fact the premium is only paid during the year following the taxation year to which it relates, it is only eligible for the medical expense credit in the year following the year to which it relates. For Quebec purposes, taxpayers wishing to do so may claim the premium as a medical expense by choosing a 12-month period that includes December 31 of the year to which the premium refers to claim their medical expenses.

Ontario

The Ontario Drug Benefit Program (DBP) is a prescription drug insurance plan available to persons who are 65 years of age or older.³¹ Under the DBP program, taxpayers are required to pay an annual deductible of $100 plus a flat fee per prescription drug issued or refilled once the deductible is paid in full. Low-income individuals may apply for relief.³²

The Ontario Health Insurance Program + completely covers the cost of all medications funded by the DBP for children and youth aged 25 and under who are not covered by a private plan. There is no deductible or co-payment. The Trillium Drug Program supplements coverage for persons who are not eligible for the Ontario DBP.³³

New Brunswick

New Brunswick residents must have drug insurance. The New Brunswick Drug Program is an income-based drug plan that provides drug coverage to eligible uninsured residents of New Brunswick. The New Brunswick Prescription Drug Program offers coverage to low-income individuals, clients of the New Brunswick Social Development department, and others suffering from certain medical issues.³⁴

²⁹ The federal government is working on the introduction of a universal drug insurance plan. Various dental care programs including the Canadian Dental Care Plan are also available.

³⁰ Every person under age 65 who has access to a private plan must join it. Persons 65 years of age or older have various options. For more information, refer to Prescription drug insurance | Régie de l’assurance maladie du Québec.

³¹ Some people may be eligible even if they have not reached age 65. For a detailed list of who is eligible, as well as additional information, consult: Get help with high prescription drug costs.

³² For additional information, consult: Seniors co-payment program.

³³ For more details about this program, consult: Get help with high prescription drug costs.

³⁴ For additional information, consult: The New Brunswick Prescription Drug Program.