The following is a set of Frequently Asked Questions (FAQ) about access to prescription drugs in Canada. This FAQ is based on a longer report entitled Access to Prescription Drugs in Canada(PDF).
The FAQ is divided into four sections:
1.0 Paying for Prescription Drugs
There are a number of words that are underlined in each of section of the FAQ that represent important concepts or ideas that are explained in more detail in the longer report. You can find out more about these subjects by going to the page number or section of the report that is identified in brackets following each of the terms. If you cannot find the information that you are looking for, the last section of the FAQ lists some numbers and e-mail addresses that you can use to get more information.
It is important to be aware that policies and regulations relating to prescription drugs in Canada are dynamic and subject to change. Bearing this in mind, the information in this FAQ is as accurate as possible, up to August 2004.
This section of the FAQ answers your questions about who pays for prescription drugs in Canada and what your options are if you can't afford to pay for a particular prescription drug.
1. As a Canadian, will the government cover my prescription drug costs?
In general, the provinces are responsible for providing health care services to Canadians, as established in the Canada Health Act. Each province, however, has developed its own health care plan to meet the needs of its residents. For this reason prescription drug coverage can vary greatly from province to province. Provincial governments through their formulary also decide which drugs will be covered in their province under their drug benefit plans. (For more information, please see section 1.2.3 on page 7 of the report)
All provinces provide drug coverage for low-income seniors and recipients of social assistance (welfare and disability among others). Some provinces provide universal coverage to all seniors, and one province (Quebec) provides universal coverage to all residents who do not have any form of private insurance to cover prescription drug costs. If you are wondering whether you are covered by your province's prescription drug plan you can refer to two charts on Types of Coverage and Coverage by Province found on pages 19 and 22 of the report, or you can contact your provincial formulary. (For more information, please see the List of Provincial Formularies on page 39 of the report)
The federal government also provides health services, including prescription drug coverage, to a number of Canadians. For more information on groups that are covered, please follow the links below.
Finally, many Canadians have drug coverage under some form of private health insurance, usually through their employer. If you questions about whether your private insurance covers your prescription drug costs, you should contact your employer directly or the insurance company that is responsible for providing benefits under your insurance plan.
2. What options do I have if my doctor says that I need a drug that I just can't afford?
If a doctor decides that a patient would benefit from a drug that is not listed on their provincial formulary (in other words, a drug whose cost is not covered by the provincial drug benefit plan), and if that individual is not eligible for drug benefits under any other insurance plan, they can apply to their provincial formulary (For more information, please see the list of Provincial Formularies on page 39 of the report) for Special Authorization.
Individuals may also want to contact a disease support group that deals specifically with the illness or condition that requires the use of the medication (For more information, please see the List of Sponsoring Organizations on page 43 of the report). These organizations may be able to help identify additional sources of funding and they can serve as an invaluable resource in helping to address the challenges associated with these conditions. Local charity or social service groups may also be able to direct individuals to additional sources of funding to offset the costs of prescription drugs
A final option that may be available under certain circumstances is for individuals to apply to participate in clinical trials of new drugs. Eligibility for participation in clinical trials varies with each trial depending on the type of drug that is being tested and the types of individuals that are required for the trial.
If a doctor feels very strongly that a particular prescription drug is required for a patient that is not currently approved for sale in Canada, they can ask Health Canada in writing to allow that patient to have access to that particular drug. This type of request is known as Special Access and is part of the Special Access Program (For more information, please see Section 4.2 on page 30 of the report).
This section of the FAQ provides a short summary of how prescription drugs are approved for sale in Canada, and what you can do to access prescription drugs that are not yet approved.
1. How are prescription drugs approved for sale in Canada?
Before a prescription drug can be sold in Canada it must first be authorized for sale by the Health Products and Food Branch (HPFB) of Health Canada, following a comprehensive Approval Process (For more information, please see Section 2.1.2 on page 10 of the report). Drugs that are approved for sale in Canada are considered 'safe'; however, all prescription drugs will have risks as well as benefits.
It is important for all Canadians who take prescription drugs to be aware that it is impossible for the approval process for new drugs to examine the impact of the use of new drugs in all possible situations and for all possible types of individuals. In a small number of cases, the use of a drug may produce an unexpected, negative side-effect. These side-effects are known as Adverse Events (For more information, please see Section 5 on page 32 of the report) and should be reported to a doctor who will notify the drug manufacturer and Health Canada.
2. Can I get access to prescription drugs that are not yet approved for sale in Canada?
If a doctor feels strongly that a particular prescription drug is required for a patient that is not currently approved for sale in Canada, they can ask Health Canada in writing to allow that patient to have access to that particular drug. This type of request is known as Special Access and is part of the Special Access Program (For more information, please see Section 4.2 on page 30 of the report). Requests for special access are limited to patients with serious or life-threatening conditions in the event that conventional therapies have failed, are unsuitable, or are unavailable. Access is granted on a compassionate or emergency basis only.
This section of the FAQ provides some information on what to do and who to contact if the prescription drugs you are taking are having any unexpected side-effects.
1. I had heard that some prescription drugs can have side-effects, even if used properly. How can I tell if a drug that my doctor prescribes might be harmful to me?
All prescription drugs will have both benefits and risks. When a drug has an unintended side-effect (a side effect is any unwanted reaction caused by taking the drug; for example, if an individual is taking a drug to treat high blood pressure and it also gives them a headache, the headache would be a side effect.), this is known as an Adverse Drug Reactions (For more information, please see Section 5.0 on page 32 of the report). An adverse reaction can occur even when a drug is being used as prescribed, and under normal conditions. Adverse reactions can range in severity from minor, such as a skin rash, to life threatening, such as heart attack or liver damage.
2. What should I do if a prescription drug that I am taking seems to be having a negative side-effect?
If you wish to report a negative side-effect that you think is being caused by a prescription drug you are taking, also known as an Adverse Drug Reaction (For more information, please see Section 5.0 on page 32 of the report), you should first talk with your doctor, nurse or other health care professional. These health care professionals can help to make sure that you report all the information that Health Canada needs. If you are unable to speak with a health care professional of any kind then you can file a report directly to any of the Adverse Reaction Centres (For more information, please see the List of Adverse Reaction Centres on page 41 of the report).
Reports should contain the following information:
The final section of this FAQ provides you with some links to contact numbers and e-mail addresses where you can get more information on accessing prescription drugs in Canada, if you are interested.
1. Who should I contact if I have a concern that is no addressed in this FAQ?
If you have any specific questions or concerns that are not addressed in this FAQ, you have a number of options: