Drug Coverage in Canada
There are four ways to pay for cancer drugs in Canada :
The drug is on the approved list for your government health insurance plan.
Since drug coverage varies from one province to the next, it’s important to know your eligibility for health insurance coverage. Some provinces only provide drug coverage for people who are 65 and older or on social assistance. Others may have a variety of options, such as special coverage for those facing substantive prescription drug costs. Drugs provided through cancer care centres can also vary by province. Speak with your cancer team social worker or pharmacist, or call your provincial Ministry of Health to learn about your options.
Your private drug plan will pay for the drug (many private plans also have formularies or lists of covered drugs).
If you have private health insurance or a drug plan at work, carefully review your benefits. If you are employed, meet with your human resources department or union representative to help you understand your benefits. Ask your doctor what drugs you may need in the future, and check to see if your plan covers them. Try to coordinate the benefits so that any portion of a drug cost that is not paid for by one plan is applied to any additional plans.
Some private insurance plans require that you pay up-front and then apply for reimbursement. If this is a problem, ask your insurance company to allow your pharmacy to send the bill directly to them.
The drug manufacturer will pay for all or part of the drug (if you meet certain financial eligibility criteria).
Some pharmaceutical companies have free services to help you search for coverage of specific drugs or even supply you with it. Speak with your cancer care team or search online to see if you are eligible for such a program.
You pay for the drug yourself.
What if I am denied coverage?
If you are refused coverage of a medication you need, appeal. Sometimes the insurance company may reverse the decision.