Table 2:

Characteristics of all publicly funded provincial/territorial drug plans in Canada that cover antiretrovirals for adults and seniors, December 2017

Public drug program	Eligibility	Cost-sharing plan				Restrictions		Plan covers drugs not related to HIV

		Premium^*	Deductible^†	Copayment^‡	Coordinates with other payers	Prescriber	Pharmacy
Alberta

Alberta Health Care Insurance Plan, Specialized High Cost Drug Program	Registered^§ Alberta residents	$0	$0	$0	No	Yes	Yes	No

British Columbia

British Columbia Centre for Excellence HIV Drug Treatment Program	HIV-positive BC residents Residents with coverage from another jurisdiction awaiting BC medical coverage	$0	$0	$0	No	Yes^¶	Yes	No

Manitoba

Pharmacare	Program Registered Manitoba residents	$0	3.05%–6.9% of adjusted family income^**; not prorated; minimum $100/yr	$0	Province first	No	No	Yes

Employment and Income Assistance Program — Prescription Drugs		$0	$0	$0	Province first	No	No	Yes

New Brunswick

Prescription Drug Program, HIV/AIDS Plan	Registered New Brunswick residents not receiving private insurance	$0^††	$0	$0^††	No	Yes	Yes	No

Newfoundland and Labrador

Newfoundland and Labrador Prescription Drug Program (for registered residents of Newfoundland and Labrador)

Foundation Plan	Residents who qualify for income support benefits	$0	$0	$0	NA	No	No	Yes

Access Plan	Families with children with net income ≤ $42 870 Couples without children with net income ≤ $30 009 Single individuals with net income ≤ $27 151	$0	$0	20%–70% of total prescription cost (varies with income)	Private first	No	No	Yes

Assurance Plan	Residents with eligible drug costs that exceed 5% of net income < $40 000	$0	$0	Copayment rate = income × 5%/total drug expenditure	Private first	No	No	Yes

	Residents with eligible drug costs that exceed 7.5% of net income between $40 000 and $74 999	$0	$0	Copayment rate = income × 7.5%/total drug expenditure	Private first	No	No	Yes

	Residents with eligible drug costs that exceed 10% of net income $75 000 to < $149 999	$0	$0	Copayment rate = income × 10%/total drug expenditure	Private first	No	No	Yes

65Plus Plan	Residents ≥ age 65 yr who receive old age security benefits and guaranteed income supplement	$0	$0	Maximum $6 dispensing fee	Private first	No	No	Yes

Northwest Territories (NWT)

Extended Health Benefits for Specified Disease Conditions	Non-Indigenous registered NWT residents	$0	$0	$0	Private first	No	No	Yes

Métis Health Benefits Program	For registered Indigenous Métis who are residents of NWT	$0	$0	$0	Private first	No	No	Yes

Extended Health Benefits for Seniors Program	For non-Indigenous and non-Métis registered residents of NWT who are age ≥ 60 yr	$0	$0	$0	Private first	No	No	Yes

Nova Scotia

Nova Scotia Department of Health and Wellness — Provincial High Cost Drug Program	Registered residents of Nova Scotia	$0	$0	$11.25 dispensing fee	Private first	Yes	Yes	No

Nunavut

Extended Health Benefits Program	Non-Indigenous registered Nunavut residents with a specified condition Non-Indigenous residents age ≥ 65 yr Registered residents who are not fully covered by third-party insurance	$0	$0	$0	Private first	No	No	Yes

Ontario

Ontario Drug Benefit program	Residents of long-term care facilities Ontario residents enrolled in the Home Care Program People enrolled in Ontario Works for income support People enrolled in the Ontario Disability Support Program for income support and other services	$0	$0	$2 per prescription	Private first	Yes	No	Yes

	Registered residents age ≥ 65 yr with net annual income ≤ $19 300 (single) or net annual income ≤ $32 300 (with spouse)	$0	$0	$2 per prescription	Province first	Yes	No	Yes

	Registered residents age ≥ 65 yr with annual net income > $19 300 (single) or > $32 300 (with spouse)	$0	$100	$6.11 per prescription	Province first	Yes	No	Yes

	Registered Ontario residents enrolled in the Trillium Drug Program who have high drug costs relative to their income	$0	~4% of net household income; prorated and payable quarterly	$2 per prescription	Private first	Yes	No	Yes

Prince Edward Island (PEI)

PEI Pharmacare, AIDS/HIV Program	Registered HIV-positive residents of Prince Edward Island	$0	$0	$0	No	No	Yes	No

Quebec

Régie de l’assurance maladie du Québec

Régie de l’assurance maladie du Québec	Recipients of Social Assistance and Social Solidarity Program Single adults, age 18–25 yr, living with parents and full-time students in an educational institution at the secondary, college or university level	$0	$0	$0	No	No	No	Yes

	Registered Quebec residents age ≥ 65 yr receiving 94%–100% of the guaranteed income supplement, without private insurance	$0	$0	$0	No	No	No	Yes

	Registered Quebec residents age ≥ 65 yr receiving 1%–93% of the guaranteed income supplement, without private insurance	$0–$667 (varies with net family income)	$19.45 monthly	After deductible, (total cost of Rx – 19.45) × 34.8% up to maximum of $52.65/mo ($632/yr)	No	No	No	Yes

	Registered Quebec residents age ≥ 65 yr not receiving any guaranteed income supplement, without private insurance	$0–$667 (varies with net family income)	$19.45 monthly	After deductible, (total cost of Rx – 19.45) × 34.8% up to maximum of $88.83/mo ($1066/yr)	No	No	No	Yes

	Registered residents of Quebec without private insurance	$0–$667 (varies with net family income)	$19.45 monthly	After deductible, (total cost of Rx – 19.45) × 34.5% up to maximum of $88.83/mo ($1066/yr)	No	No	No	Yes

Saskatchewan^‡‡

Saskatchewan Drug Plan

Special Support Plan	Registered residents with drug costs greater than 3.4% of taxable income	$0	3.4% of taxable income	$0	Province first	Yes	No	Yes

Seniors’ Drug Plan	Age ≥ 65 yr with net income of ≤ $68 000	$0	$0	Maximum of $25 per prescription	Province first	Yes	No	Yes

Supplementary Health Program		$0	$0	$2 per prescription	Province first	Yes	No	Yes

Yukon

Chronic Disease and Disability Benefits Program	Registered Yukon residents	$0	First $250 of eligible costs per year ($500 per family)	$0	Private first	Yes	No	Yes

Pharmacare and Extended Health Benefits Program	Registered residents age ≥ 65 yr, or > 60 yr and married to a Yukon resident who is ≥ 65 yr	$0	$0	$0	Private first	Yes	No	Yes

Note: NA = not applicable, Rx = prescription.
↵* The amount an individual must pay to be enrolled in the program.
↵† The amount that must be paid by the individual before the program pays for any part of the drug costs.
↵‡ The amount or portion an individual pays with each prescription filled.
↵§ Registered residents are defined as residents with valid provincial/territorial health coverage.
↵¶ All antiretroviral regimens must be authorized by a British Columbia Centre for Excellence physician before medications can be dispensed.
↵** In Manitoba, an adjusted total family income is the total taxable income minus $3000 for each dependent under the age of 18 years (www.gov.mb.ca/health/pharmacare/estimator.html).
↵†† In New Brunswick, a copayment of 20% of the prescription to a max of $20 or $500/family unit/yr with annual registration of $50 is not collected.
↵‡‡ On Apr. 10, 2018, the government of Saskatchewan announced a change in its reimbursement policy to provide universal coverage for HIV medication to all registered residents. Data presented are those extracted in December 2017.