Understanding Public and Private Prescription Drug Insurance Coverage in Canada

The Conference Board of Canada, February 13, 2018
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The report, Understanding the Gap: A Pan-Canadian Analysis of Prescription Drug Insurance Coverage, finds that 95 per cent of Canadians (more than 34 million) are eligible for some form of prescription drug coverage. Ontario residents represent a significant share of Canadians without insurance coverage, with just over 13 per cent of Ontario’s population considered uninsured. Understanding the complex landscape of public and private prescription drug insurance coverage in Canada can provide opportunities to ensure all Canadians have access to affordable medicines.

In this webinar, author Greg Sutherland will provide an overview of the main report highlights, including how the majority of Canadians have access to prescription drug coverage through private or public plans and the number of those who enrol in such programs. Greg will also discuss how The Conference Board of Canada estimated the number of uninsured Canadians and provide a closer look at out-of-pocket spending on prescription drugs. Finally, Greg will discuss how insurance plan designs vary across provinces, some of the reasons for non-enrolment, and the research and policy implications of this work going forward.

Webinar Highlights

  • Approximately 5 per cent of the total Canadian population are currently not eligible for enrolment in either a public or private prescription drug insurance plan. This number drops to less than 2 per cent on January 1, 2018 when the Ontario Health Insurance Program is expanded to cover prescription drugs for residents age 24 and under.
  • Just over 4 million Canadians without private insurance do not enrol in a public program for which they are eligible. Reasons for not to enrolling in a public program may include lack of awareness of the existence of the program and their eligibility, out-of-pocket costs, or lack of need.
  • According to a recent survey conducted by Nanos Research for this report, of the 7 per cent of Canadians who did not take their medications as prescribed, more than half were either unaware or unsure that there might be a public program to help pay for prescription drug. Seven per cent of those reporting not taking medications as prescribed, cited costs as being a reason (represents less than 1 per cent of the total population).
  • While most provinces try to limit the financial burden by using a sliding scale for deductibles based on household income, this can represent a disadvantage for lower income working Canadians. Those on income assistance programs normally have access to public coverage free of charge.
  • Further research on affordability of prescription drug insurance from different perspectives, including individuals, governments, and private insurance plan-sponsors is required.

About Greg

Photo of Greg SutherlandGreg Sutherland joined The Conference Board of Canada in 2002, and is currently a Principal Economist in the Canadian Alliance for Sustainable Health Care. Greg’s role is to provide quantitative analysis of the sustainability of the Canadian health care system, as well as provide economic analysis for all projects undertaken by the Canadian Alliance for Sustainable Health Care.

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