Glossary

This consultation is open to all Canadians, and we invite you to join the discussions and share your thoughts on national pharmacare.

The Council is inviting Canadians to share their ideas and views about national pharmacare by:

• joining the online discussion forum
• sending in written submissions
• completing an online questionnaire

The input gathered will help inform the Council’s advice to the Government on how to best implement national pharmacare.

The deadline for written submissions, discussion forums and the online questionnaire is September 28, 2018. 

            Contact information

Email address: pharmacare-assurancemedicaments@canada.ca

Pharmacare is a system of health insurance coverage that provides people with access to necessary prescription drugs. This can be accomplished in different ways.

In most industrialized countries, pharmacare is part of a universal health care system. Prescription drugs are included as part of insured health services along with hospital care, medical care and a range of other health services.

Most Canadians have some form of prescription drug coverage—often through their employer—but the terms of coverage vary considerably, leaving some households without adequate coverage to meet their health care needs.

As Canada considers how to move forward on a national approach to this issue, it has many options available. No decisions on a particular model or approach have yet been made. Understanding what will work for Canadians is essential to enabling the Government to make an informed decision.

A recent study suggests that 95% of Canadians (more than 34 million) are eligible for some form of public or private prescription drug coverage. But even those with drug coverage can face significant out-of-pocket costs, either in the form of deductibles or co-payments, or if their expenses exceed the annual maximum for their drug plan. These costs can make affording drugs a challenge.

Nearly two million Canadians reported not being able to afford one or more drugs in the past year, leading to poorer health and increased doctor visits and hospital admissions.

Another recent report estimates that hundreds of premature deaths occur each year among working age Canadians unable to afford their prescription medicines (Canadian Federation of Nurses Unions, 2018).

The Council members were selected to reflect the regional, gender, linguistic and demographic diversity of Canada, as well as several perspectives that are key to shaping the pharmacare debate. These perspectives include health policy, finance and fiscal policy, intergovernmental relations, business and labour, and the patient experience.

The Minister of Health and the Minister of Finance invited their counterparts to propose potential members for the Council. Suggestions were also received from a number of stakeholders.

The Council was officially launched on June 20, 2018. Consultations, both in-person and online, began immediately following the launch and will continue throughout the summer and fall.

The Council will provide the Minister of Health and the Minister of Finance with a final report in Spring 2019.

In the coming months, the Council will engage with provincial and territorial governments, and Indigenous governments and representative organizations. It will also engage with representatives and experts in relevant fields, including health care providers, private insurers, businesses, labour representatives, patients, the pharmaceutical industry and other Canadians.

This online consultation platform has also been launched to provide a starting point for the Council’s dialogue with Canadians about the implementation of national pharmacare. This platform gives all Canadians the opportunity to have their say and to help shape national pharmacare for the future.

To support a focused dialogue around the benefits and trade-offs of various models of pharmacare, the Council will be asking Canadians questions on the following key issues:

• Who should be covered by national pharmacare?
• What scope of drugs should be covered?
• How should national pharmacare be paid for and administered?

A system of health insurance that provides people with access to necessary prescription drugs. Its design can be determined by a number of factors, including which population groups are targeted, which types of drugs are covered, and how it is financed.

After any applicable deductible limit has been reached, the amount paid out-of-pocket by the drug insurance plan member each time a prescription is filled, with the remainder of the cost paid by the insurance plan. This can either be a percentage amount (e.g. 20% of total prescription cost) or a fixed payment per prescription (e.g. $5 per prescription). See also ‘deductible.’

The amount that a plan member must pay out-of-pocket on drugs within a certain period of time (e.g., annually) before the drug insurance plan will begin to pay for eligible prescription drug costs. See also ‘co-payment.’

Health insurance plans that reimburse the cost of health care services, such as vision care, dental care, physiotherapy, and prescription drugs that are not covered by government health insurance. Also known as supplemental health insurance.

A list of drugs whose costs are eligible for reimbursement through a drug insurance plan. The formulary also lists any conditions under which a drug may be available to drug insurance plan members, e.g., the cost of a drug will only be reimbursed for plan members who meet certain clinical criteria and/or receive prior approval from the drug plan.

Filling a prescription with a generic version of a drug rather than the brand name version.

Canada's publicly funded health insurance system which covers the costs of basic physician and hospital care for Canadian citizens and permanent residents. The majority of Canadians also have additional extended health care insurance provided by employers to reimburse the costs of health care services not covered by medicare, such as vision care, dental care, physiotherapy, and prescription drugs.

The portion of drug costs paid by a drug insurance plan member, or the amount paid by an individual without drug insurance.

A member of a drug insurance plan who is eligible for coverage under the plan. The plan member’s dependents may also be eligible for insurance coverage under the plan.

A fixed amount (often paid annually) that an individual must pay to enrol in a drug insurance plan. This amount is payable whether or not the individual uses his or her benefits under the plan.

A drug that can be obtained only by means of a physician's prescription. Different types of prescription drugs include:

• Brand name drug: the original version of a drug that is usually marketed by the company that developed and patented it under a specific brand name
• Generic drug: a drug that is equivalent to the brand name drug which enters the market after the patent on the brand name drug has expired

Drug insurance plans that are sponsored by public and private sector employers for their employees, and by unions and professional associations for their members. Also drug insurance plans that are purchased by individuals.

Drug insurance plans that are funded by government to serve as a social safety net for citizens, e.g, seniors or those with low incomes. Also known as pharmacare.

A drug insurance plan that covers the whole population.

The personal information you provide is protected in accordance with the Privacy Act and collected under the authority of the Department of Health Act and the Public Health Agency of Canada Act.  Your personal information will be collected to help inform the Council’s advice to the Government on how to best implement national pharmacare. You have the right to request access to and correction of your personal information. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly. For more information about the handling of your personal information, please contact the Privacy Management Division at 613-948-3179 or hc.privacy-vie.privee.sc@canada.ca.