April 29, 2014

Are you eligible for government drug coverage?

Prescription drug plans vary by province and territory. Here’s how to find out if your government’s plan covers you.

Prescription drugs can be expensive, so it’s important to know if you may be covered under a government drug benefit plan.

Provincial and territorial health assistance programs come under the umbrella of the Canada Health Act, as set out by Parliament in 1984. While the act specifies coverage for doctors’ care and hospitalization, it does not require coverage for prescription drugs. To help address some of this gap, the 13 provinces and territories have created a patchwork of varied coverage plans.

Drug coverage by province

Some provinces have programs aimed at specific populations, such as seniors or people on social assistance. The following provincial and territorial government health websites have full details for their residents about drug plan eligibility and coverage:

Differences in Quebec

In Quebec, drug coverage works differently than in other provinces. By law, all Quebec residents must have either public or private insurance coverage for prescription drugs.

Employers, unions, associations and professional organizations can give their employees or members access to a private plan as part of a benefits package.

The public plan is administered by the Régie de l’assurance maladie du Québec, and covers residents who do not have access to a private plan, including:

  • People not eligible for a private plan (self-employed workers, for example)
  • People aged 65 and over
  • People receiving financial assistance from the government
  • Children of residents covered by the public plan

Federal government coverage

The federal government also provides drug coverage to certain groups of people:

  • First Nations living on reserves
  • Inmates in federal penitentiaries
  • Inuit
  • Military personnel
  • Royal Canada Mounted Police employees
  • Some recent immigrants
  • Veterans

It's important to note that unless you're a member of one of the groups specified by the federal or provincial governments, you're not covered by a government drug plan.

Supplemental insurance

Depending on your income, age and other factors such as whether you have a chronic illness, the drug coverage you receive from your provincial or territorial government may not be enough to pay for all or even most of the prescription medications you need. This is where supplemental insurance can add an extra layer of protection. You can buy supplemental insurance as part of a group (through your employer, union or alumni association, for example) or individually.

Once you have checked your province’s drug plan to see whether you have any coverage, you can decide whether it makes sense for you to buy supplemental insurance. 

Need advice? Talk to a Sun Life advisor

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