Beneficiary Cost Sharing Under Canadian Provincial Prescription Drug Benefit Programs: History and Assessment

Federal legislation outlined in the Medical Care Act of 1965 and the Canada Health Act of 1984 stipulates that Canadian provincial governments are to administer insurance programs for medically necessary services provided by hospitals and physicians. The legislation did not mandate provincial government coverage for prescription drugs taken outside of the hospital. Each province has, however, provided coverage to seniors and social assistance recipients; some have introduced drug coverage for the general public. This paper reviews the history of the provincial drug insurance programs for these 3 beneficiary groups, from the inception dates of the programs to August 31, 1999. Attention is given to the terms and conditions for coverage, including eligibility conditions and amounts of beneficiary cost sharing. Review of the history of the provincial drug programs reveals significant variation in the amounts of patient cost sharing between and within programs and over time. In addition, there is a trend in most provinces to increase the generosity of coverage for those with large drug expenses relative to income, irrespective of beneficiary age. Some implications of these findings for proposals to extend public prescription drug coverage are drawn.