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How Prescription Drugs are Accessed in Canada

Check out this Understanding Access Fact Sheet as a handy reference for ways people may access treatments for psoriasis and psoriatic arthritis in Canada.

In Canada, prescription drugs administered in hospitals are provided to patients at no cost. Hospitals decide what drugs to list on their formularies (official list giving details of medications that are covered under a particular insurance policy).

Outside of a hospital setting, provinces and territories are responsible for the development and administration of public drug plans for eligible patient groups. These public plans are typically developed for patients of certain age demographics, recipients of social assistance, or those with diseases that may require high-cost drug therapy. The most up-to-date eligibility criteria for each province’s drug plan can be found on its website. In order to verify whether or not a specific medication is covered under a provincial drug plan, you should contact the plan directly or ask your local pharmacist for assistance. To find information about your specific province / territory click here.

Eligible First Nations and Inuit people, refugees, federal inmates, Canadian military personnel, veterans, and federal public service employees can access medication coverage through federal public programs. Each of these programs has its own eligibility criteria and its own formularies and is funded through different federal departments.  Under some of these programs, individuals who may be eligible under other private or public programs are required to seek medication coverage through these prior to submitting claims through the federal program.

Non-Insured Health Benefits (NHIB) program for eligible First Nations and Inuit

Interim Federal Health Program (IFHP) for eligible protected persons (refugees)

Almost two-thirds of Canadians are enrolled in a private health insurance plan with drug benefits. Depending on the plan, insurers may pay either a portion of or the total cost of medications. If you are enrolled in a private health insurance plan through an employer or a spouse, it may be worthwhile to investigate what your insurance covers. This can typically be done by checking your insurer’s website, or by calling your private health insurance plan directly. Where appropriate, you could ask your company’s human resource department, but do keep in mind that there is no confidentiality attached to these conversations. It is important to consider how much information about your health you are comfortable disclosing before you take this route.

Patients starting treatment with a biologic for their psoriasis or psoriatic arthritis can face many barriers. Paying for and obtaining the medication, as well as learning how to administer the biologic are just some of the challenges patients may face. In recognition of this, biologic and biosimilar manufacturers have created support programs designed to assist patients during their treatment.

Patient support programs are typically staffed with registered nurses. These nurses can facilitate insurance requests and can help you obtain your biologic or biosimilar. They can also coordinate how and where you receive your injection, and in many cases can educate you on how to self-administer your medication. Staff members who work with patient support programs will be in close contact with your prescribing physician to ensure they are updated on how your treatment is progressing, and to ensure that you are receiving the best care available.

For people who meet certain financial criteria and who would potentially pay out-of-pocket for the full price of a drug because it is not funded by private or public plans could be eligible for some financial relief through patient support programs.

For more information about programs specific to each treatment, visit the Biologics and Biosimilars section.

Last updated November, 2021