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May 10, 2013
For immediate release
Catastrophic drug coverage for all Islanders
Health and Wellness
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Islanders will soon benefit from a catastrophic drug program, says Premier Robert Ghiz.
“The goal of the program is to protect any individual or family whose drug costs are consuming an unreasonable share of their income, be it from a combined cost of using drugs for several common diseases, or one extremely high cost drug for a less common or rare disease,” said Premier Ghiz. “We need to help families facing financial hardship because of the high cost of prescription drugs, and this drug plan will put prescription coverage within everyone’s reach.”
“We recognize and are very sympathetic to individuals and families who struggle to afford their prescription medications,” said Health and Wellness Minister Doug Currie. “This new program is not based on age or disease, but is designed instead to assist people based on the cost of their drugs and their ability to pay. It is consistent with the approach taken by other provinces in the country, where we will be treating all residents fairly, and ensuring that we provide coverage for our most vulnerable residents.”
The new Catastrophic Drug Program will provide support to any individual whose prescription drug costs are affecting their household’s ability to maintain life essentials.
The program, which has been created specifically for Prince Edward Island, requires no premium or fees to enroll, and it places no ceilings on drug costs nor limits on participation.
Through this new program, Island families will have their annual out-of-pocket drug costs for prescription medications capped at an amount not exceeding a set percentage of their family income. It will provide the greatest benefit to those who need it the most.
Once an individual or family’s prescription drug spending has reached their capped amount, the government will pay the remainder of their prescription drug costs for the year.
For example, a family with annual household income of $40,000 will have an annual cap of 5% of their household income, or $2,000. With prescription medications for asthma, diabetes and cholesterol, their prescription drug spending reaches $6,000 annually. Under the new program, they will only pay the first $2,000 and the program will pay the remaining $4,000.
The Catastrophic Drug Program formulary (list of covered prescription drugs) will be broader than the current PEI Pharmacare formulary, and approximately 60 new drugs will be added immediately. An expert panel will manage the formulary.
“This program will allow us to provide coverage for almost every prescription medication recommended by the National Common Review Plan and the Pan-Canadian Oncology Drug Review Plan,” said Minister Currie. “We estimate that over 6,000 Islanders will benefit from this new program.”
“This is not about only providing coverage for people who have a catastrophic medical condition, it is about providing coverage for any Islander whose prescription drug costs are becoming a financial burden,” said Premier Ghiz. “People shouldn’t have to choose between buying groceries or getting their prescription filed. Placing a cap on out-of-pocket prescription drug costs will ensure every Islander has access to the medications they require.”
Under this new program, individuals currently receiving benefits from the Provincial Pharmacare programs may receive additional benefits, resulting in further savings to them. For example, if a person’s co-payment amount under the Pharmacare Program exceeds the set percentage of their household income, government will pay the exceeding portion.
The government will continue to offer all of its current Pharmacare programs, including the High Cost Drug Program, which is already benefiting over 500 Islanders. The High Cost Drug Program provides income-based coverage for a number of high cost medications; coverage is based on clinical criteria. Some of the conditions under the High Cost Drug Program include: some cancers, multiple sclerosis, pulmonary hypertension, severe rheumatoid arthritis, Crohn’s disease, and wet age-related macular degeneration.
Spending on Prince Edward Island’s Pharmacare Program has increased approximately 42% since 2006/07. Together the High Cost Drug Program and the new Catastrophic Program will result in $8.2 million in provincial funding to support Islanders who need prescription medications.
“The Catastrophic Drug Program provides a safety net for Islanders against extremely high drug costs, so they can focus on their health,” said Premier Ghiz.
Targeted date for implementation of Prince Edward Island’s Catastrophic Drug Program is October 1, 2013.
Prince Edward Island’s Catastrophic Drug Program
Prince Edward Island’s Catastrophic Drug Program provides assistance in the purchasing of prescription medications to Islanders whose drug expenses exceed a certain percentage of family income resulting in the inability of the family to maintain other life essentials. The focus of the program is that residents of the province should not be denied access to health care because of financial restrictions.
An expert committee will be established to ensure an evidence-based approach to benefit coverage. This enables informed decision-making by government regarding the coverage of therapies that rely on the expenditure of public funds.
Rationale for the new program
Despite current coverage, and recent expansion, there are some Islanders who still struggle to afford the prescription medications they need to maintain their health.
After much research, testing and discussions with NGOs and other jurisdictions, it was determined that an income-based assessment would be the most appropriate approach to assessing people for coverage. As such, a financial assessment process was developed that would result in one income-based test to determine coverage. This enhancement will see an individual/family’s contribution to their drug costs capped to the level of:
• 3% of an annual family income if that income is $0 - $20,000
• 5% of an annual family income if that income is $20,001 - $50,000
• 8% of an annual family income if that income is $50,001 - $100,000
• 12% of an annual family income if that income is $100,001 +
Government will pay all eligible prescription drug fees above the set percentage of a family’s income.
This approach is equitable for all residents. It is not age, gender or disease-specific. The goal is to protect any individual or family whose drug costs are consuming an unreasonable share of their income, be it from a combined cost of using drugs for several common diseases or one extremely high cost drug for a less common or rare disease.
It will protect both lower-income Islanders, as well as mid- and high-income families from catastrophic costs related to prescription medications.
To be eligible for coverage, there will be an assessment process. The assessment will be based on an application whereby a family’s income is provided, as well as documentation regarding their annual prescription drug costs.
Details on the assessment process are under development and further details will be announced at a later time.