Ask Your Pharmacist

January 6, 2017
Q:

My spouse changed jobs, and we are losing our drug coverage at the end of the month. We are both on a couple of medications and are concerned about not being insured. What coverage options do we have?

A:

Questions such as these are common in pharmacies. Many people experience changes to their insurance coverage over time as events such as career changes, retirements, job losses and divorces occur. Furthermore, individuals receiving provincial coverage through programs such as social assistance can lose coverage if their income levels increase. Being suddenly left without prescription coverage can be scary and confusing as many medications are difficult to afford, and most people don’t understand what coverage options are available. This article will provide some information on what to consider should you find yourself in this situation.

In my experience, the first place patients often look for coverage is a private insurance company to purchase a comparable plan to the one that has been lost. There are several considerations to think about when it comes to private coverage. First, patients are often surprised to learn that the monthly premiums to maintain the plan are much higher than they were through their previous employer. There are a couple of reasons for this. Generally, employers pay a portion of the premium on behalf of the employee. Also, insurance companies offer rates based upon the size of the pool of patients being covered as the rates for those with minimal medical needs offset those with higher usage of the plan. Another consideration when it comes to private plans is pre-existing conditions which are often denied coverage. This means that any medications (including those already being taken) used for a diagnoses made prior to purchasing the plan will not be covered. For example, if you were taking high blood pressure medications prior to purchasing the plan, you will not be covered for any such medications in the future.

Another option that I ask my patients to consider is the New Brunswick Drug Plan that was introduced by the province in May 2014. This plan was designed for residents of the province who either don’t have drug coverage, have reached their maximum for drug coverage under their existing plan, or have been prescribed a specific drug that is not covered by their existing plan, but is by the New Brunswick Drug Plan.

Unlike the private plans discussed above, this plan does not exclude coverage for pre-existing conditions and has a payment structure that is tiered according to the income level of the individual or family that is seeking coverage. There are six different payment schedules available that vary according the enrollee’s previous year’s income tax return. At the low end of the scale, an individual earning less than $17,885 or family earning less than $$26,827 pays $16.67 per month in premiums and copays are 30 per cent of the cost of the prescription to a maximum of $5 per prescription. At the top end, individuals earning over $75,000 or families earning over $100,000 pay a monthly premium of $166.67 and the copay is 30 per cent of the prescription cost which is capped at $30 per prescription. 

It is important to note that not all drugs are covered by the New Brunswick Drug Plan. It follows the same formulary that has been developed for the provincially funded drug plans such as the senior drug plan and the social assistance health card.  The formulary, along with links for enrollment and frequently asked questions are available online at www2.gnb.ca.

Some patients choose to pay out of pocket their prescriptions, and depending on their health needs, this can be the most cost-effective option. I often sit down one-on-one with patients when they are considering purchasing a plan to work out what their annual out of pocket costs would be with and without insurance based on their current prescriptions. You can easily do this analysis on your own if you have access to your prescription expenses and the drug plan website.

Several options are available for drug coverage. Your own pharmacist can help you determine which best fits you and your family.

Ryan Kennedy (BSc., Doctorate of Pharmacy, MBA) is a pharmacist/owner at Jean Coutu in Saint John. His opinions expressed in this newspaper are published for educational and informational purposes only and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com