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The Voice of People With Breast Cancer

your path to accessing financial resources


Health Insurance and Benefits

Getting Help with Costs

When Insurance isn’t Available, or Isn’t Enough – Getting Help with the Cost of Drugs and Supplies

You may not have access to a health benefits plan, or you may find that even with that plan there are leftover costs you can’t manage.  There are several options to explore for help:

Provincial or Territorial Drug Plans

Every province and territory in Canada has a public drug plan[1].  There are usually several options available.  Some plans also cover the cost of certain supplies and over the counter drugs.  Your eligibility for these plans may depend on your age, income or need but this is not always the case.   The following list describes the most common types of provincial and territorial plans.  A complete list can be found here.

Seniors (age 65+) – every province and territory offers a drug plan for seniors who are without a private insurance benefits option; these plans usually require the senior to pay a fee to enroll; the seniors usually needs to pay a small but manageable co-payment on each prescription.

General Population (age 18+ and their dependents) – most provinces now offer a broader public drug plan to the general public; many of these programs are designed to cover the family if a person has children who need coverage as well;  these programs are designed to help you even if you have a health benefits plan through an insurer but have leftover costs; usually the insurer is billed first, then the public drug plan;  some of these programs require you to pay a fee to enroll, but most do not; instead, they apply a deductible - an amount you have to pay first on prescriptions before coverage is initiated; any fees or deductibles are based on your family income[2].

There can be differences in the types of drugs and supplies listed on a private insurance plan and the ones listed on a public drug plan.  You may want to first explore if enrolling in a public plan is right for your situation and that it will help with the cost of your product(s).

Income Assistance – if you are on a social assistance or income assistance program through the province, you have access to a provincial drug plan; if you are unsure or have difficulty accessing this plan, inquire with your caseworker to make sure it was activated.

Catastrophic – some provinces have programs or processes designed to help you when your prescription drug costs exceed a certain amount;  usually you need to either confirm the name of the drug you have been prescribed OR show that you have already spent a certain amount that year on prescription drugs;  each program is different in what you need to show and how much you need to spend before you are able to access assistance with the cost.

Disease or drug-specific programs – some provinces have programs designed to help cancer patients at low income who lack health benefits, and some offer programs that cover specific drugs at 100% to ensure you receive the drug in a timely fashion; what is available differs by province; check the list of programs available here or inquire with your local cancer centre.

Patient Support Programs

Most Canadian pharmaceutical companies that make higher cost treatment drugs also offer special programs to help you navigate coverage of the drug.  Many also help with the leftover costs.  These programs are offered at the discretion of the pharmaceutical company, so assistance varies.   They are usually only available for newer treatment drugs that are not covered under universal medicare or a provincial cancer agency.  If you are prescribed a drug for treatment of your cancer and you are told you will need to rely on a health benefits plan or a provincial drug plan for help with the cost, check with the cancer centre staff to see if a patient support program is also available for that drug product. Contact information for patient support programs is available here. You can also find resources on accessing drugs here.

Brand Assistance Cards

If you have access to a health benefits or provincial drug plan but the plan only pays to the generic price for your drug – and you need or want to have the brand version of the drug – there may be a brand assistance card available to help pay the difference in cost[3].   These cards are manufactured by two different companies in Canada - Innovicares and Rxhelp – and are available at no cost to you.  You can apply for their cards through their website or inquire with the prescribing physician.  When you obtain your card, you take it to the pharmacy.  Each time you fill your prescription, the drug is first billed to your plan, and the difference in generic/brand cost is then billed to brand assistance card.  You may still be responsible for paying a copayment as per the terms of your plan.

Provincial & Charitable Programs for Prosthetic Devices and Certain Supplies

Most provinces and territories offer programs to help with the cost of prosthetic devices, wigs, and other supplies needed by cancer patients.  Each program is different.  Most will want you to first use your health benefits plan to cover at least part of the cost.  For a listing of programs, click here.

[1] In Québec, legislation exists that makes it mandatory for residents to have a drug plan.  If a person does not have access to a health benefits plan through their employer, then they are required to enroll in a drug plan through the provincial agency RAMQ.  It is also legislated that insurers must match the list of drugs provided in the RAMQ so coverage is similar.  If you do not have a health benefits plan and have not enrolled in RAMQ, click here.

[2] Every provincial general drug plan has some option for adjustment of the required deductibles/fees if your income has recently changed; this information can usually be found on the website or in the information booklet for the program;  you can also inquire by calling the provincial plan directly.

[3] In Québec, recent legislation restricts the use of brand assistance cards.  Speak to your pharmacist for more information.



Where metastatic drugs are available in Canada

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