Private health insurance

The majority of Canadians have private insurance/third party insurance for prescription drugs as part of health benefits provided by their employers; most plans also cover the employee’s family or dependants. Employers purchase these plans from insurance companies and determine the terms of the plans for their employees.

Private insurance plans will cover some or all of the prescription medications that are used on an outpatient basis. This can include oral, inhaled and injectable medications, or some drugs for intravenous infusion used in an ambulatory setting. Private plans do not usually pay for medications used for patients staying in the hospital [10].

How to find out if the medication is covered

  • Phone the insurance carrier to determine the extent of your coverage
  • Supply the insurance company with the policy number or group health benefits number
  • Know what the drug identification number (DIN) of the medication [11]

Private health insurance resources – Private insurance – A guide on understanding if a private insurance company will pay for prescriptions, private insurance plans, special authorization, and the reimbursement methods

Health Canada – Drug product database – The drug product database contains specific information on drugs approved for use in Canada

Canadian life and health insurances association (CLHIA) – A full listing of Canadian insurance companies

Patient assistance programs (PAPS)

Pharmaceutical company-sponsored patient assistant programs (PAPS) help a patient find other payment options or provide financial assistance for their own drug plans; navigating private drug plan coverage can be challenging but pharmaceutical companies can provide trained staff members who help patients navigate their available coverage options [12].

Cancer centre coverage

Cancer treatment centres will sometimes provide financial assistance to patients in emergency situations when funding from other sources and services is not available. Contact the Patient and Family Counselling department at the nearest regional Cancer Centre and ask about financial assistance options available for patients.

To view a list of resources cited above, please click here.