Summary: HIV antiretroviral medication coverage in Canada
Organization: Public Health Agency of Canada
Published: 2023-02-15
Cat.: HP40-333/2023E-PDF
ISBN: 978-0-660-47279-9
Pub.: 220735
The following document provides a summary of the provincial and territorial coverage of antiretroviral [ARV] medication in Canada. Data was collected from secondary data sources between September and December 2022. The purpose of this document is to provide a snapshot of the current provincial and territorial coverage in 2022 and is not meant to be an exhaustive list of all possible ARV coverage options in Canada. It is acknowledged that key populations are disproportionately affected by the HIV/AIDS epidemic in Canada. There are additional federal programs that may be available for those that qualify.
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | No |
ARV Drug Process |
|
Eligibility |
|
Formulary | British Columbia drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | No |
ARV Drug Process | Full coverage of ARV medication is offered with no cost, regardless of age or income. No deductible or co-payment. |
Eligibility | AHCIP eligibility
|
Formulary | Alberta drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | No |
ARV Drug Process |
Note: Regarding other drug coverage in Saskatchewan [Not ARV, but may relate to HIV/AIDS management], there are additional programs:
|
Eligibility | Eligibility for Saskatchewan health benefits
|
Formulary | The Saskatchewan drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | Yes |
Co-payment | No |
ARV Drug Process |
HIV antiretroviral treatment [ART] Program
Access to this program will facilitate timely access to a prescribed ART regimen and will allow clients and their caregivers more time to explore and establish long-term options for medication coverage.
|
Eligibility | Eligibility for Manitoba Health Care Coverage
|
Formulary | Manitoba drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | Yes |
Co-payment | Yes |
ARV Drug Process | Coverage depends on age, income, disability and/or whether the client has private insurance coverage OHIP + eligibility [Ages ≤ 24 years]
Trillium Drug Program [Ages 25 - 64 years of age]
Ontario Drug Benefit [ODB] Program [Ages ≥ 65 years]
Ontario Works [OW] and Ontario Disability Support Program [ODSP]
|
Eligibility | See above |
Formulary | Ontario drug formulary There is an exceptional access program [EAP] for medications not covered under the formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | Yes |
Co-payment | Yes |
ARV Drug Process |
RAMQ administers the Québec Health Insurance Plan ["the public plan"]. There are deductibles and co-payments
There are no costs for the following populations [assuming no private insurance]
[Note: GIC = guaranteed income support] |
Eligibility |
|
Formulary | Quebec drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No [annual registration fee] |
Co-payment | Yes |
ARV Drug Process |
Within Plan U:
|
Eligibility | New Brunswick plan eligibility
|
Formulary | New Brunswick drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | No [however, there are user fees] |
ARV Drug Process |
|
Eligibility | Nova Scotia Pharmacare eligibility Must be a NS resident, have a valid Nova Scotia Health card and agree to:
Note that while there may be deductibles [based on family size and annual income] for other medications, this does not apply to ARV medications. |
Formulary | Nova Scotia drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | No |
ARV Drug Process |
|
Eligibility | Prince Edward Island [PEI] plan eligibility is as follows:
|
Formulary | PEI drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | Yes |
ARV Drug Process | The NLPDP may provide financial assistance for the purchase of eligible medications. ARV coverage through the NLPDP plans is provided based on income. A provincial summary outlines the 4 plans. Note that private insurance is used first. NLPDP is the payer of last resort. Foundation Plan
The 65Plus Plan
The Access Plan
The Assurance Plan.
drug costs exceed:
For the Access and Assurance Plan, co-payment is based on income and drug costs and is a percentage of prescription costs. |
Eligibility | Eligibility to the Newfoundland and Labrador plans There are NLPDP forms that must be completed for coverage |
Formulary | Newfoundland and Labrador drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | No |
ARV Drug Process | A] The Nunavut Health Care Plan is managed by Nunavut Health Insurance Programs Office [in Rankin Inlet].
chronic disease or illness as per defined list of diseases [this includes HIV].
health care insurance options Note that the EHB Formulary is the same as the NIHB Formulary. EHB will pay the full cost of approved prescriptions drugs listed in the NIHB formulary. B] Non-Insured Health Benefits [NIHB] - A federal program, for those that qualify. NIHB drug and pharmacy benefits
[commonly referred to as a "Status Indian"]
Covers the full cost of ARVs listed in the NIHB formulary. |
Eligibility | Nunavut EHB Eligibility Non-Insured Health Benefits [NIHB] eligibility |
Formulary | EHB and NIHB drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | No |
Co-payment | No |
ARV Drug Process | A. The Government of Northwest Territories [GNWT] sponsors the Extended Health Benefits Program [EHB]. Private insurance must be used first [not eligible for EHB if client has other drug coverage]. Eligible if a permanent resident of Northwest Territories [NWT] and
There is an EHB application form for those <60 years and a form for those ≥ 60 years
B. Non-Insured Health Benefits [NIHB] - A federal program, for those that qualify. NIHB drug and pharmacy benefits
|
Eligibility | Northwest Territories EHB eligibility Non-Insured Health Benefits [NIHB] eligibility |
Formulary | EHB and NIHB drug formulary |
Category | Details |
---|---|
ARV Drug Program |
|
Deductible | Yes |
Co-payment | No |
ARV Drug Process | Private insurance must be used first. The Yukon public plan is the payer of last resort. If needed, there are additional Drug Plans under which medications may be covered [must be registered with Yukon Health Care Insurance Plan]
1. Chronic Disease and Disability Benefits Program
2. Pharmacare
3. Children's Drug & Optical Program [CDOP]
|
Eligibility | Note that drug approval is done 'case-by-case'. Medications are approved based on infectious disease [ID] specialist recommendation. There is currently no ID specialist in the Yukon; thus, residents are dependent on a visiting ID specialist. The Yukon Communicable Disease Control Clinic is central to HIV care. |
Formulary | Yukon drug formulary |
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