Prescription Care - Frequently Asked Questions
Prescription Care makes eligible prescription medications more affordable for PEI residents. Answers to common questions about the program are provided here.
What is Prescription Care?
Since March 2022, the Government of PEI has partnered with the Government of Canada to support affordable access to eligible prescriptions through the Improving Affordable Access to Prescription Drugs project (IAAPD). The Government of Canada may use learnings from these initiatives to inform the federal government’s future planning for national pharmacare.
What are the goals of Prescription Care for PEI?
- Give better access to necessary medications by making more prescription drugs available on the PEI Pharmacare formulary.
- Give more affordable access to medications by lowering out of pocket costs for eligible medications in the Public Drug Programs.
Did the public have input?
Yes. A stakeholder engagement survey launched in October 2022 and was completed in November 2022. This was held to help make sure that the project investments and key activities met the needs of Islanders. We heard from 332 survey respondents and conducted 20 stakeholder interviews. A stakeholder engagement report has been published.
What changes have been made to the drug formulary?
Since December 2022, more than 80 drugs have been added to the Pharmacare and Cancer Treatment Centre formularies through this program. These additions make medications more accessible to Island residents. The PEI Pharmacare formulary outlines all the drugs that are listed under the public drug programs, which programs they are available in, and the criteria for use.
What changes have been made to public drug programs?
Substance Use Harm Reduction Program (SUHRP)
The Substance Use Harm Reduction Program replaced the Opioid Replacement Therapy Drug Program on June 1, 2022. The SUHRP covers a broader array of eligible medications for the treatment of both opioid and alcohol dependence to eligible clients in all Island communities with no out of pocket cost.
Community Mental Health Program
In August 2022, the Community Mental Health Drug Program was expanded to include second generation long-acting antipsychotic medications, a change that had been requested by local care providers.
Removal of Special Authorization for certain medications
Since August 2022, the special authorization requirement for 24 eligible drugs has been removed, making them open benefit under the programs they are listed under. This change makes the drugs easier to access for clients by removing administrative burden on prescribers. See the PEI Pharmacare formulary for special authorization criteria for medications.
High-Cost Drug Program
The High-Cost Drug Program supports Island residents with the cost of eligible high-cost medications. Effective June 1, 2023 the program has been expanded so that all Island residents are eligible to apply for coverage under this program. As well, changes have been made to remove barriers to access to the eligible high-cost medications covered in the formulary for those clients in the Financial Assistance and Nursing Home programs.
Catastrophic Drug Program
Effective with the start of the new program year on July 1, 2023 updates will be made to the Catastrophic Drug Program. The number of income levels has been increased from four to 12, which means deductible amounts paid by clients will be lower than in previous years. These changes will result in out of pocket savings for clients registered in the Catastrophic Drug Program.
What is the Prescription Care $5 copay for eligible medications?
Effective June 1, 2023 certain eligible medications for cardiovascular disease, mental health, and diabetes that are listed in the PEI Pharmacare formulary will be available to Island residents covered under the Generic Drug Program, Seniors' Drug Program, Family Health Benefit Drug Program, and Diabetes Drug Program for a $5 copay.
How were the Prescription Care $5 copay medications chosen?
The medications included in the list were selected based on the work completed by a national group to identify commonly used medications for cardiovascular disease, mental health, and diabetes. These medications make up about 60% of all dispenses in PEI’s drug programs and were chosen to help reduce the burden of medication cost for many Island residents and families. The eligible medications include approximately 100 drugs for cardiovascular disease, and over 80 drugs for diabetes and mental health.
How will the Prescription Care $5 copay medications help me?
Here is a scenario that shows the potential savings:
A senior with diabetes, high cholesterol, and high blood pressure may take the following medications (note that some of the medications in this scenario are dispensed on a 3-month basis):
|Medication||Current Copay||New Copay||Savings|
|Insulin 1||$19.95 / month||$5.00 / month||$14.95 / month|
|Insulin 2||$19.95 / month||$5.00 / month||$14.95 / month|
|Blood pressure||$15.94 / 3-months||$5.00 / 3-months||$10.94 / 3-months|
|Cholesterol||$15.94 / 3-months||$5.00 / 3-months||$10.94 / 3-months|
Do I have to apply for the Prescription Care $5 copay?
You do not have to apply for the $5 copay. After June 1, 2023 when you pick up a prescription from your pharmacy for an eligible medication from the Prescription Care $5 list, the copay will be $5 if you are enrolled in the Seniors, Generic Drug, Diabetes, or Family Health Benefit Program.
How do I know which medications are available for $5.00 and which aren’t?
Medications available for $5.00 are identified in the PEI Pharmacare Formulary with the following symbol: ⑤
What about medications that are not on the Prescription Care $5 list?
Your other medications that are not on the $5 list will still be available to you with the same copay as you had before, depending on the medication you take and the program(s) that you are enrolled in.
Do I still need special authorization to access some of the $5.00 medications?
Yes, there are certain medications on the $5.00 funded list that will require your prescriber to request access for you.
How much will this Prescription Care $5 copay initiative cost?
It is estimated that the Government spend on this program will be approximately $3 million/year.