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Canadian Medicare Updates and Information.

The following information is for reference only and should not be used without checking its accuracy with the Ministry of Health for your Province.

Generic Drug Substitution:

Generic Drug Substitution is the substitution of a generic drug in place of a brand name drug (where a generic exists). Under Ontario Bill 55 a pharmacist must dispense the lowest priced generic equivalent drug. However, if the doctor indicates "no substitutions" or the patient requests a particular brand then the drug will be dispensed as requested.
The look and color of a generic medication may be different to the brand name, but your doctor or your pharmacist will assure you that the generic is the exact same drug and provides the same therapeutic benefits.
Generic dugs cost less and save you money.. Ask for them whenever you have a prescription filled. You'll be surprised as to how much money you can save yourself and / or your Drug Plan.

Changes under Ontario Bill 26

• Changes in Fee Payments to Ontario Practioners!
  Chiropractor and Podiatrist fees are covered expenses under most group health plans. These expenses are payable by a group health plan after the Ontario Provincial plan annual maximum has been paid by the Province. Currently under Section 14 of the Ontario Health Insurance Act coverage for Chiropractor, Podiatrist or Osteopath services are not allowed until the annual maximum under the O.H.I.P. has been paid.
• Effective August 1, 1996 the Ontario Ministry Of Health is planning to put into place a new regulation exempting Chiropractors,and Podiatrists from Section 14 of the Ontario Health Insurance Act . This new regulation will impact Group health plans that cover expenses for Chiropractors & Podiatrists. With the new regulation service fees will be payable starting with the first visit. This means expenses in excess of the Provincial plan per visit limit would be payable by a Group Health Plan.

• Changes to the Ontario Drug Benefit Plan (ODB)

  • ODB Dispensing Fee
    The maximum dispensing fee under the ODB plan is currrently $6.11 In the past, this fee has been a result of negotiation between the Provincial Government and the Ontario Pharmacists Association. Under Bill 26 the government will set the maximum dispensing fee through regulation. This change is expected to come into effect around June 1, 1996.
  • Drug Pricing Changes
    At the present time, the maximum a pharmacy can charge for drugs that are included in the ODB formulary is Best Available Price*{BAP} plus a markup of 10 to 20%. This maximum charge applies to drugs that are dispensed to both the general public and ODB benefit recipients. There are no regulatory restrictions on the price charged for drugs NOT INCLUDED in the ODB formulary. (BAP) is the lowest price at which a particular dosage and strength of a drug can be purchased in Canada.
    Under Bill 26
  • • - The price of the drug and the mark-up will still be subject to regulation, but only for ODB plan recipients. The term BAP will be replaced with Drug Benefit Price and the Government will negotiate this price with the drug manufacturer directly.
    • - The Government will no longer regulate the mark-up or price of drugs charged to the general public including drugs included in the ODB formulary.
    • -The mark-up on drugs will no longer be restricted to between 10 to 20% but will be set by regulation. For now the mark-up will be set at 10%

    These changes are expected to come into effect around June 1, 1996.

  • Ontario Drug Benefit Deductible
    Under Bill 26, effective June 1, 1996 ODB recipients will be required to pay a deductible when receiving drugs under the Plan. The deductible will be as follows:

  ODB Deductible Chart
  Net Income		Single	Family of Two	Family of Three	Family of 3 or More
  Single Seniors	$16,000 or Less	$2 Co-Payment	N/A	N/A	N/A
  Senior Couples	$24,000 or Less	N/A	$2 Co-Payment	N/A	N/A
  Single Seniors	Over $16,000	First $100 then the ODB dispensing fee	N/A.	N/A.	N/A.
  Senior Couples	Over $24,000	N/A.	First $100 Each then the ODB dispensing fee.	N/A.	N/A.
  Social Assistance	N/A	$2 Co-Payment	$2 Co-Payment	$2 Co-Payment	$2 Co-Payment
  Trillium Program for Ontarians with low incomes	6,500 or Less	$350 then $2 Co-Payment	$250 then $2 Co-Payment	$200 then $2 Co-Payment	$150 then $2 Co-Payment
  	$10,000	$387 then $2 Co-payment	$287 then $2 Co-payment	$237 then $2 Co-payment	$187 then $2 Co-payment
  	$15,000	$444 then $2 Co-payment	$344 then $2 Co-payment	$294 then $2 Co-payment	$244 then $2 Co-payment
  	$18,000	$478 then $2 Co-payment	$378 then $2 Co-payment	$328 then $2 Co-payment	$278 then $2 Co-payment
  	$20,000 and over	No Change to Deductible amount but these recipients now pay $2 Co-payment on each prescription filled.

  In Brief this means:

• Low Income Seniors
  $2 for each prescription. This will apply to single seniors earning less than $16,000 a year and to senior couples earning less than $24, 000 a year, and also to residents of nursing homes and home care recipients.
• All Other Seniors
  The first $100 in prescription cost per person per year. After this the Ontario Drug Benfit Plan dispensing fee for each prescription filled during the year. Currently this is $6.11.
• All other ODB Recipients.
  $2 for each prescription.

In our opinion the deregulation of drug prices in Ontario may lead to an increase in drug costs for the general public. Ultimately private and group health insurance plans will end up bearing these costs, which in turn are passed on to employees through increased premiums or benefit cut-backs. Now is a good time to have one of our Health Insurance Specialist contact you or your plan sponsor to discuss ways to lessen the impact of some of the changes proposed by Bill 26.

The preceding information is for reference only and should not be used without checking its accuracy with the Ministry of Health for your Province.

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Last Update:March 21, 1996, February 4, 1997
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