Methodology
Definitions
Deductible/Co-pay on Eligible Rx - The total cost of Peter/Janet's deductible and/or co-pay they
must incur to purchase the prescription drugs and supplies available through a public drug formulary.
Other Drug/Supply Cost (minus subsidy) - The total cost of Peter/Janet's prescription drugs
and diabetic supplies not covered by a public plan or program, less any government subsidy to offset
diabetic supplies expenses.
Total Out-of-Pocket - The total cost of Peter/Janet's deductibles and co-pays on covered drugs and supplies plus
the cost of non-covered drugs and diabetic supplies, less any government subsidy to offset supply costs.
Formulas
Drug Cost = unit cost x # of annual units + pharmacy mark-up + dispensing fees
(ASA is exception - no mark-up or dispensing fee)
Supply Cost = unit cost x # of annual units + pharmacy mark-up
Deductible -- typically, the deductible is 2%-4% of family income. Peter's eligible drug costs never surpassed the deductible level.
Co-pay = total drug costs x co-pay %
No research or consideration for exact differences between co-pay subsidies available in each public drug plan
if not included in provincial summaries; if not readily available, then assumed maximum dispensing fee per Rx
% of Peter's Annual Income = (total out-of-pocket costs / $30,000) x 100
% of Janet's Annual Income = (total out-of-pocket costs / $14,500) x 100
GST/PST/HST has not been added to any formulas
Peter Example (British Columbia)
MED, SUPPLY, ETC BC
Apo-Metformin 500mg Tab $ 329.47 Using Peter's individual worksheet drug cost and regimen tables, pharmacy
Altace 10mg Cap $ 510.15 mark-up, dispensing fee and supply policy data, and the formulas for calculating
Novo-Hydrazide 25mg Tab $ 124.71 drug and supply costs, the amounts to the left were determined to be Peter's
Lipitor 20mg Tab $ 1,028.08 annual regimen expenses.
Avandia 4mg Tab $ 1,032.28
Lancets $ 42.34 BC Pharmacare covers a portion of Peter's drug and supply costs (orange).
One Touch Ultra Meter $ -
One Touch Ultra Test Strips $ 674.52
ASA 81 mg tablets $ 40.15
SUBTOTAL COST PER YEAR $ 3,781.70 The total annual cost for Peter to follow his recommended regimen.
Deductible/Co-pay on Eligible Rx $ 1,815.00 Dedutible is 3% of NFI $55,000 ($1,650) + 30% of $550* ($165) = $1,815
Other Drug/Supply Cost (minus subsidy) $ 1,114.77 Avandia $1,032.28 + Lancets $42.34 + ASA $40.15 = $1,114.77
TOTAL Out-of-Pocket $ 2,964.77 Deductible/co-pay $1,815 + Other drug/supply $1,114.77 = $2,964.77
% of Peter's Annual Income 9.88% (Total out-of-pocket $2,964.77 / Annual Income $30,000) x 100 = 9.88%
Pharmacy Mark Up (Cash Drugs) 15%
Pharmacy Mark Up (Public Plan Drugs) 10%
Dispensing Fee $ 8.60
Max Days Supply 30
Fully Covered
Partially Covered
Not Covered
*$550 is the difference between Peter's maximum annual drug costs of 4% NFI and his deductible; he pays 30% for this portion
Janet Example (Alberta)
MED, SUPPLY, ETC AB
Humalog 100U/mL Inj Sol-5x3mL Pk $ 794.97 Using Janet's individual worksheet drug cost and regimen tables, pharmacy
Humulin N 100U/mL Inj Susp-5x3mL Pk $ 369.38 mark-up, dispensing fee and supply policy data, and the formulas for calculating
BD Pen Needles $ 404.42 drug and supply costs, the amounts to the left were determined to be Janet's
Lancets $ 105.85 annual regimen expenses.
One Touch Ultra Meter $ -
One Touch Ultra Test Strips $ 1,706.38
Humapen $ -
TOTAL COST PER YEAR $ 3,381.00 The total annual cost for Janet to follow her recommended regimen.
Deductible/Co-pay on Eligible Rx $ 558.43 ((Humalog $794.97 + Humulin $369.38) x 30% co-pay) + $209.12 premium = $558.43
Other Drug/Supply Cost (minus subsidy) $ 1,666.65 Needles $404.42 + Lancets $105.85 + Strips $1,706.38 - Subsidy $550 = $1,666.65
TOTAL Out-of-Pocket $ 2,225.07 Deductible/co-pay $558.43 + Other drug/supply $1,666.65 = $2,225.07
% of Janet's Annual Income 15.3% (Total out-of-pocket $2,225.07 / Annual Income $14,500) x 100 = 15.3%
Pharmacy Mark Up (Cash Drugs) 15%
Pharmacy Mark Up (Public Plan Drugs) 10%
Dispensing Fee/Co-Pay $ 9.90
Max Days Supply 30
Fully Covered
Partially Covered
Not Covered
Peter - Type 2
MED, SUPPLY, ETC BC AB SK MB
Apo-Metformin 500mg Tab $ 329.47 $ 321.81 $ 225.45 $ 293.10
Altace 10mg Cap $ 510.15 $ 546.65 $ 538.62 $ 509.91
Novo-Hydrazide 25mg Tab $ 124.71 $ 149.16 $ 113.03 $ 120.45
Lipitor 20mg Tab $ 1,028.08 $ 1,048.52 $ 1,080.64 $ 1,007.77
Avandia 4mg Tab $ 936.25 $ 988.30 $ 985.99 $ 902.32
Lancets $ 42.34 $ 42.34 $ 42.34 $ 42.34
One Touch Ultra Meter $ - $ - $ - $ -
One Touch Ultra Test Strips $ 779.15 $ 738.79 $ 771.49 $ 766.87
ASA 81 mg tablets $ 40.15 $ 40.15 $ 40.15 $ 40.15
SUBTOTAL COST PER YEAR $ 3,790.30 $ 3,875.72 $ 3,797.70 $ 3,682.89
Deductible/Co-pay on Eligible Rx/Supply $ 1,815.00 $ 1,162.33 $ 2,185.55 $ 2,184.00
Other Drug/Supply Cost $ 82.49 $ 821.28 $ 40.15 $ 40.15
Government Special Program Subsidies $ - $ 250.00 $ - $ -
TOTAL Out-of-Pocket $ 1,897.49 $ 1,733.61 $ 2,225.70 $ 2,224.15
% of Peter's Annual Income 6.32% 5.78% 7.42% 7.41%
Pharmacy Mark Up (Cash Drugs) 15% 15% 15% 15%
Pharmacy Mark Up (Public Plan Drugs) 10% 10% 10% 10%
Dispensing Fee $ 8.60 $ 10.61 $ 7.97 $ 8.25
Max Days Supply (Public Plans) 30 30 30 30
Fully Covered
Partially Covered Coverage coding is specific to Peter, not gener
Not Covered
WHOLESALE PRICE (UNIT)
BC AB SK MB
Apo-Metformin 500mg Tab $ 0.14 $ 0.12 $ 0.08 $ 0.12
Altace 10mg Cap $ 1.01 $ 1.04 $ 1.10 $ 1.02
Novo-Hydrazide 25mg Tab $ 0.05 $ 0.05 $ 0.04 $ 0.05
Lipitor 20mg Tab $ 2.30 $ 2.29 $ 2.45 $ 2.26
Avandia4mg Tab $ 2.21 $ 2.14 $ 2.33 $ 2.13
Lancets $ 0.06 $ 0.06 $ 0.06 $ 0.06
One Touch Ultra Meter $ - $ - $ - $ -
One Touch Ultra Test Strips $ 0.84 $ 0.85 $ 0.84 $ 0.83
ASA (Incl. Pharmacy Mark-up) $ 0.11 $ 0.11 $ 0.11 $ 0.11
QUANTITY REQUIRED PER YEAR Daily Annual
Apo-Metformin 500mg Tab 4 1460
Altace 10mg Cap 1 365
Novo-Hydrazide 25mg Tab 1 365
Lipitor 20mg Tab 1 365
Avandia4mg Tab 1 365
Lancets 2 730
One Touch Ultra Meter 0 0
One Touch Ultra Test Strips 2 730
ASA 1 365
Federal/Provincial/Territorial Plans
ON QC NB NS PEI NF NU YK
$ 233.11 $ 287.62 $ 251.06 $ 249.37 $ 310.01 $ 298.50 $ 360.26 $ 315.24
$ 441.89 $ 560.64 $ 444.15 $ 442.46 $ 502.73 $ 499.25 $ 602.25 $ 520.00
$ 40.39 $ 110.96 $ 25.19 $ 30.53 $ 109.26 $ 47.56 $ 137.24 $ 126.53
$ 907.63 $ 946.08 $ 1,091.38 $ 1,034.30 $ 1,076.87 $ 1,142.56 $ 1,228.59 $ 1,049.98
$ 980.36 $ 868.29 $ 1,003.22 $ 883.19 $ 926.25 $ 987.44 $ 1,185.89 $ 1,013.85
$ 42.34 $ 42.34 $ 42.34 $ 42.34 $ 42.34 $ 42.34 $ 42.34 $ 42.34
$ - $ - $ - $ - $ - $ - $ - $ -
$ 562.34 $ 761.39 $ 776.55 $ 719.49 $ 745.76 $ 836.88 $ 948.64 $ 813.10
$ 40.15 $ 40.15 $ 40.15 $ 40.15 $ 40.15 $ 40.15 $ 40.15 $ 40.15
$ 3,248.23 $ 3,617.47 $ 3,674.03 $ 3,441.83 $ 3,753.36 $ 3,894.68 $ 4,545.35 $ 3,921.20
$ 1,964.00 $ 1,378.00 $ - $ - $ - $ - $ - $ 250.00
$ 82.49 $ 82.49 $ 3,674.03 $ 3,441.83 $ 3,753.36 $ 3,894.68 $ 40.15 $ 40.15
$ - $ - $ - $ - $ 528.00 $ - $ - $ -
$ 2,046.49 $ 1,460.49 $ 3,674.03 $ 3,441.83 $ 3,225.36 $ 3,894.68 $ 40.15 $ 290.15
6.82% 4.87% 12.25% 11.47% 10.75% 12.98% 0.13% 0.97%
15% 15% 15% 15% 15% 25% 30% 15%
10% 10% 10% 10% 10% 10% 30% 10%
$ 2.00 $ 7.80 See Notes See Notes $ 7.00 $ 6.50 $ 9.33 $ 8.75
30 30 30 30 30 30 30 30
ing is specific to Peter, not generally representative of plans' coverage for all diabetics
Federal/Provincial/Territorial Plans
ON QC NB NS PEI NF NU YK
$ 0.13 $ 0.12 $ 0.14 $ 0.14 $ 0.14 $ 0.16 $ 0.13 $ 0.13
$ 1.04 $ 1.16 $ 1.02 $ 1.02 $ 1.04 $ 1.08 $ 1.03 $ 1.03
$ 0.04 $ 0.04 $ 0.04 $ 0.05 $ 0.06 $ 0.09 $ 0.05 $ 0.05
$ 2.20 $ 2.12 $ 2.50 $ 2.43 $ 2.47 $ 2.49 $ 2.35 $ 2.35
$ 2.32 $ 2.05 $ 2.34 $ 2.07 $ 2.19 $ 2.15 $ 2.26 $ 2.26
$ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06
$ - $ - $ - $ - $ - $ - $ - $ -
$ 0.67 $ 0.83 $ 0.90 $ 0.84 $ 0.88 $ 0.91 $ 0.88 $ 0.88
$ 0.11 $ 0.11 $ 0.11 $ 0.11 $ 0.11 $ 0.11 $ 0.11 $ 0.11
NWT NIHB
$ 360.26 $ 319.98
$ 602.25 $ 524.75
$ 137.24 $ 131.28
$ 1,228.59 $ 1,054.73
$ 1,185.89 $ 1,018.59
$ 42.34 $ 42.34
$ - $ -
$ 948.64 $ 817.84
$ 40.15 $ 40.15
$ 4,545.35 $ 3,949.67
$ - $ -
$ 40.15 $ 40.15
$ - $ -
$ 40.15 $ 40.15 $ 1,873.89 Average $ 1,971.99 Median
0.13% 0.13% 6.25% Average 6.57% Median
30% 15%
30% 10%
$ 9.33 $ 9.14
30 30
NWT NIHB
$ 0.13 $ 0.13
$ 1.03 $ 1.03
$ 0.05 $ 0.05
$ 2.35 $ 2.35
$ 2.26 $ 2.26
$ 0.06 $ 0.06
$ - $ -
$ 0.88 $ 0.88
$ 0.11 $ 0.11
PETER
Drug prices in reference table include wholesale mark-up
Public prices were used whenever available, as they most closely reflect what manufacturers charge (RM)
National price for ASA assumed
Assume 30 days maximum supply (standard in Quebec; common in other provinces; applied to rest of Canada for consistency)
Assume that the max day supply policy applies only when drugs/supplies are subsidized through a public program
Lancets purchased for entire year, so not subject to maximum supply effect
Lancets are $.06 per unit across Canada (available at www.canadadrugs.com $10.87 box + $12.14 shipping fee)
Lancets do not include additional Pharmacy Mark-up or Dispensing Fee (purchased online)
Assume test strips require a Rx; public subsidized subject to max day supply; private bought once per year
Assume there is a public reimbursement mechanism for non-Rx supply purchases (incl. online)
Where full or partial government cost offset is available, then pharmacy mark-up is at public plan rate
Cash purchase pharmacy mark-up is based on pharmacist-quoted range of 10-25%
Public plan pharmacy mark-up is assumed at 10% Ontario limit, except where other information available
When no public drug coverage is available, then assume that Peter buys a full year supply to avoid multiple dispensing fees
Altace 10MG caplets used (pricing information not available for tablets)
British Columbia
Peter's total eligible drug/supply costs are $2,771.56 (not including Avandia, which is not covered)
His deductible is $1,650 (3% of NFI) and he must cover 30% of the amount above the deductible up to $2,200 (4% of NFI),
which is $165, and Pharmacare covers 100% after $2,200
Thus, Peter's deductible and co-pay total is $1,815
Assume that Peter has a Certificate of Training from an approved Diabetes Education Centre
Alberta
Peter must pay an income-based $246 premium ($61.50x4) to the Alberta Blue Cross drug program
Peter qualifies for 30% co-pay on eligible drugs
Peter does not qualify under "special circumstances"
Peter is eligible for the Alberta Monitoring For Health program ($250 for people managing diabetes with oral meds)
Peter pays a $25.21 dispensing fee on his test strips because his Rx is more than $150.00
Saskatchewan
Assume Peter is eligible for Special Support Program for drug costs above 3.4% of family income ($1,870)
Assume Peter's co-pay is 35% (typical of other SK plans)
Peter's drug and supply costs are approximately $2,771.56, but his deductible/co-pay is $2,185.55 ($1,870 + $315.55)
Assume Peter is not eligible for Avandia
Manitoba
Peter pays a 4% deductible on his adjusted family income of $52,000 ($2,184 deductible)
4,000 strips are covered per year and lancets partially covered
Assume no access to Avandia
Ontario
Assume Trillium coverage because drug (excl. Avandia) and supply costs are approx. $2,225/yr or 7.4% of his income
Peter's Trillium deductible is $1,964
Peter's Trillium co-pay is $2, which is figured into eligible drug/supply costs
Peter is not eligible for Avandia (thus, he buys one year supply to avoid multiple Rx dispensing fees); one-time fee is $6.54
Quebec
Assume Peter is paying $521 premium + 28.5% eligible-drug co-insurance + $11.90/month deductible
Peter's annual maximum for the drug plan is $1,378 ($521 premium + $857 maximum co-insurance and deductible)
The premium, co-insurance and deductible numbers used in the model reflect costs for 2005/06
Assume Peter is not eligible for Avandia
New Brunswick
No coverage for drugs or supplies
Peter's dispensing fees are: Apo-Metformin $16.00; Altace $16.00; Novo-Hydrazide $8.40; Lipitor $21x2 ($42.00);
Avandia $21.00; test strips $21.00
Nova Scotia
No coverage for drugs or supplies
Dispensing fees in Nova Scotia are $14.31 for Rx >$130.00; Novo-Hydrazide's fee is $9.54
Peter buys his Rx drugs for an entire year at one time to avoid multiple dispensing fees
Newfoundland/Labrador
Private price is used for test strips since public price is listed as $1.12; as an alternative Peter could purchase strips
online at a much lower price than $1.12 per strip
Newfoundland Pharmacy mark-up is 25% to take into account 10% ingredient cost premium pharmacist can charge
when ingredient cost is >$30
Peter buys drugs for an entire year at one time (avoids multiple dispensing fees but incurs N&L 25% pharmacy mark-up)
PEI
Prices based on average of other 3 Atlantic provinces' drug prices
Assume Peter is registered with Diabetes Control Program ($11 per Rx subsidy)
Peter will have approximately 48 eligible prescriptions annually (x $11 = $528) -- 30 days supply assumed
Assumes that all drugs (except Avandia) are eligible
NIHB, Yukon, NWT & Nunavut
Similar assumptions
Applied NIHB prices to territories
Everything covered; Yukon requires $250 copay for non-NIHB people with diabetes
Assume access to Avandia
Pharmacists in NWT and NU are entitled to a 30% pharmacy mark-up
NIHB pharmacy dispensing fee is the average of the fees in the three territories
Janet - Type 1
MED, SUPPLY, ETC BC AB SK MB
Humalog 100U/mL Inj Sol-5x3mL Pk $ 743.02 $ 803.61 $ 638.99 $ 666.49
Humulin N 100U/mL Inj Susp-5x3mL Pk $ 345.53 $ 378.02 $ 297.72 $ 293.10
BD Pen Needles $ 404.42 $ 404.42 $ 404.42 $ 404.42
Lancets $ 105.85 $ 105.85 $ 105.85 $ 105.85
One Touch Ultra Meter $ - $ - $ - $ -
One Touch Ultra Test Strips $ 1,790.93 $ 1,835.46 $ 1,783.27 $ 1,766.60
Humapen $ - $ - $ - $ -
TOTAL COST PER YEAR $ 3,389.76 $ 3,527.36 $ 3,230.25 $ 3,236.46
Deductible/Co-pay on Eligible Rx/Supply $ 290.00 $ 563.61 $ 1,451.04 $ 336.40
Other Drug/Supply Cost $ 105.85 $ 2,345.73 $ - $ -
Government Special Program Subsidies $ - $ 550.00 $ - $ -
TOTAL Out-of-Pocket $ 395.85 $ 2,359.34 $ 1,451.04 $ 336.40
% of Janet's Annual Income 2.7% 16.3% 10.0% 2.3%
Pharmacy Mark Up (Cash Drugs) 15% 15% 15% 15%
Pharmacy Mark Up (Public Plan Drugs) 10% 10% 10% 10%
Dispensing Fee/Co-Pay $ 8.60 $ 10.61 $ 7.97 $ 8.25
Max Days Supply (Public Plans) 30 30 30 30
Fully Covered
Partially Covered Coverage coding is specific to Janet, not ge
Not Covered
WHOLESALE PRICE (UNIT)
BC AB SK MB
Humalog 100U/mL Inj Sol-5x3mL Pk $ 0.05 $ 0.06 $ 0.05 $ 0.05
Humulin N 100U/mL Inj Susp-5x3mL Pk $ 0.03 $ 0.03 $ 0.03 $ 0.02
BD Pen Needles (Incl. Pharmacy Mark-up) $ 0.28 $ 0.28 $ 0.28 $ 0.28
Lancets (Incl. Pharmacy Mark-up) $ 0.06 $ 0.06 $ 0.06 $ 0.06
One Touch Ultra Meter (NO CHARGE) $ - $ - $ - $ -
One Touch Ultra Test Strips $ 0.84 $ 0.85 $ 0.84 $ 0.83
Humapen (NO CHARGE) $ - $ - $ - $ -
QUANTITY REQUIRED PER YEAR Daily Annual
Humalog 100U/mL Inj Sol-5x3mL Pk 30 10950
Humulin N 100U/mL Inj Susp-5x3mL Pk 20 7300
BD Pen Needles 4 1460
Lancets 5 1825
One Touch Ultra Meter 0 0
One Touch Ultra Test Strips 5 1825
Humapen 0 0
Federal/Provincial/Territorial Plans
ON QC NB NS PEI NF NU YK
$ 722.94 $ 709.20 $ 587.66 $ 888.35 $ 674.40 $ 737.75 $ 967.62 $ 829.16
$ 329.47 $ 375.95 $ 326.62 $ 409.83 $ 317.62 $ 308.88 $ 493.12 $ 427.66
$ 404.42 $ 404.42 $ 404.42 $ 404.42 $ 404.42 $ 404.42 $ 404.42 $ 404.42
$ 105.85 $ 105.85 $ 105.85 $ 105.85 $ 105.85 $ 105.85 $ 105.85 $ 105.85
$ - $ - $ - $ - $ - $ - $ - $ -
$ 1,369.36 $ 1,761.13 $ 1,930.88 $ 1,777.26 $ 1,853.90 $ 2,082.44 $ 2,201.32 $ 1,873.06
$ - $ - $ - $ - $ - $ - $ - $ -
$ 2,932.05 $ 3,356.54 $ 3,355.42 $ 3,585.71 $ 3,356.19 $ 3,639.33 $ 4,172.32 $ 3,640.15
$ 438.00 $ 857.00 $ - $ - $ 992.02 $ - $ - $ 250.00
$ 510.27 $ 105.85 $ 3,355.42 $ 3,585.71 $ 2,364.17 $ 3,639.33 $ - $ -
$ - $ - $ - $ - $ 240.00 $ - $ - $ -
$ 948.27 $ 962.85 $ 3,355.42 $ 3,585.71 $ 3,116.19 $ 3,639.33 $ - $ 250.00
6.5% 6.6% 23.1% 24.7% 21.5% 25.1% 0.0% 1.7%
15% 15% 15% 15% 15% 25% 30% 15%
10% 10% 10% 10% 10% 10% 30% 10%
$ 2.00 $ 7.80 See Notes $ 14.31 $ 7.00 $ 6.50 $ 9.33 $ 8.75
30 30 30 30 30 30 30 30
ng is specific to Janet, not generally representative of plans' coverage for all diabetics
Federal/Provincial/Territorial Plans
ON QC NB NS PEI NF NU YK
$ 0.06 $ 0.05 $ 0.05 $ 0.07 $ 0.05 $ 0.05 $ 0.06 $ 0.06
$ 0.04 $ 0.04 $ 0.04 $ 0.04 $ 0.04 $ 0.03 $ 0.04 $ 0.04
$ 0.28 $ 0.28 $ 0.28 $ 0.28 $ 0.28 $ 0.28 $ 0.28 $ 0.28
$ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06 $ 0.06
$ - $ - $ - $ - $ - $ - $ - $ -
$ 0.67 $ 0.83 $ 0.90 $ 0.84 $ 0.88 $ 0.91 $ 0.88 $ 0.88
$ - $ - $ - $ - $ - $ - $ - $ -
NWT NIHB
$ 967.62 $ 833.90
$ 493.12 $ 432.40
$ 404.42 $ 404.42
$ 105.85 $ 105.85
$ - $ -
$ 2,201.32 $ 1,877.80
$ - $ -
$ 4,172.32 $ 3,654.38
$ 550.00 $ -
$ - $ -
$ - $ -
$ 550.00 $ - $ 1,496.46 Average $ 955.56 Median
3.8% 0.0% 10.3% Average 6.6% Median
30% 15%
30% 10%
$ 9.33 $ 9.14
30 30
NWT NIHB
$ 0.06 $ 0.06
$ 0.04 $ 0.04
$ 0.28 $ 0.28
$ 0.06 $ 0.06
$ - $ -
$ 0.88 $ 0.88
$ - $ -
JANET
Janet earns approx. $14,500 annually
Drug prices in reference data table include wholesale mark-up
Public prices were used whenever available, as they most closely reflect what manufacturers charge (RM)
Cash purchase pharmacy mark-up is based on pharmacist-quoted range of 10-25%
Public plan pharmacy mark-up is assumed at 10% Ontario limit, except where other information available
Public plan-related pharmacy mark-up applies when government assistance is provided
Assume that Janet buys non-covered insulin quarterly (max 4 dispensing fees per year per Rx)
National price for ASA assumed
BD Pens are $0.28 per unit across Canada (available at www.canadadrugs.com $27.28 box + 1/2 of $12.14 shipping fee)
Lancets are $.06 per unit across Canada (available at www.canadadrugs.com $10.87 box +1/2 of $12.14 shipping fee)
Assume that Janet orders pens and lancets for entire year, thus one shipping fee of $12.14
Lancets and pen needles do not include additional Pharmacy Mark-up or Dispensing Fee (purchased online @ retail)
Assume test strips require a Rx; publicly-subsidized strips subject to max day supply; private bought once per year
Assume there is a public reimbursement mechanism for non-Rx supply purchases (incl. online)
Assume 30 days maximum supply (standard in Quebec; common in other provinces; applied to rest of Canada for consistency)
Assume that the max day supply policy applies only when drugs/supplies are subsidized through a public program
Insulin Pricing Methodology
100U/mL = 100 units per mL
3.0mL x 100 units = 300 units
5x3.0mL = 1,500 units
Claim / 1,500 units = cost per unit
British Columbia
Janet incurs a $290.00 co-pay for her eligible prescriptions (2% of income)
Janet pays for lancets, which are not covered/subsidized
Assume that Janet has a Certificate of Training from an approved Diabetes Education Centre
Alberta
Janet's supplies costs are offset by $550 subsidy from the Alberta Monitoring For Health program
Janet incurs a $209.12 annual premium and 30% co-pay for her insulin costs ($354.49) = $563.61
Premium = $52.28 per quarter (partial subsidy because income between $12,450 and $15,970)
Janet's premium is estimated (1/2 of the difference between regular quarterly of $61.50 and full subsidy quarterly of $43.05)
Saskatchewan
Assume Janet is eligible for Special Support Program and has to pay a $493 deductible (3.4% of her income)
Assume Janet's co-pay is 35%
Thus, $3,230.25(total drug and supply cost) -$493=$2,737.25*.35=$958.04+$493 = $1,451.04
All supplies partially covered
Manitoba
Janet pays $336.40 deductible (2.32% of income)
4,000 test strips are covered; other supplies are partially covered
Ontario
Assume Janet is eligible for the Trillium Drug Program
Janet pays an annual $438 deductible (Trillium)
Through Trillium, Janet also has a $2.00 dispensing fee per Rx (figured into drug/supply costs)
Janet does not qualify for Monitoring For Health program because she is receiving Trillium support
Pen needles and lancets are not covered
Quebec
Assume Janet does not pay premium because of her low income
Assumes Janet pays max for co-insurance and deductible (28.5% of drug cost and $11.90 per month; $857 annual maximum)
Lancets not covered
Blood glucose testing strips and needles partially covered
Quebec has been assigned the Canadian average price for insulin
New Brunswick
No coverage for drugs or supplies
The dispensing fees are: Humalog $21.00; Humulin $16.00; and test strips $21x2 ($42.00)
Nova Scotia
No coverage for drugs or supplies
Janet buys drugs for entire year at one time (avoids multiple dispensing fees but incurs N&L 25% pharmacy mark-up)
Newfoundland & Labrador
Newfoundland Pharmacy Mark-up is 25% to take into account 10% ingredient cost premium pharmacist can charge
when ingredient cost is >$30
Private price is used for test strips since public price is listed as $1.12; as an alternative Peter could purchase strips
online at a much lower price than $1.12 per strip
PEI
Assume Janet is registered with the Diabetes Control Program
Janet must pay the "cash" mark-up because it is assumed that the DCP does not entitle her to the public mark-up
Janet receives $20 per box of 3.0ml cartridges supplement (7.3 boxes Humalog + 4.9 boxes Humulin = approx $240)
Assume Janet buys an annual supply of insulin to avoid multiple dispensing fees
Yukon
Janet is subject to a $250 deductible because she is not eligible for the "hardship" waiver
Nunavut and NIHB
All costs covered
Pharmacists in Nunavut are entitled to a 30% pharmacy mark-up
The NIHB pharmacy dispensing fee is the average of the fees in the three territories
Northwest Territories
Only 100 strips per month (1,200 per year) are covered by the government but Janet requires 1,825 per year
(1825 strips needed - 1200 strips covered)*$.088 = $550
Pharmacists are entitled to 30% pharmacy mark-up