Letter to Roy Cairns Re: Life and health insurers' questions regarding PEI's proposed pharmacare program

Date de parution : 05/16/2013
Personne(s)-ressource(s) : Stephen Frank

May 16, 2013

Mr. Roy Cairns
Pharmacy Consultant
Health System Planning & Development
Department of Health and Wellness
20 Fitzroy Street, Charlottetown
Prince Edward Island, C1A 7N8

Dear Mr. Cairns:

Re: Life and health insurers' key questions regarding proposed pharmacare program

Thank you for taking the time to speak with me recently about the proposed introduction of a new pharmacare program for the province of PEI. As we discussed, the introduction of this new program will have implications for private insurance in the province and we look forward to working with you as you finalise the details of how the new program will work.

The Canadian Life and Health Insurance Association (CLHIA) is a voluntary trade association and our member companies account for 99 per cent of the life and health insurance in force. At the end of 2011, our members provided supplemental health coverage to over 500 plans in PEI that covered 100,000 people with supplementary health benefit coverage. Cumulatively, the industry reimbursed in excess of $36 million to residents of PEI for drug costs.

Below, I highlight our high level understanding of how the proposed pharmacare program is intended to work. I also list some preliminary questions that we have that will aide in our assessment of any impacts for private payers in the province.

Overview of CLHIA Understanding of Proposed Pharmacare Program

The following is our understanding of the key elements of the proposed pharmacare model:

    · The new program will be payer of last resort – i.e. if an individual has private coverage, the private coverage remains first payer whether or not the individual is out-of-pocket the deductible amount.
      · For those without any form of coverage, household income-based deductibles apply, and the province is the first payer once the individual's income-based deductible is met.

    1. How will the program be coordinated between private insurers and the public plan?

      · If a private plan has a maximum benefit amount and an individual passes that level, can that individual to transition to the new public plan?
        · Would any amounts an individual paid in premiums for insurance coverage count against the deductible amount?
          · Do you know what the application process will look like for individuals applying for coverage by the province?

        2. What drugs will be covered on the provincial formulary? Will there be multiple formularies (full, partial and non-benefit lists as in BC for example)?

        3. What will happen to existing public drug coverage plans in PEI?

        4. Can you indicate what the target implementation date is for launch of the new program?
          Thank you for your attention to this important matter. As mentioned, we appreciate your input and look forward to working with you as you continue your work towards implementing this important change for the residents of PEI.


          (Original signed by)

          Stephen Frank