There are two types of medications that you may require during your cancer treatment - medications used to treat your cancer, and those used to support your cancer treatment and deal with side effects such as anti-biotics, anti-nausea medications, pain medications, etc.
Treatment Medications
The medications used most commonly for cancer treatment are called chemotherapy. These treatments are usually delivered intravenously (IV therapy) and are delivered in the hospital. Most patients receive IV chemotherapy. You come in to the hospital to receive your chemotherapy and go home the same day. Since your medication is delivered in the hospital, it is considered an insured service under MSI and the cost is covered by the provincial government.
If you are admitted into hospital for your treatment, your medications will be covered during the duration of your hospital stay.
Some chemotherapy and other forms of cancer treatment are not delivered in hospital. These medications come as a pill or injection and can be delivered at home. You may take them yourself or have a nurse or family physician administer it. Since these treatments are taken outside of the hospital, under the Canada Health Act the province is not responsible to cover the cost under MSI. The responsibility falls to the patient to pay for it.
These out-of-hospital treatments are typically used for only a few types of cancer diagnoses. The average price can range from $700/month - $8,000/month. Most patients rely on their insurance or public drug plans to cover the cost of these treatments.
Supportive Medications
You may require a variety of medications during your treatment to support your therapy or deal with side effects. In Nova Scotia, a patient is responsible to pay for these medications.
How many medications you will require depends on your health status and the type of treatment you receive (surgery, chemotherapy, radiation). Some treatments have fewer side effects and patients require fewer medications.
If you are receiving IV chemotherapy, you will receive prescriptions at your initial appointment for medications that you will need to take along with it to help with nausea and other potential side effects. The prescriptions you receive and their cost depend on the chemotherapy treatment, but the average patient in Nova Scotia can expect to pay about $75-100 per cycle of chemotherapy. Again, most people rely on their private or public drug plan to help with these costs.
For our purposes here, a "private" drug plan means an insurance policy for drug coverage that you pay for either yourself or that is provided through an employer-sponsored plan. Some common private plan carriers in Nova Scotia include Medavie Blue Cross, SunLife (including the PSHCP and GSMIP federal employees’ plans), Manulife, Great West Life, Managed Health Care, Desjardins, Greenshield.
A public drug plan is a government-funded program that provides full or partial assistance with drug costs.
The federal government plans apply to specific groups and include Veterans Affairs VAC Benefits, the Non-Insured Health Benefits (NIHB) program of the First Nations and Inuit Health Branch (FNIHB), the Interim Federal Health (IFH) program for refugees, the Canadian Armed Forces plan, and a plan for Correctional Services of Canada.
The provincial public drug program in Nova Scotia is called Nova Scotia Pharmacare, which actually includes a number of different programs. These programs are open to anyone with a NS Health Card Number, and specific eligibility criteria apply in some programs.
The Nova Scotia government offers a range of public drug programs under Nova Scotia Pharmacare. There are five (5) different programs:
Seniors Pharmacare - available to anyone over the age of 65 with a valid NS Health Card; the person cannot have drug coverage through Veterans Affairs Canada, Non-Insured Health Benefits, Nova Scotia Family Pharmacare, or any other public or private plan that covers most of your medications and supplies after age 65. There is a fee to enroll that may be reduced or waived depending on income. Once enrolled there is a co-pay portion paid by the patient on each prescription to a yearly maximum of $382. If you plan to enroll in Seniors Pharmacare and are doing so past the age of 65, you will be subject to a late fee penalty and a 3 month waiting period; this waiting period can be waived by Pharmacare if a letter is submitted indicating you are a cancer patient .
Family Pharmacare - available to anyone who is a permanent resident of Nova Scotia and has a valid NS Health Card; this program is available to families of one or more persons. It does not cost anything to apply. The level of assistance with drug costs is calculated based on family income and size. Once enrolled, there is a family deductible that must be met and a 20% co-payment on each medication. The co-payments may be capped annually based on family income and size. This program covers a range of medications as approved under the Nova Scotia Formulary.
Drug Assistance for Cancer Patients - available to anyone under 65 years of age with a valid NS Health Card, and with a gross family income under $15,720 per year; it does not cost anything to enroll and once enrolled you do not pay anything for your medications; this program only covers cancer-related medications as approved under the Nova Scotia Formulary; you can be enrolled in this program and Family Pharmacare at the same time
Diabetes Assistance Program - provides assistance with diabetes-related medications and supplies, as approved under the Nova Scotia Formulary; see the Nova Scotia Pharmacare website for more details
Community Services Pharmacare benefit - available to clients of Community Services who are on Income Assistance, disability and child welfare programs; provides assistance with medications as approved under the Nova Scotia Formulary; you must qualify for one of these programs to receive this benefit; clients pay a $5 co-pay per prescription; this co-payment can be waived by the caseworker if you have 3 or more prescriptions on an ongoing basis
Application forms and details for most of these programs are available on the Nova Scotia Pharmacare website. You can also call the program at 1-800-544-6191.
The coverage of cancer medications on private drug plans varies. You should call your insurer to check your level of coverage if you are unsure whether your prescribed medications are covered. See Question 7 for tips on talking with your insurer.
The Nova Scotia Family Pharmacare Program pays for certain prescribed drugs and supplies listed as benefits in the Nova Scotia Formulary. A committee of experts keep the benefit list updated based on the latest evidence. Prescriptions must be filled by a Nova Scotia pharmacy to be paid for by Pharmacare.
There is a searchable formulary available through the Nova Scotia Pharmacare website.
Simply type in the name of your medication, or its DIN number, and a list of codes will appear. Click on Benefit Details and this will explain which program covers the medication.
There are a number of reasons why a medication may not be covered.
The medication may need a form filled out by your physician in order to be approved for coverage. These medications are referred to as "Special Authorization" drugs or, for NS Pharmacare, "Exception Status" drugs. You can ask your pharmacist for more details on why the medication was rejected for coverage, or you can ask your pharmacist to call your insurer or NS Pharmacare to check for you.
You can also check the NS Pharmacare Formulary (see Question 5). If you type in your medication name and an "E" appears next to your Pharmacare program code, it means it requires an Exception Status form to be completed (e.g. "SE" means it is an Exception Status drug under the Seniors Pharmacare program). This form can be downloaded by your prescribing physician from the Pharmacare website.
The drug you have been prescribed may not be covered because you are first required to try another drug. This other drug may be cheaper or a generic version. You can ask your pharmacist to check this for you.
Your prescribed medication may not be covered by your plan. In this case, you will need to call or return to your doctor to discuss other options. Your physician may prescribe an alternate drug or may consult with a specialist in the cancer program to identify another potential funding option.
When calling your private drug plan/insurer to check whether a medication is covered::
--Have your policy and/or certificate number(s) ready
--Tell your insurer that you are checking whether a medication is covered on your plan
--Provide the DIN number(s) for each dose of the medication (your physician or pharmacist can provide this number)
If the drug is covered, ask:
»» Is a Special Authorization form or doctor's letter required?
»» Is there a "term" (or time limit) applied to the approval?
»» Is there an annual "maximum" on how much is covered?
»» How much am I responsible to pay (a "co-payment")?
»» Is there a cap on how much I pay out-of-pocket?
»» Can I apply to have this drug billed directly from the pharmacy (if you normally have to pay up front and are reimbursed)?
There are two possible options for residents of Nova Scotia with a valid NS Health Card number:
(1) Apply to the NS Family Pharmacare program. Once you are enrolled, the Family Pharmacare program becomes payer of last resort. This means your private insurance would first be used to pay your claim, and leftover costs (deductibles, co-pays) on the same claim will then be billed to the Family Pharmacare program. The medication being billed would have to be an approved benefit under the Nova Scotia Pharmacare Formulary. For Family Pharmacare to pay towards this leftover cost, you would first have to satisfy the deductible and co-pay requirement on this program.
(2) If you are over 65 years old, you can submit receipts to the NS Seniors Pharmacare program and claim the difference between what you paid on your co-payments on your private insurance and what you would have paid if you were enrolled in the Seniors Pharmacare program (currently $806 annually). The medications must be approved benefits under the Nova Scotia Formulary. You do not have to enroll in the program to submit receipts.
You can also ask your oncologist or family physician if the pharmaceutical company that makes your medication(s) offers a "patient support" or "patient assistance" program. These types of programs are typically supported by a pharmaceutical company to help patients navigate their private drug coverage of a particular medication. In some cases, the program may offer financial assistance with some of the leftover costs. These programs are usually only offered for higher cost medications for which there is no generic form. Each program is different and has different eligibility criteria and processes for financial assistance.
The Canadian Cancer Society - Nova Scotia Division does not provide a drug coverage program, nor do they provide funds to assist with prescription medication costs. The funds raised for CCS-NS are allocated to cancer research, prevention, and various programs that support persons with cancer and their families, such as Camp Goodtime, the Lodge that Gives, and peer support programs.
You will be covered under your provincial public health plan from your province of origin while your NS Health Card is being processed. Medications delivered in-hospital and covered by your provincial public health plan will be billed back to your province of origin.
You will be responsible to pay for medications that are not delivered within the hospital (see Question 1 for further details). If you have private drug insurance, you should check with your insurance company on your ability to use the insurance in another province. If you typically rely on a provincial public drug plan in your province of origin for these types of medications, check with that program to see if you will be covered while in another province. You may not be covered, or you may be able to send back receipts for reimbursement. This depends on how your province of origin typically covers cancer-related medications.
If you are a Canadian citizen or "Permanent Resident" returning to Nova Scotia you will be covered under MSI for medications covered under insured hospital services as described in Question 1. Coverage starts on Day 1 of your arrival. Contact MSI upon arrival to ensure you have a valid Nova Scotia Health Card.
If you are moving to Nova Scotia from another country and hold a work permit, you can apply for provincial health insurance (MSI) upon arrival. Certain conditions must be met. If you hold a study permit, you can apply for MSI coverage the first day of the 13th month following date of arrival in Nova Scotia as a student.
Once MSI coverage is in place and you have a valid Nova Scotia Health Card number, your cancer medications will be covered as described in Question 1. If you lack a private drug plan, you should consider applying to a NS Pharmacare program once you receive your provincial Health Card number.
If you are entering Nova Scotia as a refugee you will have emergency drug coverage provided through a federal program called the Interim Federal Health program.
Benefits Consultant - If you have a private drug plan through your employer, it would be best to first speak with a benefits consultant in your company's Human Resources Department, or the person responsible for overseeing the company's health care plan. This person can answer your questions related to your insurance plan.
Insurance Representative - If you have a self-paid or individual private drug plan, you should speak with your insurance company representative with any concerns you may have about your plan.