Prescription Drugs

Prescription drugs are medications that can only be dispensed by a licensed pharmacist with a valid prescription from a qualified healthcare professional, such as a physician or nurse practitioner. These drugs are used to treat, manage, or prevent medical conditions and form one of the core components of most extended health care insurance plans. Prescription drug coverage helps offset the cost of medications that are not funded by provincial or territorial health programs.

Health insurance plans typically reimburse a percentage of the eligible drug cost, subject to limits such as deductibles, coinsurance, or maximums. Many plans also use a drug formulary, which is a list of approved medications covered under the policy. Some plans apply generic substitution, meaning reimbursement is based on the cost of the generic equivalent if one exists.

Example:

If your plan covers 80 percent of prescription drugs and your prescribed medication costs $120, your insurer pays $96 directly to the pharmacy through your pay-direct card, and you pay the remaining $24.

What to Watch For:

Confirm whether your prescribed medication is listed on your plan’s formulary and whether prior authorization is required for high-cost drugs. Ask your pharmacist about generic or lower-cost alternatives if the brand-name drug is not fully covered. Provincial drug programs may also coordinate with your private plan, reducing out-of-pocket costs for eligible medications.