Reimbursement policies specify the allowable limits that are placed on the costs for prescription drugs. These can include policies and limitations related to ingredient pricing, the maximum cost of generic drugs, coverage of drugs with lower-cost alternatives and biosimilar switching initiatives. Each jurisdiction in Canada defines its own reimbursement policies.
| Jurisdiction | Category | Sub-category | Policy |
|---|---|---|---|
| Prince Edward Island |
Reimbursement policy
|
n/a | If a beneficiary paid cash at the pharmacy, they have 6 months to submit receipts for reimbursement. For the Children in Care Drug Program, coverage is not retroactive. Reimbursements for medications already purchased will not be granted. |
| Nova Scotia |
Generic pricing policy
|
n/a | Generic drug prices are subject to the pan-Canadian Tiered-Pricing Framework. |
| Nova Scotia |
Ingredient price
|
Pharmacare reimbursement price (PRP) | A special maximum amount the program reimburses providers for 1 unit of a drug, supply or service as assigned by the minister to each of the following: certain groups of drugs that are similar in therapeutic effect, specific services for which coverage is established, certain unit doses and special delivery formats that are also available in less-expensive bulk form, and certain different supplies that are used for the same function. |
| Nova Scotia |
Ingredient price
|
Maximum allowable cost (MAC)/maximum allowable price (MAP) | The maximum cost established by the Pharmacare Program at which a benefit is reimbursed to a provider or beneficiary for a category of interchangeable products. |
| Nova Scotia |
Ingredient price
|
Manufacturer's list price (MLP) | The published price at which a drug or device is sold to a provider or wholesaler; does not include any markup for distribution. |
| Nova Scotia |
Ingredient price
|
Biosimilars Initiative | Nova Scotia Pharmacare has implemented a Biosimilar Initiative that requires beneficiaries to transition from an originator biologic to an eligible biosimilar version of that molecule for coverage to continue. All beneficiaries must transition to a biosimilar version of their medication by February 3, 2023. After that date, claims for the originator will not be accepted by Pharmacare unless approved through an Exception Status Drug request. |
| Nova Scotia |
Ingredient price
|
Actual acquisition cost (AAC) | The net cost to the provider after deducting all rebates, allowances, free products, etc. Net cost is the drug ingredient (or supply) costs based on date of purchase. Incentives for prompt payment are not included in the calculation. |
| Nova Scotia |
Reimbursement policy
|
n/a | If a beneficiary paid cash at the pharmacy, they have up to 6 months from the date of purchase to send original receipts to Pharmacare for reimbursement. Prescriptions filled at a pharmacy outside Nova Scotia but within Canada are reimbursed in medical emergencies only. There is no reimbursement, emergency or otherwise, for prescriptions filled outside of Canada. |
| New Brunswick |
Generic pricing policy
|
n/a | 25% for solid oral dosage forms, 35% for non-solid oral dosage forms; in addition, some drugs are subject to the pan-Canadian competitive value price initiative for generic drugs. Under this initiative, the prices of certain generic drugs are set at 10%, or 18% of the brand name drug price. |
| New Brunswick |
Ingredient price
|
Maximum allowable cost (MAC)/maximum allowable price (MAP) | The maximum amount that the New Brunswick Drug Plans will reimburse for 1 unit of a drug product in this category (e.g., pharmaceutical equivalent, pharmaceutical alternative, interchangeable) is the maximum allowable price (MAP) specified in the MAP list. The MAP for each category is determined by calculating a percentage of the price of the reference brand-name drug. |