At the age of 65, every resident of Alberta becomes eligible to receive benefits under the seniors' program by Alberta Health. Under the plan, seniors' benefits include coverage of prescription drugs, diabetic supplies, ambulance services and home nursing care.
But for some, getting your prescription medications filled at your local pharmacy can be confusing with the addition of co-payments, special authorization for certain drugs and plan spending limits.
It's all in the name
Choosing the brand name of a prescription drug over the generic equivalent can mean burning a hefty hole in your wallet.
Generic drugs, copies of brand-name drugs that are sold after the original patent expires, are dispensed to fill more than 40 per cent of all prescriptions in Canada.
"For generics to pass government standards it has to be between 80 and 125 per cent of the active ingredient compared to the brand name," said Karen Moak, pharmacist and owner of the Target pharmacy in St. Albert, adding that brand name drug companies have the same standard of deviation between lot numbers.
Moak said most of her customers opt for generic drugs because they are just as effective as the brand name but at a fraction of the price. Most insurance plans, including Alberta Blue Cross, cover the majority cost of the generic compared to the brand.
"Many of our plans will pay to the least cost alternative and that way it ensures the sustainability and affordability of the program," said Susan Bramm, spokesperson for Blue Cross.
Bramm explained seniors are responsible for paying the cost difference out of their own pockets if they wish to stick with the brand name drug or the drug is not included on the Alberta drug benefit list.
What's covered … and what's not
Under seniors' health coverage, seniors are required to pay a co-payment, a portion of the prescription cost at the pharmacy when they have a prescription filled. The co-payment for seniors' Blue Cross is 30 per cent to a maximum of $25 per prescription.
Moak noted that a number of cold and flu medications are not covered by the government-sponsored program including commonly prescribed cough suppressants such as CoActifed (Ratio-Cotridin) and nasal sprays for allergies including Nasonex, Beclomethasone, Avamys and Omnaris.
Zostavax, a vaccine for shingles recommended for use in people aged 60 and older, is another medication not covered by seniors' Blue Cross.
Moak said a typical comment from customers is that they were told by their doctor that the medication would be covered.
"Well the doctor has no idea, there are (many) different plans. If it's a private plan, it depends on what the employer chooses to have covered and sometimes even they have exceptions," she remarked.
Alberta Blue Cross also identifies a list of medications that require special authorization. These types of drugs which treat everything from diabetes (Glumetza and Onglyza) to Alzheimer's disease (Aricept), osteoporosis (Fosamax and Actonel) and erectile dysfunction (Viagra and Cialis) require a doctor's approval before they will be covered.
Knowing your plan
"A lot of people don't know what their benefits include and often they don't have their (drug) card with them when they come to the pharmacy," said Moak. She added that it is difficult explaining a person's drug plan to them when a community pharmacy doesn't have that information.
She explained St. Albert residents typically have two drug plans – one from each spouse – and coordinating them can also be a challenge if the pharmacy isn't given both plans for billing.
She urges people to bring all the necessary information when they come to fill their prescription, including their Alberta personal health card, their drug insurance card, prescription, and the details of their plan (co-payments and annual deductibles).
