{"id":927950,"date":"2026-10-10T16:04:11","date_gmt":"2026-10-10T16:04:11","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/927950\/"},"modified":"2026-10-10T16:04:11","modified_gmt":"2026-10-10T16:04:11","slug":"how-does-p-e-i-decide-which-drugs-to-cover-its-more-complicated-than-you-might-think","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/927950\/","title":{"rendered":"How does P.E.I. decide which drugs to cover? It\u2019s more complicated than you might think"},"content":{"rendered":"

A doctor’s prescription can be the simplest part of getting access to medication. Figuring out what happens next can be much more complicated.<\/p>\n

Whether a drug is covered by a public plan, how much a patient pays and what conditions apply can depend on a series of decisions made by federal and provincial governments.<\/p>\n

\u201cPharmaceuticals are a really interesting aspect of Canadian Medicare, largely because they are left out of it for the most part,\u201d said Katherine Fierlbeck, a political science professor at Dalhousie University whose work focuses on health policy.<\/p>\n

That gap is part of why Prince Edward Island’s drug formulary \u2014 the list of medications covered by public drug plans \u2014 is back in focus.<\/p>\n<\/p>\n

The federal government recently announced $32 million<\/a> over three years for P.E.I. to renew the Improving Affordable Access to Prescription Drugs program, or IAAPD.<\/p>\n

The program has helped the province add more than 100 medications to its public formulary since IAAPD launched as a pilot in 2021, while also reducing some costs for Islanders.<\/p>\n

But deciding which drugs make the list is a much bigger process.<\/p>\n

Health Canada approval ‘only the start’<\/p>\n

Health Canada first reviews a medication and authorizes it for sale. That approval does not mean a public drug plan will pay for it.<\/p>\n

\u201cOnce a drug is approved by Health Canada \u2026 that\u2019s only the start of the whole process,\u201d Fierlbeck said.<\/p>\n

Next, the Patented Medicine Prices Review Board assesses whether the price a drug company is asking is fair. Fierlbeck said the board was established to help keep Canadian prices from rising to U.S. levels.<\/p>\n

\"\"<\/p>\n

Katherine Fierlbeck, a political science professor at Dalhousie University, says P.E.I. is one of only four jurisdictions participating in the federal pharmacare program and also has the separate IAAPD, which supports a broader provincial formulary and lower patient costs. (Contributed\/Dalhousie University)<\/p>\n

After that, Canada\u2019s Drug Agency evaluates the cost-effectiveness of approved drugs. It considers a drug\u2019s efficacy, safety and price, then advises whether it should be included in provincial formularies.<\/p>\n

The agency\u2019s recommendations are not binding, Fierlbeck said.<\/p>\n

\u201cEach province can determine for itself whether it wants to take the advice,\u201d she said.<\/p>\n

The Pan-Canadian Pharmaceutical Alliance then acts as a collective bargaining organization for public drug plans, negotiating prices with manufacturers.<\/p>\n

\u201cYou buy in bulk and you get cheaper prices,\u201d Fierlbeck said.<\/p>\n

The provincial government still has the final say on whether a drug is covered.<\/p>\n

Fiona Clement, a professor in the University of Calgary\u2019s department of community health sciences and director of its Centre for Health Policy, said governments weigh several considerations \u2014 whether a drug meets an unmet need, whether other effective treatments are available, how much the drug costs and whether doctors have the expertise and resources to use it.<\/p>\n

\u201cThere\u2019s only so much money to go around,\u201d Clement said.<\/p>\n

Health economics can help governments compare the cost of a treatment with the benefits it provides.<\/p>\n

Those benefits can include medical outcomes, Clement said, but also whether someone can return to work or take part in the activities they enjoy.<\/p>\n

Prices \u2014 and coverage rules \u2014 can change<\/p>\n

A drug\u2019s cost \u2014 and a province\u2019s willingness to cover it \u2014 may shift when a generic version becomes available.<\/p>\n

\u201cWhen a generic entry comes on, that is often a game-changing point,\u201d Clement said, adding that the first generic can be priced significantly lower than the brand-name drug.<\/p>\n

Provinces may then add the drug to their formularies or ease restrictions, such as requiring patients to try less expensive treatments first.<\/p>\n

WATCH | As P.E.I. signs another pharmacare deal with Ottawa, federal minister calls province ‘ground zero’:\"\"<\/p>\n

As P.E.I. signs another pharmacare deal with Ottawa, federal minister calls province ‘ground zero’<\/p>\n

With a change in the federal Liberal leadership just days away, the Trudeau government has announced a last-minute pharmacare deal with P.E.I. The new deal will provide coverage for diabetes supplies and contraceptives, and it puts P.E.I. in a unique position among all provinces, when it comes to plans for universal drug coverage. CBC’s Kerry Campbell reports.<\/p>\n

For Islanders, coverage also depends on which public program applies.<\/p>\n

P.E.I. participates in the federal pharmacare program<\/a>, which covers contraceptives as well as diabetes medications and supplies.<\/p>\n

Fierlbeck noted that the Improving Affordable Access to Prescription Drugs program is separate. <\/p>\n

\u201cThe IAAPD is much broader, and what it does is to support the expansion of the whole provincial formulary, as well as reduced patient charges for these drugs,\u201d she said.<\/p>\n

Fierlbeck added that the program was designed in part to address P.E.I.\u2019s smaller formulary and its high deductibles and copayments. It lowers copayments to $5<\/a> for many eligible medications.<\/p>\n

A system shaped by history<\/p>\n

Fierlbeck said prescription drugs were largely left outside of Canada\u2019s universal health-care system because, at its inception, the system was designed around hospital and physician care.<\/p>\n

\u201cBack in the day, most people had acute conditions rather than chronic conditions,\u201d she said, pointing to things like farm injuries and heart attacks that were typically treated in hospitals.<\/p>\n

Today, she said, many people live with chronic conditions such as diabetes and COPD that are managed at home, often with medication.<\/p>\n

WATCH | Why doesn’t universal health care include prescription drugs?:\"\"<\/p>\n

Pharmacare: Why doesn’t universal health care include prescription drugs?<\/p>\n

Universal health care usually includes prescription drugs — but not in Canada.<\/p>\n

Fierlbeck said a landmark report that helped shape Canada\u2019s health-care system envisioned drug coverage being added after hospital and physician services.<\/p>\n

\u201cIf you read the whole report, they’re saying, ‘Well, let’s start with hospital care. Let’s start with GPs, and then let’s add on drugs down the road.’\u201d\u00a0<\/p>\n

That next step never fully happened.<\/p>\n

“It was too expensive with the initial setup,” Fierlbeck said. “And once the initial setup proved itself to be quite expensive, there was not a lot of interest in adding pharmaceuticals into the mix.”<\/p>\n","protected":false},"excerpt":{"rendered":"A doctor’s prescription can be the simplest part of getting access to medication. Figuring out what happens next…\n","protected":false},"author":2,"featured_media":927951,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[49,48,84,392],"class_list":["post-927950","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-ca","tag-canada","tag-health","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/927950","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=927950"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/927950\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/927951"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=927950"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=927950"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=927950"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}