Canadian benefits glossary

Drug coverage

Assistance-linked drug coverage

Prescription coverage provided automatically when you receive social assistance or some disability programs.

Losing assistance can end drug coverage the same month, plan transitions carefully.

Drug coverage

Copayment

Your fixed share of a prescription cost at the pharmacy after the plan pays its portion.

Drug coverage

Cost sharing (drug plans)

The combination of deductibles, copayments, and premiums you pay while the plan pays the rest.

Understanding your share helps budget for chronic medications.

Drug coverage

Drug Identification Number (DIN)

An eight-digit number Health Canada assigns to each drug product sold in Canada, used to identify exact brands and strengths.

Formulary searches and coverage decisions often require the DIN, not just the drug name.

Drug coverage

Exception Drug Status

Saskatchewan's process for covering drugs that are not on the standard formulary, similar to Special Authority elsewhere.

Drug coverage

Formulary

The official list of prescription drugs a public or private plan will consider covering, often with conditions on each drug.

A drug can be approved in Canada but still not listed on your plan's formulary.

Drug coverage

Limited use (drug listing)

A formulary listing that covers a drug only for specific diagnoses or clinical situations listed by the plan.

Your prescriber must document that you meet the limited-use criteria.

Drug coverage

National Pharmacare

Federal bilateral agreements covering specific drug categories in participating jurisdictions, alongside provincial pharmacare systems.

National Pharmacare is one pathway within broader public drug coverage, not a replacement for all provincial plans.

Drug coverage

Pharmacare

A provincial or territorial public drug insurance program that helps residents pay for prescription medications.

Each province runs its own pharmacare with different deductibles, premiums, and formularies.

Drug coverage

Pharmacare deductible

The amount you pay out of pocket for eligible drugs each year before a public plan starts paying its share.

Deductibles are often based on income, lower income can mean lower or no deductible.

Drug coverage

Pharmacare premium

A monthly fee some provincial drug plans charge based on income or family size before drug coverage applies.

Drug coverage

Pharmacist coverage check

Asking your pharmacist whether a drug is covered on your plan before filling a prescription, especially for expensive medications.

Pharmacists can often see real-time billing results and suggest covered alternatives to discuss with your prescriber.

Drug coverage

Prior authorization

A requirement to get plan approval before filling a prescription, common for expensive or restricted drugs.

Drug coverage

Rare-disease drug pathway

Special federal and provincial processes for expensive drugs treating rare conditions, including Health Canada's common list and province elections.

Standard formulary rules often do not apply, separate applications and clinical criteria apply.

Drug coverage

Special Authority

Extra approval a prescriber must obtain before a public drug plan will pay for certain medications not routinely covered.

Without approval, you may pay full price even if the drug is listed with conditions.