Insurance Coverage

for Inflammatory Bowel Disease (IBD)

Provincial drug plan and private insurance plans:

The provincial drug plan and private insurance plans may cover part or all of your medication costs.

All Canadian provinces and territories have public plans that cover some of the costs of medicines for qualified persons.

You have to make an application to be included in the plan. Your pharmacy will have information about this.

Provincial and private plans usually have a deductible that you must pay before your coverage starts. Some plans have a maximum dispensing fee that they will cover. You pay the remainder.
Most medicines are covered by insurance, but newer medicines may not be.
Your pharmacist will be able to tell you if a medicine is covered by your insurance plan. You can also check with the insurance plan or the plan administrator in your workplace.
Insurance plans can be complicated. Most plans have a phone number you can call for more information.

Supplemental health insurance:

Many families have coverage for medicines through supplementary health insurance plans offered through work or school.

Many plans require you to pay a portion of the total prescription cost or a set deductible amount.
Dependents and unmarried young adults may be covered by a parent’s plan until age 21 or until age 25 if they are full-time students.
Some plans only cover the generic form of a drug if a generic is available.
Some newer medicines may not be covered.
Coverage differs from plan to plan. It is wise to check the plan brochure or the information on the plan’s website to find the details. You may also phone for more information.

Health care spending accounts:

Some employers provide these accounts, which cover a range of health services, including medication costs not covered by other insurance. If you have a plan, check what is covered and the amount.

First Nations plans:

A Health Canada plan covers prescription drug expenses for First Nations people with a plan identification card that are not covered by other plans (Non-Insured Health Benefits program). The plan covers the best priced alternative for prescription drugs. Most drugs are covered – a pharmacist will have information about what drugs are covered.

Brand name and generic drugs:

Brand name drugs are produced by the company that developed that drug and are generally more costly.

Once a drug has been available for a number of years, it may be sold by a generic brand company.
Generic brands have the same composition for the active ingredient but may have different components for other ingredients (like colouring or binding agents).
Generic brands are generally less costly.
Generic brands generally work as well as name brands
A new type of generic for biological agents is called a biosimilar. There are biosimilar drugs available now for infliximab.
If you are concerned about the medicine having a different colour or appearance discuss this with your pharmacist or doctor.
Some insurance plans will cover only the cost of the generic drugor a biosimilar drug if one is available. Some plans will pay for the brand name drug if you have a form completed by your doctor. Your workplace plan administrator or pharmacist may be able to help you with information about this.
Brand name drug companies may have plans to help people with difficulty paying for costly medications. You may ask your pharmacist about this.

Last reviewed: March 2020

For more information and fact sheets about IBD and its treatment please visit: http://www.crohnsandcolitis.ca

Disclaimer: This information is provided for educational purposes only. Always consult a qualified health care professional for your specific care.

Source: This summary provides scientifically accurate information. It was prepared in a research review by researchers with the IBD Clinical and Research Centre, University of Manitoba with assistance from colleagues in Canada and internationally.

Acknowledgement: Preparation of this material was supported by funding from the Canadian Institutes of Health Research.

©2016 Charles N. Bernstein, John R. Walker on behalf of Manitoba IBD Clinical and Research Centre. This work is licensed under a Creative Commons Attribution-nonCommercial-NoDerivs 2.5 Canada License. You are free to copy and distribute this material in its entirety as long as: 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes, 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/.