End of exemption from paying deductible for medication a bitter pill for some Manitobans

Manitobans who were previously exempt from paying deductibles to the provincial drug program have been notified that will come to an end on April 1.

Patients grandfathered into current provincial drug program to begin paying deductibles

About 1,100 Manitobans enrolled in the Special Drug Program will have to start paying the deductible for their medication as of April 1. (David Donnelly/CBC)

Manitobans who were previously exempt from paying deductibles under the provincial drug program have been notified that exemption will come to an end on April 1.

Doug Hillier, who lives with cystic fibrosis and diabetes, got a letter on Friday notifying him of the changes. He says the deductible he'll now have to pay is money he just doesn't have.

"My monthly expenses come in and they go out, and there's nothing at the end of the month," said Hillier.

Doug Hillier takes 19 different medications costing about $4,000 per month, which were covered entirely by the Special Drug Program. Starting in April, he will have to pay an $1,800-per-year deductible. (Submitted by Laura Hillier)

"I don't know what I would have to do [to find] this deductible. I have no clue."

Hillier is one of about 1,100 Manitobans enrolled in the Special Drug Program, or SDP, formerly called the Life-Saving Drug Program.

The program began in 1968 to help those with medical conditions associated with high drug costs, and who had their prescriptions paid for entirely by the province.

When the province's current drug program, Pharmacare, was introduced in 1996, those people were "grandfathered in" and continued to benefit from the exemption, while other Manitobans began paying a deductible based on their household income.

"Essentially the time has come where we really need to ensure that there is one single program in place where there is equity," said Patricia Caetano, executive director of Manitoba Health's provincial drug program.

Caetano said the changes will impact about 800 families, whose deductibles will be determined based on household income.

She says it isn't known yet how much money will be saved by the change, because that will depend on the deductibles, but the move was more about making the system fair as opposed to saving money.

"I think it's increasingly difficult in this day and age to try to explain to one client why they have to pay their Pharmacare deductible while another client doesn't," said Caetano.

The change is about fairness, says Patricia Caetano, the executive director of Manitoba Health's provincial drug program. 'I think it's increasingly difficult in this day and age to try to explain to one client why they have to pay their Pharmacare deductible while another client doesn't.' (CBC)

Those born or diagnosed after 1996 were automatically enrolled in the deductible system, she said.

"They wouldn't have even had a chance to be eligible for the Special Drug Program," she said. "That creates some level of inequity in our program that we want to eliminate."

The SDP is not specific to any particular condition or medication, and was brought in at a time when extraordinarily high drug costs were rare — something Caetano said is no longer the case.

She said patients can also submit up to three months worth of claims before the program expires at the end of March, giving them about five months before they will need to pay deductibles.

'No warning whatsoever'

Hillier said he takes 19 different prescriptions to treat his cystic fibrosis and diabetes, which costs about $4,000 per month — currently, entirely covered by the SDP.

Cystic fibrosis is a genetic condition that affects the lungs and the digestive system and requires lifelong treatment. Hillier is currently on a waiting list for a double lung transplant and requires medication daily.

"It helps me breathe. It helps me live," he said.

He's worried he might not be able to afford the medication he requires once he has to start paying the deductible.

Come April, he will have to pay a deductible of $150 per month before Pharmacare will pay for the rest of his medication.

Hillier's medications cost hundreds of dollars each. He worries if he can't come up with the deductible, he won't be able to get the medicines he needs. (Submitted by Laura Hillier)

Hillier is on long-term disability but the deductible is based on what he and his wife make combined.

He said he understands that there are others in similar situations who have to pay a deductible already, but it would have been nice to know it was coming and to have some consultation before the change.

"It's been something that's been there for years, for myself and other people," said Hillier.

"There was no warning whatsoever that the government was thinking of doing something like this."

'Severe impacts'

On Tuesday, Cystic Fibrosis Canada said it was "disappointed" by the change.

The organization called on the Manitoba government to extend the timeline for the implementation of the change, saying it left people who could not afford the deductible on short notice in a vulnerable position.

"This could potentially have severe impacts on the health and well-being of Manitobans with CF, who were given very little time to figure out how they will pay a large amount of money to access their medications," Cystic Fibrosis Canada said in its news release.

Hillier said the small number of deductibles that will now be collected won't provide much of a cost saving to the province if people stop taking medications because they can't afford them.

"If you don't stay on your meds … you're going to probably get sick. If you get sick, you're gonna have to go to the hospital," he said.

"You're gonna cost the health-care [system] more money than having a deductible to pay."