The Saskatchewan Drug Plan is a program available to all residents in the province. However, many people do not even know it exists. In this plan, Sask Health steps in to pay for a percentage of a Saskatchewan resident’s prescription drugs. The amount paid is based on their annual income. A family or individual qualifies for the Sask Health Drug Program once they have spent 3.4% of their gross family income on drugs.
Whether you are a benefits plan administrator, an employee enrolled in your company’s plan, or resident of Saskatchewan, there are some important points to be aware of to avoid issues with prescription coverage.
1. Residents of Saskatchewan Can Apply for Sask Health Drug Plan at Any Time
The government requires residents to apply for the program. This is an important change that took place over a decade ago but is not well-known. Individuals can complete the application at any time, and coverage will kick in once the family or individual qualifies for coverage.
For example, if someone applies but does not yet qualify for coverage, they are still in the system. At a later date when they do qualify, the coverage will automatically start. Applying early also means that the person is giving Sask Health permission to access their CRA return every year to determine their family income. This is the only application form a person should use, otherwise they have to apply every year.
2. Deductible in the Plan
There is a 6-month deductible period from January to July. When a person is accepted to the program, they will receive a letter from Sask Health. The letter indicates the deductible amount, and what percentage of their drugs Sask Health will cover as the first payor.
3. First Payor and the Impact on Employee Benefits Plans
Once someone qualifies for the Sask Health Drug Plan, Sask Health automatically becomes the first payor at the pharmacy, and a deduction is taken off of the total cost of the drug right away. If a person is also a member of an employee benefits plan, that coverage will kick in against the balance owing after the Sask Health deduction.
There can be challenges with this because every carrier manages drug claims differently. In some cases, carriers would automatically decline coverage once a person reaches their spend threshold. Carriers will suspend coverage until a person has applied to and qualifies for the Sask Health program. Although there is retroactive coverage in an employee benefits plan, this can be problematic for the employee because they will have to to pay out of pocket until they qualify in the Sask Health Drug Plan, which can often be delayed.
Because carriers do not always communicate this in advance, it can lead to frustrations for the employee. If you are a plan administrator and know that you have high drug claims, it’s important to be aware of this. The best approach to avoid unwanted problems like this is to proactively apply to the Sask Health program at the individual level.
4. Sask Health Drug Plan Does Not Cover All Drugs
The Saskatchewan Drug Plan does not necessarily cover all drugs in the marketplace, especially those that might be new or recently released. Sask Health has a list of accepted drugs that are covered, and your pharmacist can advise on whether the list includes your prescription. About 80% of drugs are covered in the program so there is no reason not to apply.
The last thing anyone wants is to pay out of pocket when their drugs can be covered. Residents of the province should proactively apply to the Saskatchewan Drug Plan to avoid issues and delays in coverage. Doing this ensures that they will be in the system so when they do qualify, coverage will automatically start with no impact on them or their enrollment in an employee benefits plan.
Do you have questions about the Sask Health plan or how it impacts employee benefits? Get in touch with us and we’ll be happy to help!