Pharmacists worry updated health benefits program is a 'barrier' for N.W.T.ers with chronic diseases

N.W.T. patients who previously had no medical costs may now have to pay for some of their medications due to changes to the territorial government's extended health benefits program.

The extended health benefits program offers additional health coverage for N.W.T. residents beyond what is provided by their health-care card. As of Sept. 4, the program now covers everyone in the territory on an income-based threshold, instead of covering around 50 specific chronic conditions.

Ian Wasserman, a pharmacist and owner of theMedicine Shoppe Pharmacy in Yellowknife, is worried the change may lead patients including those with diabetes, heart disease, and arthritis to stop taking their prescribed medications.

"These conditions, when left untreated or poorly managed, lead to a lower quality of life and serious long-term complications," Wasserman said in an email.

Health-care cards in the N.W.T. cover hospital visits and doctors appointments. The extended health benefits program goes a step further, covering things like prescription drugs, dental care, medical travel, medical supplies and glasses.

Nick Saturnino, adirector of health services administration for the territory, said under the updated program families with higher incomes will pay up to a maximum four per cent of their income for these benefits. After reaching that amount, the government covers the rest for the benefit year, which runs from September to August.

He said patients will need to complete a health-care application form to apply. He also said part of the extended health benefits program that provides coverage to seniors non-Indigenous residents who are 60 or older hasn't changed.

'Not fair' says one patient

Trevor Thompson, a Type 1 diabetic for over 30 years who has also been dealing with kidney problems for sevenyears, says he doesn't think he should have to pay for life-sustaining medication.

He found the old system easier because his insulin pump and medication supplies were fully covered. But under the newprogram, he will have to pay for his medication due to his income.

"It's not fair for a lot of people. It's going to make my life harder. The money I get each month is just enough for rent and bills ... and now they're adding an extra expense," Thompson said.

He also said the yearly paperwork required to determine income eligibility is burdensome.

Renewal process a potential barrier

Rafiq Salehmohamed, president of the N.W.T. Pharmaceutical Association, said the enrolment and yearly renewal process may pose challenges for many patients.

He suggested the N.W.T. government consider a system like British Columbia's, where residents only need to enrol once and authorize the government to check their tax returns automatically to determine their income level.

"It would take a large burden off patients," he said in an email.

From a pharmacy's perspective, Salehmohamed said the major change will be with medical supplies.

"There may be some logistical challenges in figuring out how much to charge a patient for a medical supply now that there are co-pays and family maximums," Salehmohamed wrote.

He also said there were several gaps in the previous program, which are eliminated under the new program. For example, he said, mental health conditions were previously not covered.

Changes make the program more equitable says N.W.T. gov't

Saturnino said there are currently 1,200 active patients receiving benefits under the extended health benefits program each year. He said there are an estimated 2,200 people who weren't covered under the previous program, who may now be eligible.

"We'll see how many people apply for the program for the first year," he said.

Saturnino said the specified disease conditions list was created in the late 1980s and included conditions such as cancer, diabetes, asthma and other chronic diseases.

"If you didn't fall under one of those 50 or so diseases, you were ineligible for the program, even though you may have a chronic disease," Saturnino said. "It's just been outdated, never been updated, and we feel this is a more fair and equitable way to run the program."

Pharmacist Ian Wasserman says it's still too early to predict the overall impact of the changes.

"It is my hope that the health of our population is not negatively impacted. But adding healthcare costs to residents with chronic diseases does present a potential barrier to care," Wasserman said.