If you live in Canada, then you know that while the Canadian public healthcare system (see information) is generally excellent, it is not centralized: each territory has its own public insurance plan, which determines which prescription drugs are covered. Apart from that, many people have additional paid insurance plans provided by private insurance companies, which cover much of the rest.

health-insurance

 When buying medications from traditional pharmacies, there is usually no issue with getting the price of meds refunded by the insurance plan. However, the rise of large online pharmacies in Canada in last few years – such as the Canadian Health&Care Mall, for example – has created a lot of confusion among customers. Do online pharmacies accept insurance plans – and if yes, which ones? Are lifestyle drugs bought from online pharmacies covered, if they are included on one’s private insurance plan? Can you replace a brand-name drug with a generic and vice versa? Can you use a U.S. or overseas insurance?

The short answer is – it depends. There are hundreds of online pharmacies in Canada right now, many of them specializing on prescription drugs – for example, those that treat depression, erectile dysfunction, asthma, depression, and premature ejaculation, as well as antibiotics, weight loss pills, and fertility drugs. Of course, brand-name pills are usually on offer, but the majority are usually generics – potent, efficient, and safe, but much more affordable.

The test

In order to analyze how the Canadian insurance system and the market of online pharmacies interact, we have conducted a poll among 25 online pharmacies, writing (or calling)  to their customer support under the pretext of desiring to buy certain prescription drugs (for asthma, depression, and an antibiotic) over four consecutive days. The first three days, we asked if the pharmacy would accept a certain insurance plan  and asking if the pharmacy would accept a certain insurance plan (we chose 3 different insurance plans that did not belong to the top-5 of the most popular programs). On the fourth day, we asked pharmacies if it was possible to use a U.S. insurance plan. Unfortunately, 70% of the polled pharmacies did not accept any of the insurance plans we cited, 20% accepted only one of the, 2 pharmacies accepted two of our three suggested plans, and only one online pharmacy – Canadian Health&Care Mall (website https://www.canadahealthcaremall.com) – was willing to accept all three.

As for our U.S. insurance plan test, 20 pharmacies out of 25 replied that unfortunately they could not help us, and the remaining 5 (including Canadian Health&Care Mall) answered that while they had no contracts with U.S. insurance companies per se, they would be willing to send us official receipts that could be then presented to the insurer for a refund.

The conclusion that can be drawn from this simple study is that one should look not only at prices when searching for medications online. Many insurance companies prefer to work with  just one or two mail-order pharmacies and are often unwilling to sign agreements with online pharmacies. This has nothing to do with the quality or reliability of service, of course: large online pharmacies usually have the same suppliers as mail-order pharmacies. However, purchasing medications online is still quite a novel feature; we can only hope that in a few years all major insurance companies will work with a range of online pharmacies.

When a copayment is higher than a generic

The question of insurance plans being or not being accepted by a certain online pharmacy is only part of the issue, however. You may have heard that Canada is one of the few Western countries where even essential medications are often not covered by public health insurance. For citizens on state support and seniors, many prescription medications are usually covered, but for people of working age copayments are often high, and many drugs that are essential for individual well-being (such as erectile dysfunction pills, for example) are not covered by insurance at all. Circa 10% of Canadians cannot afford the medication they need, which causes many seriously ill people who don’t have a high-paying job and corporate benefits to stop taking their meds altogether.

There is talk about introducing a state-wide pharma care system, but it is still years away. Meanwhile, for many patients it can actually be cheaper to buy a generic drug online and pay its full price rather than purchase the exact drug prescribed and pay the copay. This is where online pharmacies can be especially useful: they offer a large range of generics for each brand-name drug. By subscribing to a pharmacy mailing list, a customer can learn about all the ongoing sales and special offers and often receive exclusive coupon deals, which results in significant savings.

While the authorities are deliberating about the necessity of a state-wide insurance policy covering prescription drugs, we can only hope that the number of online pharmacies that accept all popular insurance plans expands. For now, we have only managed to identify one – Canadian Health and Care Mall. We are planning to repeat our test next year; meanwhile, make sure to check with the customer support of a given pharmacy if they accept your insurance before you place an order!