What you need to know about changes to the Alberta Seniors Drug Benefit Program

An estimated 46,000 Albertans under the age of 65 who currently receive drug benefits through a spouse or parent as part of the Alberta Seniors Drug Benefit Program are set to lose their coverage as of March 1.

The Alberta government made the change as part of the fall budget and started sending letters to affected spouses and dependents earlier this month.

The policy shift has sparked surprise and confusion among some people who aren't sure what this means to them.

Here's how it breaks down.

How the change will work

According to Alberta Health, people who want to maintain their benefits have a couple of options, including buying private insurance or paying into the government-sponsored Non-Group Program administered by Blue Cross.

"It's the same coverage," said Health Minister Tyler Shandro of the latter option.

"There are no concerns with pre-existing conditions. I've seen some concerns that people have had with that. It's not private insurance at all. It's administered by Blue Cross. It's one of our 22 drug programs that we have that are sponsored by the government."

The drugs covered under the Alberta Seniors Drug Benefit Program are the same as those covered under the Non-Group plan.

And people are being told if they make the switch prior to March 1 there will be no waiting period, meaning there should be no interruption in their coverage.

The change — to a program that costs the province $600 million a year — is expected to garner an annual savings of $36 million, which Alberta Health says will be reinvested in the health system.

"The key is we have to make sure that we have a drug program for our seniors that is going to be sustainable and that the money we spend on seniors is spent on seniors — that we also make sure that we have an all-access drug program, like Non-Group, that people are aware of and that's going to be available to all Albertans," said Shandro.

But there is one key difference.

Cost to Albertans

People moving to the Non-Group plan are now facing a monthly premium of $63.50 for an individual and $118 for a family.

For those who qualify as low-income (people with a taxable income below $21,000) there are subsidized premiums of $44.45 per month for an individual and $82.60 per month for a family.

There were no fees for them as dependents under the seniors' drug program.

"I think the key piece will be, can people afford to stay in that coverage?" said Scot Simpson, professor and chair in patient health management in the Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta.

"Now you've added in this unexpected expense. So maybe they are unable to afford [it]."

According to Simpson, the premiums (which add up to $762 per year for an individual or $533 for those who qualify as low-income) could be tough for some people to pay at a time in their lives when their household income may be decreasing — especially if they're nearing retirement themselves or have a spouse who is older and struggling with expensive health problems of their own. 

That's also a concern to Neal Davies, dean of pharmacy and pharmaceutical sciences at the University of Alberta.

"Some people won't be able to afford those costs and they're going to have to make a decision between eating and medications," he said. "And if they're making those decisions, in the long term, the health-care system is going to lose."

He worries some people may opt out of any kind of coverage, leaving them without medication to treat chronic illnesses and resulting in bigger health problems down the line.

"That's my fear," Davies said.

"This is very short-sighted. It doesn't have a long-term view and its not part of a cohesive, well articulated plan."

Other options

Shandro says beyond the subsidized premiums under the Non-Group plan there are other options for low-income people, including the Alberta Adult Health Benefit, which provides support for those who are pregnant or have high ongoing prescription drug needs. The income cut-off for a single person under that program is $16,580.

"I have a huge amount of compassion for all Albertans who need any of our drug programs." said Shandro.

"If somebody is a low-income Albertan and if they were currently the dependent of a senior, it's actually in their best interest to move to the Alberta [Adult] Health Benefit, which actually has an expanded formulary from the senior program."

Diabetic coverage

Diabetes advocates believe many Albertans with the chronic disease will have to make the switch to another drug plan as a result of this change and they say while some may be able to absorb the increased costs, others may struggle.

"Anything that poses an additional cost is an additional barrier," said Joan King, government relations director for the West with Diabetes Canada.

Insulin-dependent diabetics have additional expenses for medical supplies, such as test strips, which are capped at $600 per person per year under both the seniors benefit program and the Non-Group plan.

According to King, neither program meets the needs of diabetics because the $600 coverage for supplies may only last people three months of the year. After that, they're paying out of pocket for supplies.

"So whatever burden this is going to place on those patients with diabetes will just be adding to their burden that they already live with here in Alberta."

The key, according to King, will be ensuring that Albertans affected by the change are directed to the proper program.

"I hope that ... Alberta Health helps them find the program that's affordable to them and manageable for them," she said.

For example, King says drug coverage through AISH (Assured Income for the Severely Handicapped) may be a better fit in some cases.

In its letter to affected Albertans, the province provides a link to its website outlining drug coverage options as well as a link to the AISH website.

Seniors advocates watching closely

The change has been prompting calls to the Calgary Seniors' Resource Society.

"What I've heard from people is, 'What do I do now?' What's going to happen to my coverage? How do I move forward?' — those kinds of questions," said Connor Walsh, who leads a team of social workers at the society. 

He's worried that Albertans who are losing coverage under the Alberta Seniors Drug Benefit Program may not have been given enough time to make the necessary changes. The province started sending letters out earlier in January, less than two months before the change takes effect.

"All of that takes time to understand," he said. "And if you're dealing with other problems in terms of your mental health that exacerbates the experience of this changeover as well. So looking at vulnerable people ... those are the people who really do need the extra time and that extra level of support to manage these transitions."

"Those are the people that are already reaching out, that we're already working with," said Lori Paine, executive director of the Calgary Seniors' Resource Society. "That's not even including those [who are] isolated."

Walsh and Paine worry some people may not be able to arrange their new benefits in time and may lose their coverage, even temporarily, as a result.

Shandro says he understands the change may be confusing and says any Albertans with questions about their coverage should contact Alberta Health or Alberta Blue Cross, which administers both the Alberta Seniors Drug Benefit Program and the Non-Group plan.

"Any questions they have are going to be answered," he said.