N.W.T.'s revamped health benefits program means more financial strain for some patients, pharmacist says

An N.W.T. pharmacist says income-based coverage of medication costs is creating significant barriers for many patients.

It has been six months since the territorial government introduced its revamped extended health benefits (EHB) program, which provides additional health coverage beyond what is offered by an N.W.T. health-care card or work insurance.

The program now covers everyone in the territory on an income-based threshold, instead of covering around 50 specific chronic conditions. Individuals whose income exceeds the threshold must pay deductibles and an annual maximum for their medications. 

For example, in Yellowknife, a single person without children pays for medications only if they earn over $64,260. If that person has a salary of $65,000, their deductible is $365 and their yearly maximum is $550. Someone in a similar situation with an income of $100,000 has a deductible of $800 and a yearly maximum of $1,200.

There are 30 income thresholds. The deductible ranges from $365 to $5,000 and the annual maximum ranges from $550 to $8,000. A government calculator helps people figure out their individual threshold, which depends on their region and number of dependents.

Rafiq Salehmohamed, president of the N.W.T. Pharmaceutical Association and pharmacy manager at Wally's Drug in Fort Smith, argues that income isn't always the best indicator of someone's financial situation.

"The method of income can sometimes not always capture the uniqueness of each person and the financial strains or challenges they may be going through," he said.

Salehmohamed says many patients with chronic illnesses are financially struggling.

"I've seen patients decreasing their doses. It is unfortunate," he said. "Going from not paying for your medications to paying for your medications is always going to be a barrier."

While some lower-income patients now have benefits, he says higher-income individuals face high deductibles and rely on private insurance or out-of-pocket payments.

'An added stress'

Katie Hart, a university student from Yellowknife, was diagnosed with cystic fibrosis at birth and type 1 diabetes at age 10. Her medical costs total about $400,000 a year, including for Trikafta, an expensive medication for cystic fibrosis that Hart calls a "miracle drug."

"For the rest of my life I will be on these drugs, and I have no choice," Hart said.

As a student with no income, she currently falls into the lowest bracket and isn't affected by the EHB changes — yet.

"Right now, as I essentially have zero income, I do fall in that lowest bracket," she said.

But Hart knows that if her future income exceeds the thresholds, she'll need to budget for her medications.

"So that's kind of an added stress," she said.

While she understands the need to expand the program, she says the territorial government ignored much of the public feedback from a 2022 engagement survey.

That survey found that 51 per cent of respondents opposed the changes, while 40 per cent supported them and 9 per cent were neutral.

"They kind of dismissed everything that the public did say," Hart said.

Too early to assess impact of changes, gov't says

Previously, 1,200 patients received benefits under the EHB program each year. The territorial government estimates that 2,200 additional residents who weren't covered before could now be eligible under the revamped program.

Government spokesperson Andrew Wind told CBC that 853 people have registered so far.

"It's too early to determine the impact the new benefit program has had. We will know more once we review the data after a year," Wind said in an email.

The government is encouraging eligible residents to apply.

According to Salehmohamed, one of the biggest frustrations for patients so far is the need to reapply every year, as coverage runs from September to August.

Pharmacies, he says, are reminding patients to apply early for the next coverage year.

A key improvement, he says, is that the program now covers mental health conditions, which were not included in the previous EHB plan that covered only 50 specific diseases or conditions.

"It has captured some patients that were being entirely missed by the system before," Salehmohamed said.

He says many patients previously paid for mental health medications out of pocket because they had no insurance, and the public plan did not cover them.