Drug coverage for workers below the StatsCan Lower Income Measure (‘working poor’)

(note: We do not endorse a single insurance provider; this information is shared for the benefit of patients who may choose to investigate this further.)

GreenShield Cares’ Essential Medicines Program

Program Overview:

GreenShield Cares’ Essential Medicines program provides eligible patients coverage of up to $1,000 for drugs included in GreenShield’s approved essential medicines list. Medications are dispensed and delivered by GreenShield Health’s digital pharmacy.

GreenShield’s essential medicines list was developed by members of GreenShield’s Pharmacy and Therapeutics Committee and was informed by the World Health Organization’s model list of essential medicines. The list includes drugs that meet the priority healthcare needs of a population and were selected based on evidence for clinical efficacy, safety, and cost-effectiveness.

The pilot program has started in Ontario, in partnership with select community health centres, and has been designed as a scalable model that can rapidly expand with government support.

Who will qualify:

The following individuals qualify for the GreenShield Cares program:

  • A resident of Ontario
  • Currently employed (but do not have to be currently working)
  • Aged 25 to 64
  • Have an income below Statistics Canada Low-Income Measure (LIM)* – see chart below.
  • Require prescription medications to treat a diagnosed medical condition
  • Not enrolled in any private or employee drug plan
  • Not enrolled in an Ontario public drug program, with the exception of the Trillium Drug Program

FYI – these numbers will be increasing, but may use as a guide. No formal evidence is required for enrollment.

These numbers will be increasing, but can be used as a guide for now. No formal evidence is required for enrollment.
Brief Process Overview:
  • Identify someone who may benefit (see above criteria)
  • Provide generic information to the patient to fill out paperwork, or assist in the simple application form.
  • Inform patient not all meds that are prescribed will be covered, and that they must obtain the funded medications from an online-pharmacy (The Health Depot), located in London. Patients do not need to switch all of their prescriptions to this pharmacy, but there is a dedicated clinical pharmacist who is able to provide clinical services as needed (medication reviews, pharmaceutical opinions, etc.) and the dispensing fee tends to be lower than most retail pharmacies.
  • Medications will be filled by this pharmacy and shipped to your home / address of choice.
  • Coverage lasts 1 year and must be reapplied for at the end of that time.

If you would like to understand what drugs are covered, please call or email GreenShield:

More information:

Here is a summary of the evidence that this program is based on:

Evidence Synopsis:

RCT of 786 Ontario patients who could not afford their prescription medication were randomized to free access compared to usual care/access of medications.

Findings:

  1. Adherence absolute increase 10% in adherence
  2. 60% increase (absolute) in patients now being able to make ends meet (rent, food, etc)
  3. Healthcare system perspective – ~$1000 Median or $2000 (mean) savings per patient over 2-year study (reduce ER visits and hospitalizations)

Qualitative results from study:

  • less stress
  • greater ability to afford other necessities
  • improved relationship with prescriber (less anxious to go to MD because they could afford prescribed medications)
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