TABLE 3.
Asthma simulation model of out-of-pocket expenditures
| Province | Out-of-Pocket Expenditure | Percent of Income | Comment |
|---|---|---|---|
| Newfoundland & Labrador | |||
| $20,000 | $1,401.33 | 7% | No benefits, regardless of income |
| $24,000 | $1,401.33 | 6% | No benefits, regardless of income |
| Prince Edward Island | |||
| $20,000 | $195.00 | 1% | Fixed dispensing fees only |
| $24,000 | $1,401.33 | 6% | No benefits |
| Nova Scotia | |||
| $20,000 < 1 year after Social Assistance | $130.00 | <1% | Fixed co-pay only |
| $20,000 < 1 year after Social Assistance | $1,401.33 | 7% | No benefits |
| New Brunswick | |||
| $20,000 | $1,401.33 | 7% | No benefits, regardless of income |
| $24,000 | $1,401.33 | 6% | No benefits, regardless of income |
| Quebec | |||
| $20,000 | $0.00 | 0% | Full benefits, regardless of income |
| $24,000 | $0.00 | 0% | Full benefits, regardless of income |
| Ontario | |||
| $20,000 | $332.00 | 2% | Deductible is adjusted by income and family size + fixed co-pay |
| $24,000 | $501.00 | 2% | |
| Manitoba | |||
| $20,000 | $341.60 | 2% | Deductible is adjusted by income and family size |
| $24,000 | 657.00 | 3% | Deductible is adjusted by income and family size |
| Saskatchewan | |||
| low income (family benefit)* | $620.46 | Deductible + co-pay | |
| $24,000 | $288.16 | 1% | Percent co-pay |
| Alberta | |||
| $26,000 | 0.00 | 0% | Full benefits |
| $27,000 | $617.78 | 2% | Fixed and percent co-pay |
| $35,000 | $740.78 | 2% | Full premium + co-pay |
| British Columbia | |||
| $20,000 | $650.00 | 3% | Deductible + co-pay |
| $30,000 | $840.40 | 3% | Deductible + co-pay |
| Yukon | |||
| $30,000 | $0.00 | 0% | Full benefits |
| $51,500 | $500.00 | 1% | Deductible only |
| $52,000 | $1,401.33 | 3% | No benefits |
The above table simulates a family’s out-of-pocket expenditures in each province in 2004 for the specified levels of household income for the following scenario: Two-parent household with 2 children where one suffers from moderate to severe asthma requiring treatment with Flovent Disku™, Ventodisk™ and Serevent Diskus™. It was assumed that 1) drug plans paid for drugs designated as limited use, 2) the family does not qualify for social assistance, 3) the family has no private insurance, 4) the children are not wards of the state and 5) the child’s asthma drugs are the family’s only prescription medications. * Low income is defined as low-income working families eligible for the Sakatchewan Child Benefit or the Saskatchewan Employment Supplement as determined by the Saskatchewan Health Drug Plan & Extended Benefits Branch.