Issue link: http://clhia.uberflip.com/i/406567
26 C. IMPROVING REIMBURSEMENT MODELS It is imperative that Canadians have access to the prescription drugs they need without undue financial hardship. The current system of drug coverage in Canada is a patchwork of public and private coverage. The Canadian pharmacare system is made up of 14 different public plans that are generally run independently of each other. Each has its own design features and characteristics with respect to reimbursement, approach to coordinating with the private sector and setting, among other things, formularies. 14 Working in conjunction with this is the private payer system that in turn is highly complex with the coverage, formularies and terms of each plan determined by the plan sponsor (usually an employer). Given the patchwork of coverage in Canada, understanding the system and individual coverage can be a significant challenge for physicians, pharmacists and Canadians. As well, the current patchwork of coverage in Canada results in gaps in coverage that can result in significant financial burden for some Canadians, depending, on where they live or who their employer is. Standardization across the system, therefore, is an important policy goal for Canada. c.1 Standardized Coordination Processes Transitioning between plans, whether public or private, is a challenge for an individual who has to do so. This can occur when an individual retires or reaches the age of 65, moves provinces, changes employers, is prescribed a new drug that is not on their plan's formulary or perhaps reaches a cap in their private coverage. In such situations, individuals are often faced with the very stressful challenge of navigating the system in order to maintain some form of support. Unfortunately, in extreme cases, individuals can be faced with having to re-qualify in 14 For example, currently in Quebec, even if a private benefit plan has a mandatory generic substitution policy, the plan must reimburse a minimum of 68 per cent of the full cost of the drug that was purchased by the individual - regardless of whether the drug that was purchased was the higher cost brand drug. The same limitation does not apply to the provincial public plan.