ELIGIBLE BENEFICIARIES
Saskatchewan residents with valid Saskatchewan Health Coverage may be eligible for Drug Plan benefits.

TYPES OF BENEFICIARIES
  • Saskatchewan Assistance Plan recipients;
  • Families/Individuals applying for and approved for Special Support;
  • Guaranteed Income Supplement recipients;
  • Persons 65 years and older who reside in licensed special care homes or hospitals and whose income is at or below the Saskatchewan Income Plan level;
  • Saskatchewan Income Plan recipients living in the community;
  • Families/Individuals approved for Family Health Benefits;
  • SAIL beneficiaries (Paraplegics, Cystic Fibrosis, and Chronic Renal Disease);
  • Persons approved under the Drug Plan as Palliative Care;
  • Government Wards;
  • Inmates of provincial correctional institutions;
  • Families granted Emergency Assistance;
  • Seniors' Drug Plan & Children's Drug Plan Beneficiaries.
Information on the various programs at the Drug Plan & Extended Benefits Branch, please visit the Government of Saskatchewan Health website at Drug Plan & Extended Benefits Branch or more specifically please select from the Program Links menu tab.

NOT ELIGIBLE
Citizens whose health services are covered under First Nations & Inuit Health; Health Canada, Veterans Affairs Canada; Canadian Forces; Workers' Compensation Board or inmates of a federal penitentiary are not eligible for Drug Plan benefits under Saskatchewan Health.

Encouraging Appropriate Drug Use
The Drug Plan uses a number of activities to encourage appropriate use of drugs:
  • Use of the claims processing system to perform various edit and assessment checks.
  • Use of Exception Drug Status coverage where drugs are only intended for use in certain circumstances. e.g. products intended for second line use.
  • Provides funding support for:
    • The College of Medicine Drug Evaluation Support - Roving Professorship Program to assist in the drug review process, to provide expert opinions on an ad hoc basis, and to deliver drug information to promote the optimal use of pharmaceuticals in the province.
    • The College of Pharmacy & Nutrition Drug Information Service provides a province-wide drug information service for health professionals and consumers.
    • The Prescription Review Program (formerly known as the Triplicate Prescription Program) is operated by the College of Physicians and Surgeons. Use of special multiple prescription pads is no longer necesssary since the data required to operate this program is now captured electronically. The intent of this program is to reduce abuse and diversion.
    • The RxFiles Academic Detailing Program operated by the Saskatoon Regional Health Authority as an educational program aimed at assisting physicians in selecting the most appropriate and cost-effective drug therapy for their patients.
  • Use of the Drug Plan database for internal and external drug use studies, pharmaco-epidemiological studies, and research projects by outside agencies.
  • Use of product assurance agreements with drug manufacturers. The Drug Plan monitors use of a particular drug to ensure utilization and health outcomes occur as stated in the manufacturers documentation submitted to the Drug Advisory Committee of Saskatchewan. Where that does not occur, an intervention may occur and a financial adjustment may be made against the manufacturer.
  • The Trial Prescription Program started as a joint project with the Saskatchewan College of Pharmacists and later became a benefit of the Drug Plan. The pharmacist is encouraged to dispense a seven or ten day supply for the initial prescription of certain drugs, monitor the effect on the patient and if the outcomes are positive, dispense the full prescription as directed by the physician. There is no additional cost to the resident for this service.
Pharmacy Claims Processing
  • An online computer network transmits prescription information from the pharmacy to the central computer where it is checked against stored data to determine whether it can be approved for payment. Checking includes: is the drug a benefit, does the beneficiary have health coverage and the type, is the quantity dispensed within appropriate levels, is the number of prescriptions for the beneficiary within limits, is the prescription a duplicate or possible duplicate of another dispensed prescription, is the prescriber authorized, are the unit costs within limits. The prescription claim is adjudicated and cost information is then transmitted back to the pharmacy, detailing the consumer share and Drug Plan share.
  • Other activities that are a part of claims processing include: Special Support assessment; reimbursement to beneficiaries for prescriptions purchased out of province; selecting certain approved claims for verification with the beneficiary; and providing assistance to pharmacies and consumers via toll-free telephone lines.
Pharmacy Reimbursements
  • According to the Agreement between Saskatchewan Health and pharmacy proprietors, the prescription cost is calculated by adding the acquisition cost of the drug material, the submitted mark-up and dispensing fee (up to a maximum).
  • The maximum dispensing fee is $11.40 (effective September 1, 2015). The maximum mark-up allowance calculated on the prescription drug cost is: 30% for drug cost up to $6.30, 15% for drug cost between $6.31 and $15.80 and 10% for drug cost of $15.81 to $200.00, and a maximum mark-up of $20.00 for drug cost over $200.00.
  • For urine-testing agents the pharmacy receives acquisition cost along with the mark-up and a 50% mark-up in place of the dispensing fee. For insulin, the pharmacy receives acquisition cost plus a negotiated mark-up.
  • For the Saskatchewan Insulin Pump Program, the Drug Plan will reimburse up to the formulary list price for insulin pump supplies. If the pharmacy retail price is less than the formulary list price, pharmacies should submit the RETAIL cost in the acquisition cost field. The Drug Plan system will not allow for a mark-up or a dispensing fee.
Prescription Quantities
  • The Drug Plan places no limitation on the quantities of drugs that may be prescribed. Prescribers shall exercise their professional judgment in determining the course and duration of treatment for their patients. However, in most cases, the Drug Plan will not pay benefits or credit deductibles for more than a 3-month supply of a drug at one time.
  • The pharmacist may charge one dispensing fee for each prescription for most drugs listed in the Formulary. If a prescription is for a duration of one month or more, the pharmacist is entitled to charge a dispensing fee for each 34 day supply, however the Agreement does not prohibit the pharmacist from dispensing more than a 34 day supply for one fee. The Agreement also contains a list of Two-Month and 100-day supply drugs. Prescribing and dispensing should be in these quantities once the medical therapy of a patient is in the maintenance stage, unless there are unusual circumstances that require these quantities not be dispensed.