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Part of Coverage and benefits

Specialized drug benefits

Learn about some of the specialized drugs and drug programs available to Albertans covered as a supplementary health benefit.

Overview

Prescription drugs provided during care received in hospitals, auxiliary hospitals and nursing homes are covered under the Alberta Health Care Insurance Plan (AHCIP).

Many Albertans have insurance coverage for prescription drugs provided through private supplementary health plans sponsored by their employers. Others have coverage through publicly funded plans.

  • All Albertans are encouraged to have a supplementary health plan that covers prescription drugs.

In addition to supplementary health benefits, the Alberta government provides some specialized drug coverage and pharmacy services.

Outpatient cancer drugs

The Outpatient Cancer Drug Benefit Program provides select medications used in the direct treatment of cancer to patients at no cost.

To qualify for this program, you must:

  • be a resident of Alberta
  • be registered with the AHCIP and have not opted out of the plan
  • be registered in the Cancer Registry with a disease classified in the International Classification of Diseases for Oncology
  • require drugs to treat cancer

The Schedule of Cancer Drugs defines the drug products covered by the Outpatient Cancer Drug Benefit Program.

High cost drugs

The Specialized High Cost Drug Program provides funding for drugs used in highly specialized procedures, such as organ transplants and major heart surgeries. This Program is available to all Albertans in addition to basic health services.

To qualify for this program, you must:

  • be a resident of Alberta
  • be registered with the Alberta Health Care Insurance Plan and have not opted out of the plan
  • require an eligible high cost drug to treat an eligible medical condition specified in the program

The Specialized High Cost Drug Program provides for high cost drugs such as:

  • transplant drugs – transplant patients are eligible for immunosuppressants
  • HIV drugs – drugs for the treatment of patients with human immunodeficiency virus type 1 (HIV-1) infection are dispensed through the Southern and Northern Alberta Clinics
  • other drugs funded include:
    • Pulmozyme – for cystic fibrosis
    • human growth hormone – for pediatric growth hormone deficiency and chronic renal failure
    • Flolan – for primary pulmonary hypertension
    • Visudyne – for the classic form of wet age-related macular degeneration

Insulin pump therapy

The Insulin Pump Therapy Program (IPTP) is designed to support Alberta residents living with type 1 or type 3c diabetes.

Albertans who meet the eligibility and clinical criteria will be able to receive coverage for the cost of an insulin pump and its supplies as well as other diabetes management supplies.

On July 21, 2022, the Alberta government announced it will set up a diabetes working group to develop a comprehensive diabetes strategy for the province.

Read the news release: Securing the future for diabetes care for Albertans (July 21, 2022)

The Government of Alberta has reached agreements with the following insulin pump manufacturers: Medtronic, Ypsomed, Insulet, and Tandem.

Newer pump models have been added to the Insulin Pump Therapy Program and eligible Albertans can obtain them subject to stock availability and manufacturer operational requirements as they ramp up their capacity to provide these benefits.

The program now includes the following pumps and their supplies:

  • Insulet Canada Corporation
    • Omnipod Insulin Management System and its pump-specific pods
    • Omnipod DASH Insulin Management System and its pump-specific pods
  • Medtronic Canada
    • Minimed 630G Insulin Pump System and its pump-specific infusion sets and insulin cartridges
    • Minimed 670G Insulin Pump System and its pump-specific infusion sets and insulin cartridges
    • Minimed 770G Insulin Pump System and its pump-specific infusion sets and insulin cartridges
    • Minimed 780G Insulin Pump System and its pump-specific infusion sets and insulin cartridges
  • Tandem Diabetes Care Canada, Inc.
    • T:slim X2 Insulin Pump with Basal IQ technology and its pump-specific infusion sets and insulin cartridges
    • T:slim X2 Insulin Pump with Control IQ technology and its pump-specific infusion sets and insulin cartridges
  • Ypsomed Canada Inc.
    • YpsoPump insulin pump and its pump-specific infusion sets and insulin cartridges

RAPID program

The Retina Anti-Vascular Endothelial Growth Factor Program for Intraocular Disease (RAPID) pilot project began October 2015, in partnership with the Retinal Society of Alberta. RAPID allows patients with certain eye conditions to be treated with Avastin, Lucentis or Eylea to prevent vision loss.

The full cost of all 3 drugs is paid for by the Alberta government with no co-payments. This saves patients $25 per treatment or about $300 per year.

Avastin is a lower cost drug but Lucentis and Eylea are also covered for patients who are registered in a government-sponsored drug plan and are treated by a physician who is not a member of the Retina Society of Alberta.

Patients must receive treatment directly from their physicians.

Patients and physicians may choose either Avastin, Lucentis or Eylea.

All program participants, regardless of which drug they use, are monitored for safety and effectiveness of their treatment.

Talk to your retina specialist about RAPID.

Disease control and prevention

Under the authority of the Chief Medical Officer of Health, the Alberta Health Services Communicable Disease Control program is responsible for the public health prevention and control of communicable diseases, which are notifiable under the Communicable Disease Regulations of the Public Health Act of Alberta.

Public health strategies to control notifiable communicable diseases include:

  • preventing infection through education and/or preventative medicine, including immunization
  • minimizing transmission of infection through prompt investigation and follow-up of notifiable communicable diseases incidents and implementation of protective measures
  • providing epidemiologic data for reporting and public health response measures
  • continuous monitoring and surveillance of communicable disease incidences in the community to quickly identify and respond to emerging illnesses or outbreaks of disease

Prescription drugs for the treatment of tuberculosis and sexually transmitted disease are provided at no charge to the patient.

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