For cell J13: Pharmaceuticals: Hospital inpatient pharmaceuticals: No patient cost-sharing. Non-hospital/retail pharmaceuticals: Patient cost-sharing varies depending on insurance coverage. Most Canadians who are not part of certain groups (such as seniors or those receiving social assistance) are covered either under employer-sponsored insurance, or private drug coverage. Most have cost-sharing of some kind. This varies depending on the insurance plan, but is often a deductible, or a percentage of drug cost (which may or may not have a maximum), or both. Cost-sharing under public drug coverage is often scaled to income. OTHER COMMENTS: Each provincial and territorial health insurance plan covers medically necessary* hospital and physicians’ services that are provided on a pre-paid basis, without charges related to the provision of insured services. Medically necessary services are not defined in the Canada Health Act. It is up to the provincial and territorial health insurance plans, in consultation with their respective physician colleges or groups, to determine which services are medically necessary for health insurance purposes. If it is determined that a service is medically necessary, the full cost of the service must be covered by the public health insurance plan to be in compliance with the Act. If a service is not considered to be medically required, the province or territory need not cover it through its health insurance plan. Most provincial and territorial governments offer and fund a range of supplementary benefits for certain groups (e.g., low-income residents and seniors), such as drugs prescribed outside hospitals, ambulance costs, hearing, vision and dental care, medical equipment and appliances (prostheses, wheelchairs, etc.), independent living and the services of other health professionals (such as podiatrists and chiropractors) that are not covered under the Canada Health Act. Although the provinces and territories provide these additional benefits for certain groups of people, supplementary health services are largely financed privately. Individuals and families who do not qualify for publicly funded coverage may pay these costs directly (out-of-pocket), be covered under an employment-based group insurance plan, or buy private insurance. Under most provincial and territorial laws, private insurers are restricted from offering coverage that duplicates that of the publicly funded plans, but they can compete in the supplementary coverage market. Pharmaceuticals - It is difficult to generalize cost-sharing requirements for pharmaceuticals in Canada, as Canada’s federal government, provincial/territorial governments, and the private sector are involved in pharmaceutical coverage. Under the Canada Health Act, the provinces and territories are required to provide public health insurance coverage to their residents for medically necessary hospital and physician services. This includes in-patient pharmaceuticals. For services that are outside the scope of the Act, including non-hospital prescription drug benefits, coverage is at the discretion of the individual provinces and territories, on their own terms and conditions. Some provinces offer coverage to all of their residents, while others focus on particular groups, such as seniors or those on social assistance. Employers in Canada often provide prescription drug coverage as part of the benefit packages they offer to their employees. As well, the federal government provides drug coverage to specific federal populations for which it is responsible, such as eligible First Nations and Inuit, and members of the Canadian Armed Forces. Cost-sharing varies across these many different providers. * A number of services provided by hospitals and physicians are not considered medically necessary, and thus are not covered by provincial and territorial health insurance plans. Uninsured hospital services for which patients may be charged include preferred hospital accommodation unless prescribed by a physician, private duty nursing services, cosmetic surgery, and the provision of telephones and televisions. Uninsured physician services for which patients may be charged include telephone advice, the provision of medical certificates required for work, school, insurance purposes and fitness clubs, testimony in court, and cosmetic surgery.