The “Drug Cost Assistance Act Drug Cost Assistance Program Regulations Amendment,” which received approval from the Lieutenant Governor in Council on May 2, 2023, brings several significant updates to the drug cost assistance regulations in Prince Edward Island (PEI). These changes, implemented in two phases starting June 1, 2023, and concluding July 1, 2023, are designed to revise co-payment requirements and adjust financial thresholds for various drug programs.

A major change is the revision of the definition of “spouse” in Clause 1(h). The updated definition now includes not only married individuals but also those in voidable or void marriages and cohabiting partners in a conjugal relationship. This broader and clearer definition aligns with modern legal standards and ensures a more inclusive application of the term.

Regarding co-payments, Section 5 of the regulations has been amended to alter the structure for certain drugs. Previously, co-payments were defined under subsections (2) and (3), but the new subsection (4) introduces a fixed co-payment of $5.00 for specific benefits listed in the formulary, irrespective of previous thresholds. Section 8 similarly updates co-payments for diabetes medications, removing the former clause about the first $20 of medication costs and instituting a uniform $5.00 co-payment for all relevant drugs. It also outlines new co-payment requirements for injectable diabetes medications. Section 11 modifies the co-payment responsibilities under the Family Health Benefit Drug Program to ensure that individuals pay either a maximum of $5.00 or a lesser amount based on prior provisions, whichever is lower.

In the High Cost and Catastrophic Drug Programs, Section 5 revokes and replaces certain clauses to better align with updated income thresholds. The new provisions require individuals to pay either a specified amount based on their income or the remaining cost of the benefit, whichever is lower. Schedule B has been revised to reflect updated income-based co-payment amounts for the High Cost Drug Program, with ranges from $7 to $11,310 depending on household income. Similarly, Schedule D has been adjusted to outline eligible costs for the Catastrophic Drug Program, specifying a percentage of costs individuals must cover based on their income bracket, ranging from 3.00% to 6.50%.

These regulations officially came into effect on June 1, 2023, with specific provisions, particularly Section 7, starting on July 1, 2023. The amendments aim to simplify and clarify co-payment processes across different drug assistance programs. By updating definitions, co-payment amounts, and financial thresholds, the regulations seek to improve accessibility and predictability for individuals relying on drug cost assistance, making the program more responsive to the financial needs of its beneficiaries. Overall, the 2023 amendments enhance the effectiveness and equity of the Drug Cost Assistance Program, better supporting eligible individuals with their medication costs.

Prince Edward Island (EC2023-317) May 13, 2023