Nova Scotia's move to a seniors' pharmacare program based on income is a shift toward a British Columbia and Manitoba model where rich subsidize poor, and away from the flatter fees typically charged in Atlantic Canada.

Canada has an fragmented approach to pharmacare for seniors. Details are complicated and vary between provinces.

But Nova Scotia's latest move to increase premiums for its richest registrants is part of a general trend to deal with an ever-more expensive drug system, Carleton University public policy associate professor Marc-André Gagnon said in an interview.

"One of the trends we're seeing in all provinces is this cost-shifting onto the shoulders of patients, first and foremost," Gagnon said.

"What we're seeing is increased premiums, increased co-pays or deductibles."

As of April, individual Nova Scotia seniors making more than $75,000 will pay annual premiums of up to $1,200, nearly three times the current cap of $424. Couples making $100,000 or more will pay $2,400.

"For anyone it's problematic if you ask them to pay more for the same type of coverage," Gagnon said.

Income-based plans the trend

Nova Scotia's changes bring the province closer to income-based plans in British Columbia and Manitoba, where drug coverage is for all ages and annual fees are similar to Nova Scotia's premiums.

Manitoba bases its payments on income and a deductible rate, taking into account pension splitting and how many dependants there are in a family.

For instance, a couple that makes $24,000 annually and has no children under 18 pays $1,065 per year. After that, all prescriptions costs are covered.

By comparison, a couple that makes $100,000 a year pays $6,730. It drops to $6,326.20 if they have two children.

In British Columbia, there is a slight discount for seniors born in 1939 or earlier.

Annual fees are slightly less than in Manitoba; around $500 per year for families making $24,000 and around $3,000 for families making $100,000 or more.

Quebec has a premium similar to Nova Scotia that can go up to $640 for the highest income bracket.

How much seniors pay for their drugs depends on which province they live in. (Eric Risberg/Associated Press)

At-the-counter fees

Meanwhile, almost half of Canadian provinces have no deductible or premiums for seniors, including New Brunswick, Newfoundland, Prince Edward Island, Saskatchewan and Alberta.

Several of those provinces, including New Brunswick and Newfoundland, only cover low income seniors. In P.E.I., Saskatchewan and Alberta, everyone age 65 or older is eligible, regardless of income.

Most seniors who qualify in those provinces are charged only a small fee ranging from $6 to $25 at the pharmacy counter.

At-the-counter pharmacy costs:

New Brunswick — $15 to a maximum of $500 per year

Prince Edward Island — $15.94 for each prescription

Newfoundland — Up to $6 maximum

Quebec — 34 per cent of the prescription cost, capped at $51.83 monthly

Manitoba — Completely covered after deductible

Saskatchewan — Maximum of $20 per prescription

Ontario — Up to $6.11 after a $100 deductible for most seniors

Alberta — 30 per cent of the prescription cost up to $25

British Columbia — Between 25 and 30 per cent of prescription cost

Nova Scotia — 20 per cent of prescription cost to a maximum of $382 per year

Ontario has a flat fee, known there as a deductible, of $100 for most seniors, with some ability to lower that for the poorest seniors.

Marc-André Gagnon, a Carleton University associate professor of public policy, says costs of public drug plans are shifting onto patient shoulders. (Marc-André Gagnon/Evidence Network)

Small fixes not sustainable

Gagnon and others say a Canada-wide system — a national pharmacare plan — would be more consistent and help the country negotiate for cheaper drug prices as a single unit.

It may also help people rely less on private drug coverage to make up the gap, Gagnon said, which also contributes to diluting provincial power to negotiate on drug costs.

"That would make things more sustainable," Gagnon said.

"In the end the problem is the same. We have a very inefficient system in terms of drug coverage that's costing way too much. Somebody have to pay for that and, yes, we end up making richer people pay."