Patients who are covered through Federal programs, may request a prescription for Mifegymiso and fill it at a pharmacy of their choice and it will be fully covered when the pharmacy submits the billing to the Federal Plan assuming all other requirements for utilizing Mifegymiso are met.
Eligible First Nations and Inuit clients are covered fully for the cost of Mifegymiso for medication abortion. The claim process follows the normal submission process for other prescription drugs.
Link: https://nihb-ssna.express-scripts.ca/en/0205140506092019/16/160407
Mifegymiso is currently listed as a standard benefit on the Veterans Affairs Canada (VAF) drug benefit list. This means that it is readily accessible to eligible clients with a valid prescription.
VAC clients have a VAC healthcare identification card on which "A" and/or "B" is indicated under the heading "Program number 10". Group A clients may only use their card to obtain health benefits directly related to the treatment of their VAC pensioned medical condition.
Group B clients are eligible for approved benefits if they have demonstrated a health need and the benefits are not available to them under a provincial health plan.
In addition, since veterans are covered for basic healthcare coverage through the provincial or territorial healthcare system, their access to Mifegymiso will follow the same provincial or territorial process as other residents.
Mifegymiso is a regular benefit on the Canadian armed forces drug benefit list; no special authorization is required.
Link: http://www.cmp-cpm.forces.gc.ca/hs/en/drug-benefit-list/index.asp
RCMP officers are considered insured persons and receive basic healthcare through the healthcare system in the province or territory in which they reside, their access to Mifegymiso will follow the provincial or territorial process as other residents. Additionally, private plans that cover the cost of prescription drugs is also an option.
Link: https://bc-cb.rcmp-grc.gc.ca/ViewPage.action?siteNodeId=2234&languageId=1&contentId=58416
Coverage for Mifegymiso with IFHP is available in provinces and territories that have the medication listed on their public drug formularies.
Service for people incarcerated in federal penitentiaries is provided directly from the pharmacy within the facility.
Providers can support non-insured patients by:
Since July 24, 2017, Alberta Health, through the Women’s Choice Program, has been providing coverage for Mifegymiso through licensed pharmacies in Alberta to allow women to exercise their choice in sexual health. Alberta Blue Cross is facilitating payment of claims for Mifegymiso under this program. All Albertans with a valid Alberta Health Care Insurance Plan and Personal Health Number (PHN) are eligible for coverage; a pseudo-PHN of WC0000000 is used for Albertans without a valid PHN.
There is no limit on the number of Mifegymiso prescriptions that a plan member may receive under the Women’s Choice Program; however, pharmacies may only claim one dose at a time for a plan member.
The program provides for direct bill claims submission only. Plan members are not eligible to claim for reimbursement.
Link: https://www.ab.bluecross.ca/pdfs/pharmacy-benefacts/pharmacy-benefact-697.pdf
Mifegymiso is covered under the BC Pharmacare Assurance Plan (Plan Z and exceptional Plan Z) which provides 100% coverage. All residents of BC with active Medical Services Plan (MSP) coverage are eligible.
Link: www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/pharmacies/plan-z
All residents of Manitoba with a valid Manitoba Health Registration Card and a prescription for Mifegymiso are eligible for coverage. Clients presenting with a valid Manitoba Health card and a prescription from an authorized prescriber should not be charged any out-of-pocket costs and even if the client is enrolled in Pharmacare or another provincial drug program (e.g., Family Services/EIA), there is no requirement to meet a deductible or co-pay.
Link: https://www.gov.mb.ca/health/pharmacare/profdocs/csp_mifegymiso.pdf
Coverage is available through the Medical Abortion Program. Manual claims will not be accepted, and claims must be submitted online.
Coverage is available at no cost to individuals with a valid Medical Care Plan card. Individuals can receive a prescription through their healthcare provider, the regional health authorities, or the Athena Clinic in St. John’s. Those with private insurance will use this first, and then the province will cover any remaining cost as last payer. Claims can be submitted in real time through the Newfoundland and Labrador Prescription Drug Program (NLPDP) adjudication system regardless of eligibility.
Link: www.gov.nl.ca/hcs/files/prescription-provider-guide-program-claiming-policies.pdf
Coverage for Mifegymiso in the Northwest Territories is provided through the Northern Options for Women (NOW) Program*. The pharmacist will fill the prescription and bill your government/employer’s insurance (if applicable). The Department of Health and Social Services will be sent an invoice for any outstanding amount that your insurance plan does not cover, or will invoice the entire amount if you do not have any insurance coverage at all.
*The NOW program is only available in Yellowknife and Inuvik currently. The Department will cover the medical travel costs for residents that live outside of Yellowknife and Inuvik who choose treatment options using Mifegymiso and are referred by a practitioner.
Link (page 40/41): www.hss.gov.nt.ca/en/services/mifegymiso-northwest-territories
Effective November 1, 2017, coverage is available for all persons in Nova Scotia with a valid health card number. Any other sources of insurance, such as a private plan, must be billed first. The method for claims submission is outlined below. Should you have any questions, please contact the Pharmacare Office.
Link (see page 41): novascotia.ca/dhw/pharmacare/documents/Pharmacy-Guide.pdf
Abortions in Nunavut are free for First Nations beneficiaries and are covered under Nunavut Healthcare. An estimated 86% of Nunavut residents are eligible for coverage through the Non-Insured Health Benefits Program.
Link: www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/Mifegymiso_Access_Scan.pdf
Effective August 10, 2017, all Ontarians with a valid Ontario Health Insurance Plan (OHIP) and a valid prescription are eligible for Mifegymiso. This includes both Ontario Drug Benefit (ODB) recipients and non-ODB recipients. Pharmacies must ensure the eligible person's date of birth, health card number and name (as it appears on the Ontario Health Card) are entered correctly as part of the Health Network Solution (HNS) claims submission. Mifegymiso supplied to patients with a valid prescription will be reimbursed by the ministry.
Medication abortion Services are offered at no charge through Sexual Health, Options & Reproductive Services (SHORS) and the Women's Wellness Program. However, a valid PEI Health Card is required.
Link: www.princeedwardisland.ca/en/information/health-pei/abortion-services
Anyone who is duly registered with the Régie de l'assurance maladie du Québec (Régie) and, who holds a prescription from a physician or medical resident for the claim slip, or temporary proof of eligibility for medication will have access to the Mife-Miso for abortion without cost. A person at least fourteen (14) years of age, but under eighteen (18) years of age who consents alone to the services provided by the program, in accordance with the provisions of the Civil Code, may benefit from the program even if they do not present a valid health insurance card or claim slip. Anyone eighteen (18) and over who does not present their health insurance card or a valid claim slip must pay the benefit; therefore, they may request reimbursement from the Régie using the form provided for this purpose.
Any service obtained outside Quebec is not covered by this program. An exception to this principle is when:
Link: https://www.ramq.gouv.qc.ca/sites/default/files/documents/liste_med_2022-12-14_en_0.pdf
Saskatchewan provides 100% coverage for Mifegymiso for residents eligible under the Saskatchewan Drug Plan. Claims may be submitted electronically to the Saskatchewan Drug Plan.
Link: https://formulary.drugplan.ehealthsask.ca/SearchFormulary
Through a partnership with the Yukon Hospital Corporation, the Government of Yukon is now offering universal coverage of Mifegymiso. This partnership ensures that Yukoners have low-barrier options and more equal access to abortion services.
Physician Services for Mifegymiso are available in:
Yukon residents living in communities without resident physician services that are seeking to use Mifegymiso, will be required to travel to see a physician, who will assist in safely ending a pregnancy with this medication.
In accordance with the Travel for Medical Treatment Act and Regulations, the Medical Travel Unit will provide a travel subsidy to eligible individuals who are travelling for the purpose of obtaining Mifegymiso outside of their home community.
Link: https://open.yukon.ca/sites/default/files/mt006-mIfe.pdf