Annual Drug Maximum

The annual drug maximum is the highest amount your health plan will pay for eligible prescription drugs during a benefit year. Once you reach this limit, additional drug expenses are your responsibility until the plan renews. This feature helps insurers manage costs while providing predictable protection for routine prescriptions.

‍

Maximums can vary widely between plan tiers - from $500 in basic plans to unlimited coverage in premium options. Certain medications, such as high-cost biologics, can quickly use up this maximum, making it essential to know your yearly allowance.

‍

Example:

‍

If your annual drug maximum is $1,500 and your total eligible prescriptions cost $1,800 in a year, the plan pays $1,500 and you pay $300.

‍

What to Watch For:

‍

Check if your plan distinguishes between brand and generic drugs and whether provincial programs contribute before your private plan.