Variability in prescription medication coverage for children and youth across Canada: A scoping review

Prescription medication coverage in Canada is provided by at least 14 public drug plans and thousands of private insurance plans. Previous literature suggests that public plan coverage varies, and little is known about private drug plans.

Undertake a scoping review of recent literature evaluating coverage of prescription medication for children and youth under 25 across Canada.

Bibliographic databases (Embase, CINAHL, Web of Science, Medline) and gray literature sources were screened. Papers published between January 2005 and July 2021, focusing on prescription medication coverage for Canadians under 25 years were identified.

Of 562 titles and abstracts, 9 reports met our criteria. One report estimates 3.3% of children and youth in 10 provinces are uninsured (i.e. not eligible), with non-enrollment for those eligible for public plans ranging from 12% to 49%. Minimal information on private drug plan coverage was identified. Demographic- or income-based public drug plans report coverage in 12 of 14 jurisdictions. Those covered by a demographic- or income-based plan have access to jurisdictional formularies. 3 of 14 public plans report no cost sharing for children.

There is less variability in who and what is covered and more in how much is covered (i.e., details of cost sharing). More research is needed to adequately understand the gaps in coverage and its impact on children and youth.