Eligibility
An eligible resident of Alberta is a person who is legally entitled to be or to remain in Canada, makes his/her permanent home in Alberta and is committed to being physically present in Alberta for at least 183 days in a 12 month period.

Rates
To access AHCIP benefits, you must pay a monthly premium; the cost is $44/month for an individual or $88/month for a family of two or more. Seniors are exempt from this rate. Exemptions and subsidies are available to certain non-seniors.

Extended Benefit Programs
Beyond the AHCIP, Health and Wellness and Human Resources and Employment have contracts with Alberta Blue Cross to offer extended health plans for many Albertans.

Lastly, the Alberta Cancer Board provides medically required cancer drugs to eligible residents at no charge, while Disease Control and Prevention provides prescription drugs for treatment of tuberculosis and sexually transmitted disease, also at no charge.

100-day Supply Limits
Alberta regulations place no limit on the quantities of drugs that may be prescribed; however Alberta Health and Wellness does not typically pay benefits for more than a 100-day supply of a drug at one time. In other words, your doctor can prescribe as many days worth of a drug as s/he wishes, but you will only receive financial assistance with 100 days worth.

For some drugs for patients in maintenance, drugs in the following classes should be supplied in 100-day supplies:

• anticonvulsants
• digitalis and digitalis glycosides
• hypoglycemic agents
• thyroid drugs
• vitamins

Coverage of Ostomy Supplies
Under the Alberta Aids to Daily Living Program (AADL), eligible individuals are provided reimbursement for ostomy supplies. Residents may be eligible for AADL if they have a proven long-term or chronic illness or disability, where long-term and chronic are defined as six months or longer. Individuals on private insurance plans may not be eligible, if they have access to comparable benefits through their private plan.

The AADL benefits are typically a 75% reimbursement for ostomy supplies bought from an approved vendor. Families pay the remaining 25%, up to $500 in a year. If in a benefit year, July 1 - June 30, a family exceeds this amount, 100% reimbursement is given for any further costs. 100% coverage is provided all year if the family taxable income is less than $12 610.

Pharmacy fee reimbursements
Alberta determines the maximum amounts a pharmacy can charge for dispensing and inventory fees over 6 month intervals. The current rates are listed online.

Least Cost Alternative
An LCA is determined by comparing the costs of drugs with the same therapeutic effect and reimbursing for the lowest cost. Where the LCA price policy has been applied, the Alberta government-sponsored drug programs will pay the Actual Acquisition Cost (AAC) of the drug material to the LCA price.

Maximum Allowable Cost
The MAC price is the maximum unit cost established for a specific drug product or a selected group of drug products. The Alberta government-sponsored drug programs will pay the AAC of the drug material to a maximum of the MAC price. Where a physician prescribes a specific product subject to the MAC price policy, patients will be responsible for any additional cost(s), unless an application for Special Authorization is made.

Special Authorization
The application for Special Authorization coverage is completed by a physician and reviewed by clinical pharmacists. SA coverage may occur under the following circumstances:

• The drug is covered under specified criteria.
• The drug is normally covered by another program for a specific clinical condition, but is needed for the treatment of a clinical condition that is not covered by that program.
• The drug is required because other preparations listed in the Drug Benefit List are contraindicated or inappropriate.
• The particular brand of drug is essential in the care of a patient, such as in cases of significant allergic reactions to interchangeable products that meet the LCA criteria.
• A particular drug product or dosage form of a drug is essential in the care of a patient due to significant allergic reaction to the MAC drug.

Prior approval must be granted by Alberta Blue Cross. For those special authorization requests that are approved, the effective date is the beginning of the month in which the physician