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Technically, every Canadian aged 65 or older is covered by a provincial drug plan, but the out-of-pocket costs paid by seniors for prescription drugs vary wildly between provinces, new research shows.

For example, a 65-year-old single woman on a government pension who suffers from diabetes and high blood pressure and is being treated with four prescription drugs pays only $8 for the medication in Ontario but $503 in Manitoba.

Similarly, a 73-year-old married man with an above-average income taking five drugs to treat heart failure pays $60 for the prescription medicine in New Brunswick and $1,332 in Manitoba.

"Given differences in reimbursement according to age, income level, marital status and province of residence, drug reimbursement in Canada is manifestly unequal," said Louise Pilote with the divisions of general internal medicine and clinical epidemiology at McGill University Health Centre in Montreal.

"I don't think the provinces themselves realize how great the differences are," she said.

In a study published in today's edition of the Canadian Medical Association Journal, Dr. Pilote and her co-authors recommend a more cohesive pharmaceutical strategy to reduce these inequities, an approach they say is important given ever-increasing spending on prescription drugs.

"If we want to call ourselves a universal health system, we have to address these issues," she said.

In 2007, Canadians spent $26.9-billion on drugs, of which more than $4-billion was out-of-pocket, according to the Canadian Institute for Health Information.

Prescription drugs taken outside the hospital are not covered by medicare. About 75 per cent of Canadians have private insurance coverage for drugs.

There are also a host of government programs that reimburse drug costs, principally for seniors, recipients of social assistance and those with chronic illnesses that entail high drug costs such as HIV-AIDS and diabetes.

According to the new study, the number of people eligible for reimbursement for prescription drugs varies greatly between provinces, from a low of 9 per cent in Manitoba to a high of 43 per cent in Quebec.

The amount those with plans pay out-of-pocket also differs substantially between jurisdictions, the research shows.

New Brunswick and Prince Edward Island offer the most comprehensive drug plans for seniors, with patients either fully covered or paying up to 35 per cent of prescription drug costs, regardless of income. Ontario and Nova Scotia offer fairly comprehensive plans, but reimbursement is proportional to income. Quebec seniors generally pay more of their total annual prescription costs than those in other provinces, though there is relief for low-income seniors and those who require a lot of drug treatment. Seniors in Saskatchewan, Manitoba and Newfoundland are covered only if they have a low income.

Dr. Pilote noted that low-income non-seniors in most provinces must pay the full cost of their prescription medications unless they have insurance through work.

By contrast, social assistance recipients have their drug costs covered in all provinces, though they may pay up to 35 per cent of annual costs depending on where they live.

For example, a 40-year-old man on welfare who is suffering from high blood pressure and taking three medications whose cost totals $1,389 a year will pay nothing in Alberta, $8 in Quebec, $20 in Nova Scotia and $200 in Quebec.

To conduct the study, researchers used 32 scenarios, based on the age, income level, marital status and prescription burden of drug plan members in various provinces.