Get help paying your Fair PharmaCare deductible

Your Fair PharmaCare coverage is based on your income information from 2 years ago. If your family income has dropped by 10% or more in the past two years, you can apply for an income review, which may lower your deductible or family maximum.

To be eligible for an income review:

• Your family's income must have gone down by 10% or more compared to your net income from two years ago, and
• You will need to provide documentation to support your income information.

See Fair PharmaCare assistance levels to see how your coverage could change.

How to apply for income review

Important: You can apply for an income review only for the current year’s coverage. You must apply before December 31 of the year for which you want increased coverage.

To see if you are eligible for an income review, see page 2 of HLTH 5355 - Application for Income Review (PDF, 718KB).

If you are eligible, complete the application and submit with copies of your supporting documents.

• Online application for income review
• Paper application for income review (HLTH 5355) (PDF, 718KB).

We will review your application and, where possible, verify your income with the Canada Revenue Agency (CRA). If we approve your application, we will confirm your new level of coverage about one month from receipt of your application. If more than a month has gone by, contact us.

Note: If the income information you provide with your application cannot be verified when tax information for that year becomes available, PharmaCare will recover any overpayment of assistance.

Will PharmaCare reimburse me for amounts I paid above the lower deductible?

If your income review results in a lower deductible and family maximum, it applies to the eligible cost of any prescriptions you purchased after the later of

• January 1, or
• The date your family registered for Fair PharmaCare, or
• The date of the most recent addition or removal of a spouse from your Fair PharmaCare record, or
• The restore date after cancellation of your coverage.

If you qualify for a refund, PharmaCare will reimburse you in the spring of the following year.

Families enrolled in MDPO pay their deductible in monthly instalments spread over the year. As soon as they are enrolled, their prescription claims are processed as though they have met their deductible. In most cases, this means PharmaCare pays 70% of eligible costs (or 75% of eligible costs for families with a family member born before 1940).

This option will not benefit you if your annual prescription costs are less than your deductible or if your deductible is $0.

If you enrol and later begin receiving private health insurance that includes a drug benefit plan, you need to cancel your MDPO enrolment.

You will receive a tax receipt at the end of the year, so you can claim your monthly payments as medical expenses. Your monthly deductible payments do not show on pharmacy receipts.

Eligibility for MDPO

To be eligible, a family must:

• Register for Fair PharmaCare; and
• Not have private health insurance with a drug benefit plan (if your private health insurer contributes to your prescription costs, enrolling in MDPO could complicate or delay your private health benefits); and
• Have a Fair PharmaCare deductible greater than $0

How to make payments

You can choose to:

• Have your financial institution deduct your monthly payment
• Receive a bill each month, (payable on the 15th of the month). If you receive a monthly bill, you can use the Revenue Services BC online payment service

How to enrol in MDPO

To enrol in MDPO, contact us. For a plan for the current calendar year, you must enrol before the last business day of September. After September 30, you can request enrolment for the following year.

Staff will ensure that the MDPO is right for you. If it is, you will receive an enrolment package. You will then need to mail or fax the necessary form(s) to us.

Your enrolment will be processed 2 to 3 business days after we receive the forms.

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If I discover the payment plan doesn't help me, can I cancel my enrolment?

You can cancel your enrolment at any time by contacting us.

If you cancel, PharmaCare will reconcile your account for the previous year and issue you a statement early in the next year. You will receive a refund if you have paid more than your required contribution. If you received more assistance than your monthly payments accounted for up to the cancellation date, PharmaCare will recover that amount. Revenue Services BC manages both refunds and recoveries.

You must keep both the statement and your prescription receipts if you wish to submit your prescription costs as medical expenses on your income tax return.

What happens if my prescription costs end up being lower than my deductible?

Early in the following year, PharmaCare will reconcile your account for the previous year and issue a statement. You will receive a refund if you have paid more than your required contribution under the Fair PharmaCare plan. You must keep the statement and your prescription receipts if you wish to submit your prescription costs as medical expenses on your income tax return.

If I enrol, do I need to report changes in my family structure to PharmaCare?

In cases of marriage, separation or divorce, tell us of the change in your family. We will review the options with you (for example, changes to your monthly payment amount or account reconciliation).

If you and your spouse separate or divorce, both of you should contact us. We will arrange for your Fair PharmaCare family membership to reflect your current situation. If you and/or your former spouse experience a drop in income as a result of the change in your marital status, increased assistance may also be available.

It is also important that your children be included in the family of the appropriate parent (a child can be included in one family only). Since Fair PharmaCare and BC Medical Services Plan (MSP) share family structure information, please ensure that the children you want to include on your Fair PharmaCare account are on your MSP account.

Note: If your family structure with MSP changes, we will notify you by letter, asking you to confirm your Fair PharmaCare information. Respond to this letter promptly to prevent termination of your Fair PharmaCare coverage.

If your spouse has recently moved to a long-term care facility and you are having difficulty with the cost of your prescriptions, contact MSP and ask about qualifying as "separated." This will allow us to exclude your spouse's income when calculating your Fair PharmaCare coverage.

If MSP does not approve your request, contact us. If your combined income is less than $42,000, after subtracting your spouse's long-term care fees, you can request increased coverage.

Your spouse's income is included in the calculation of your Fair PharmaCare coverage until the end of the year. This allows your spouse's prescription costs to count towards your deductible.

However, if this creates financial difficulty, you can contact us to have your spouse's income removed. If this happens, your spouse's prescription costs will not count towards your deductible.