BC PharmaCare policies
Last updated on January 31, 2024These policies apply to all PharmaCare plans. In some cases, only the rules of your PharmaCare plan limit how much PharmaCare pays for a drug or supply (e.g. Fair PharmaCare deductible and family maximum). In other cases, general coverage policies may limit how much PharmaCare pays.
For more information about PharmaCare policies, see the PharmaCare Policy Manual and the Prosthetic and Orthotic Manual.
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PharmaCare sets a maximum amount that it will pay for each drug and device it covers. You can see this maximum amount by looking up a drug or device in the Formulary Search. If you are registered in Fair PharmaCare, only PharmaCare’s maximum amount will count towards your deductible.
Pharmacies charge different amounts for drugs and devices. If your pharmacy charges more than the amount PharmaCare will pay, you pay the additional cost (unless the Full Payment Policy applies). You may want to compare costs and services before you fill a prescription.
Pharmacies charge a dispensing fee for each prescription. The maximum amount PharmaCare will pay a pharmacy to dispense a prescription is currently $10. If you are registered in Fair PharmaCare, no more than $10 of each dispensing fee will count towards your deductible. Not all pharmacies charge the same amount for dispensing fees. If a pharmacy charges more than $10, you pay the additional cost (unless the Full Payment Policy applies). You may want to compare costs and services before you fill a prescription.
A pharmacy cannot charge you any cost of a drug or a dispensing fee when:
- You are covered under PharmaCare plans C, W, G, B, D, F, M, P, and Z (everyone in B.C. is covered under Plan Z for a small number of specific drugs.)
- You have met your Fair PharmaCare family maximum, or
- The drug is a regular benefit (or you have Special Authority approval)
If PharmaCare covers the full value of a generic version of the drug you are prescribed (i.e. through the Low Cost Alternative program) or has identified a related reference drug (under the Reference Drug Program), you may have to pay an additional cost for the non-generic or non-reference product (unless you have Special Authority approval).
If a pharmacy mistakenly charges you when the Full Payment Policy applies, they must refund you.
If you are covered under more than one PharmaCare plan, only some of your drugs may be subject to the Full Payment Policy. Example: Robert is covered under Fair PharmaCare and the Psychiatric Medication Plan (Plan G). Robert has two prescriptions to fill:
- A psychiatric drug covered under Plan G
- A skin ointment covered under Fair PharmaCare
Plan G covers 100 percent of the eligible costs of the psychiatric drug, and the Full Payment Policy applies. Robert will not be charged any additional amount for the drug. Robert has met his Fair PharmaCare deductible, but not his family maximum. PharmaCare will pay 70 percent of the eligible ointment costs. The Full Payment Policy will not apply. Robert will have to pay the amount PharmaCare does not cover (30 percent) and any amount the pharmacy charges in addition to that.
PharmaCare covers a maximum 30-day supply for:
- Short-term drug prescriptions, including antibiotics, sleeping pills and barbiturates. Some of these medications are addictive or become ineffective if used over a long period of time
- First-time maintenance drug prescriptions, including for chronic conditions such as diabetes and Parkinson's disease
When you refill a prescription for a drug intended for longer-term use, PharmaCare covers a 100-day supply. Exemptions to this policy can apply to residents of rural or remote areas without a pharmacy nearby.
If you fill a prescription too early and still have more than 14 days' supply of your drug, PharmaCare will not cover the cost, except in certain circumstances. This prevents waste in case your treatment is discontinued, and reduces the risk associated with having excess medication on hand.
As an exception to the Days' Supply Policy, PharmaCare allows you to fill a prescription earlier if you need a supply for travel outside B.C. Once every six months (180 days), if you are travelling out of province, you can top up your existing prescription(s) to PharmaCare's maximum days’ supply. Under the travel supply policy:
- For a long-term use drug, you are covered for a 30-day supply for the first fill of your prescription and 100-day supply for each refill
- For a short-term use drug, you are covered for a 30-day supply for the first fill and refill of your prescription
For your travel supply to be eligible for PharmaCare coverage, you must complete and sign a Travel Declaration form (supplied by your pharmacy) on the date your prescription is filled. Only the maximum days’ supply will be eligible for coverage. If you need more than the PharmaCare maximum days’ supply, you will be responsible for any remaining cost.
The Trial Prescription Program encourages pharmacies to dispense small amounts (10 to 14 days’ supply) of specific, expensive medications that have a high rate of side effects. This prevents medication waste if you do not tolerate the drug well.
PharmaCare covers the initial dispensing fee for the trial quantity, up to the maximum fee of $10.00. You pay the remaining dispensing fee. The amount you pay for the drug depends on your PharmaCare plan. If you fill the remainder of the prescription, you pay only your portion of the remaining drug cost and the dispensing fee, according to your PharmaCare plan rules.
- See Trial Prescription Program for the list of eligible drugs