Frequently Asked Questions about Fair PharmaCare
Your "family" includes you, your children, and/or your spouse. Dependent children on the same MSP contract as you or your spouse will receive Fair PharmaCare coverage as part of your family.
Dependent children are:
- under the age of 19, or 19-24 attending school or post-secondary education
- supported by you and/or your spouse
- neither married nor living in a marriage-like relationship
The child must be registered on the account of a parent on whose Medical Services Plan (MSP) account the child is registered. MSP and PharmaCare share family structure information, so children must be on the same parent’s account for both MSP and PharmaCare. While children may be on both parents’ MSP accounts, they may be one only one parent’s Fair PharmaCare account.
When you turn 19 years old, you must establish your own Medical Services Plan (MSP) account. If you no longer qualify as a dependent for MSP, you can:
- get separate Fair PharmaCare coverage right away, or
- stay as a dependent in your family until the end of the calendar year in which you turn 19.
If you qualify as a dependent for MSP (for example, because you are attending school full-time), you will stay on your parents’ Fair PharmaCare plan.
- To establish separate coverage, contact Health Insurance BC.
- It is better to wait until the end of the calendar year to establish your own Fair PharmaCare coverage. If you’re not sure if you should wait, contact Health Insurance BC.
- When you sign up for your own Fair PharmaCare plan, your prescription costs for the year no longer count toward your parents’ deductible.
No. For Fair PharmaCare purposes, a dependent is:
- a resident who is the legal ward or child of the registrant, and
- supported by the registrant, and
- neither married nor living and cohabitating in a marriage-like relationship, and
- either 18 years or younger or aged 19 to 24 and attending school or university full-time.
Dependents must live with the family whose PharmaCare plan they belong to. In cases of joint custody, children must be on only one parent’s Fair PharmaCare account, and they must be on the MSP account for that parent.
If your spouse is not eligible for Fair PharmaCare coverage, you still need to report their income when you register, because Fair PharmaCare coverage is based on family net income.
You have two options:
- You and your former spouse can establish separate MSP accounts. Then you can contact Health Insurance BC and register for separate Fair PharmaCare accounts; or
- You can register for Fair PharmaCare as a family and report your combined net income.
Your spouse's coverage by the federal insurer (for example, the Canadian Forces, Veteran's Affairs Canada or the Non-Insured Health Benefits program) will not change, but you will still need to include their income when you register, because Fair PharmaCare coverage is based on family net income.
Your spouse’s drug coverage (under PharmaCare Plan B) is automatically arranged through the residential care facility, but you still need to report your spouse’s income when you register for Fair PharmaCare as the plan is based on family net income. If your family experiences financial difficulty because your spouse has moved to a licenced residential care facility where they are covered under PharmaCare Plan B, you can request an income review.
You must register for Fair PharmaCare as a family. If you do not register, your spouse will not be able to register. In order to be fair, Fair PharmaCare uses family income to determine level of assistance for everyone in B.C.
You will continue to receive enhanced Fair PharmaCare coverage until the end of the year in which your spouse dies. In following years, you will receive regular Fair PharmaCare coverage.
A family’s deductible is the amount they need to spend each year on eligible costs before Fair PharmaCare starts to help with these costs. Once they reach their deductible, PharmaCare pays 70% of costs; or 75% of costs for families with a member born before 1940.
- The family maximum is the most a family needs to spend, per year, on eligible drugs, fees, and medical supplies before Fair PharmaCare pays 100% of eligible expenses.
- You can calculate your family maximum using the Fair PharmaCare estimator.
- You can see an example of how deductibles and family maximums work here.
- For all family members:
- Personal Health Number (found on the back of your driver’s license or BC Services Card)
- Birth dates
- For you and your spouse (if you have one):
- Social Insurance numbers
- Income from your tax return from two years ago, including:
- Net income (line 236)
- Any income from a Registered Disability Savings Plan (RDSP) (line 125)
You can cancel your income-based coverage at any time by withdrawing your consent to check your income.
Health Insurance BC
Attention: PharmaCare Services
PO Box 9655 Stn Prov Govt
Victoria, BC V8W 9P2
You will still have default Fair PharmaCare coverage with a $10,000 deductible and family maximum.
Your income-based coverage will continue unless:
- You withdraw your consent for PharmaCare to verify your income with the Canada Revenue Agency (CRA);
- PharmaCare could not verify your income (contact Health Insurance BC).
If your income-based coverage is cancelled but you are otherwise still eligible for Fair PharmaCare, you will have default Fair PharmaCare coverage with a $10,000 deductible and Family Maximum.
Your default Fair PharmaCare coverage will end if you:
- Opt out of the Medical Services Plan; or
- Are no longer a resident of B.C.
If you have concerns about your coverage, please contact Health Insurance BC.
No. To register for Fair PharmaCare, you must provide us with consent to verify your income with the Canada Revenue Agency. PharmaCare cannot accept a copy of your tax return or other documents in place of the consent form, as we check your income every year to ensure that the level of assistance you receive is appropriate for your income.
The federal government (Canada Revenue Agency) requires us to get your consent to view your income. Fair Pharma Care uses income to determine coverage: the lower your income, the more coverage you get. If you register but either you or your spouse do not provide consent for income verification, your family’s deductible will be set at the default level of $10,000.
Your net income is the income you reported on your tax return from two years ago. If you are registering in 2019, use your net income from 2017.
Your net income is the amount reported on Line 236 of your income tax return minus income from a Registered Disability Savings Plan (RDSP) (line 125).
- Fair PharmaCare financial assistance is based on the calendar year (January 1st - December 31st). Your financial assistance level is determined at the beginning of each year.
- Income tax returns can be filed as late as April 30th of each year. After that date, the CRA must process the returns. This means that income information from the most recent tax year is not available in time for PharmaCare to determine your assistance for the following year.
The Ministry of Health and the CRA have an agreement that permits PharmaCare to access four items of tax information with your signed consent:
Line 236 - Net Income: The line provides your net income, as defined by the CRA, and determines your level of Fair PharmaCare coverage.
Line 125 - Income from a Registered Disability Savings Plan: This amount comes off your net income when determining your level of Fair PharmaCare coverage.
Line 303 - Married Amount: The ministry will use this information to determine the income of your spouse or common-law partner only if:
- both of you have signed a consent form; and
- your spouse/common-law partner has not filed a separate income tax return.
GST/HST Credit Application: Used only under the circumstances outlined above for Line 303.
You can find your net income on Line 236 of your tax return or the Notice of Assessment that the CRA sends you after they have processed your return.
Income from a Registered Disability Savings Plan is not reported on the Notice of Assessment. If you received either of these, you will have to look them up on your income tax return.
You can contact the CRA at 1-800-959-8281, or call your local tax services office for help.
If you do not provide us with a signed consent form, we cannot determine your appropriate level of coverage. Without confirmation of your income, your level of coverage would be set at the default level of a $10,000 deductible per family. If you do not return your consent form, there is no further notification from PharmaCare, and you may need to request a new copy of the form if you wish to receive income-based coverage. You may request a new copy of the form by using our online Forms Copy Request or by contacting Health Insurance BC.
Your consent allows PharmaCare to make sure your coverage matches your income. Each year, we will verify your family net income with the Canada Revenue Agency and adjust your level of coverage automatically, based on your family net income from two years prior. Your signed consent form allows PharmaCare to access your income information in future years.
However, if your family income has dropped 10% or more in the past two years, you can request that your assistance be based on your income from a more recent year. Please see our Increased Assistance and Payment Options.
Canada Revenue Agency regulations, and the Freedom of Information and Protection of Privacy Act, ensure the privacy of your information. Only specially designated Ministry of Health and/or Health Insurance BC staff can access your information, and only for the purpose of determining your Fair PharmaCare level of coverage.
- Your earnings form part of your whole family’s net income and determine their ability to pay for prescription drugs. Applying the same definition of family net income to all B.C. families means fairness for all Fair PharmaCare registrants.
- Fair PharmaCare may cover some prescription drugs and supplies that are not covered by your federal plan. If you use any of those products, the purchases will help your family reach its deductible and family maximum sooner.
In some circumstances, your income-based Fair PharmaCare coverage may end. If you become eligible for coverage again, you can ask to have your coverage reinstated.
For instance, your coverage may have ended because:
- you did not return a consent form authorizing PharmaCare to check your income with the Canada Revenue Agency, or you withdrew your consent;
- your deductible defaulted to $10,000 per family because we could not verify your income (if, for example, you did not file a tax return);
- your coverage ended because you left B.C. to live elsewhere; or
- you opted out of the B.C. Medical Services Plan.
Contact Health Insurance BC to reinstate coverage.