Frequently asked questions about Fair PharmaCare

 Has your family changed? Contact us as soon as:

  • You marry or enter into a marriage-like relationship
  • You have a new baby or adopt a child
  • You gain primary (51% or more) custody of a child from a previous marriage or relationship
  • You separate or divorce
  • Your child is no longer considered a dependent by the Medical Services Plan (your child can remain covered by asking us to set up separate Fair PharmaCare coverage for them)

Did you lose a form? Did you submit the wrong income?

For the purposes of Fair PharmaCare coverage, a family can be a:

  • Single person
  • Married or common-law couple
  • Single person with dependent children
  • Couple with dependent children

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 to 24 attending school or post-secondary education
  • Supported by you and/or your spouse
  • Neither married nor living in a marriage-like relationship

Joint custody

In the case of joint custody, 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.

In the event of separation of divorce, while your family has Fair PharmaCare coverate, contact us to update your information. 

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 parent's/guardian's Fair PharmaCare plan.                                              

Important considerations:

  • To establish separate coverage, contact us
  • 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 us
  • 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.

 

My spouse is not eligible for Fair PharmaCare

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:

  1. You and your former spouse can establish separate MSP accounts. Then you can contact us and register for separate Fair PharmaCare accounts, or
  2. 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.

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.

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.

 

I am a guardian for a friend/family member. How do I register them for Fair PharmaCare?

As a guardian/power of attorney, you can register a friend/family member by phone or online. When you return the consent form, include a copy of the Power of Attorney that shows you have authority to act on the person's behalf.

 

What is a deductible? What is a family maximum?

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.

A family's 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.

Eligible costs are the costs of drugs and medical supplies that PharmaCare covers. Eligible costs include dispensing fees of up to $10 for each prescription, and some pharmacy services.

For all family members:

  • Personal Health Number (found on the back of your driver’s licence 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 23600)
    • Any income from a Registered Disability Savings Plan (RDSP) (line 12500)

Fair PharmaCare coverage is based on income. Families with smaller incomes receive more coverage than families with larger incomes. For more information, see How your Fair PharmaCare coverage is calculated.

Your deductible and family maximum are set for the calendar year (January 1st - December 31st). They are determined at the beginning of each year.

Income tax returns can be filed as late as April 30th of each year. This means 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 23600 of your tax return - Net Income: The line provides your net income, as defined by the CRA, and determines your level of Fair PharmaCare coverage.
  • Line 12500 - Income from a Registered Disability Savings Plan: This amount comes off your net income when determining your level of Fair PharmaCare coverage.
  • Line 30300 - 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 30300

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.

You can find your tax information on 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. You will have to look it up on your income tax return.

Contact the CRA at 1-800-959-8281 or call your local tax services office for help.

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 an income review, which could result in a lower deductible. Please see our Increased assistance and payment options.

  • 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.

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 (likely because you need to file taxes)

Your income-based Fair PharmaCare coverage may end because:

  • You did not return the consent form when you registered, authorizing PharmaCare to check your income with the CRA
  • You withdrew your consent for PharmaCare to verify your income with the CRA
  • PharmaCare could not verify your income (if, for example, you did not file a tax return)
  • You left B.C. to live elsewhere, or
  • You opted out of the BC Medical Services Plan

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.

If you have concerns about your coverage, or wish to reinstate it, please contact us.

You can cancel your income-based coverage at any time by withdrawing your consent for PharmaCare 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.

 


Questions about PharmaCare?

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If your income has gone down by more than 10% in the last two years, you can apply to have your deductible or family maximum lowered.