Increased Assistance and Payment Options
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PharmaCare has increased assistance for lower income families as of January 1, 2019. If you are already registered for Fair PharmaCare, and your income is $45,000 or less, you will receive more assistance automatically. If you are currently registered for the Monthly Deductible Payment Option (MDPO), but you will no longer have a deductible, please do NOT re-apply for MDPO for 2019.
If your family circumstances change, we may be able to adjust your Fair PharmaCare assistance.
We base your Fair PharmaCare coverage on your income information from two years ago. If your family income has dropped by 10% or more in the past two years, you can apply for an Income Review. If you meet the requirements, your level of coverage can be increased immediately.
Important: You can apply for an income review only for the current year’s coverage. You must submit your application before December 31. You cannot apply for a review for a previous year.
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 acceptable documentation to support your income information.
To estimate if you are eligible for an income review, see page 2 of the Income Review Application (PDF).
Divorce or Separation/Child Custody
If you and your spouse separate or divorce, both of you should contact Health Insurance BC (HIBC). 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 cannot be included in more than one family). Since Fair PharmaCare and B.C. 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. It is important to respond to this letter promptly to prevent termination of your Fair PharmaCare coverage.
Spouse Who is Now Living in a Residential Care Facility
If your spouse has recently moved to a residential 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 HIBC. If your combined income is less than $42,000 after subtracting your spouse's residential care fees, you can request increased coverage.
Death of a Spouse
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 having your spouse's income included creates financial difficulty you can contact HIBC to have your spouse's income removed. If this happens, your spouse's prescription costs will not count towards your deductible.
Send your completed application form and your supporting documents to:
Health Insurance BC
Attention: Fair PharmaCare
PO Box 9685 Stn Prov Govt
Victoria BC V8W 9P2
Fax to (250) 405-3598
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 in about one month of receipt of your application.
If more than a month has gone by, contact HIBC.
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.
Is there a deadline for applying?
Yes. You must apply before December 31 of the year for which you want increased coverage.
If PharmaCare assigns my family a lower deductible, will it be retroactive? (Will PharmaCare reimburse me for amounts I paid above the lower deductible?)
Yes. 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.
Many people do not have a deductible under the Fair PharmaCare plan and PharmaCare helps them with their eligible prescription costs right away.
For families that do have a deductible and find it hard to pay at the beginning of the year, PharmaCare offers the Monthly Deductible Payment Option.
Once enrolled in the Monthly Deductible Payment Option, families pay their Fair PharmaCare deductible in monthly installments and receive PharmaCare assistance with eligible prescription costs right away.
Who is eligible to enrol in the Monthly Deductible Payment Option?
- register for Fair PharmaCare and do not have private health insurance with a drug benefit plan
- if your private health insurer contributes to your prescription costs, enrolling in the MDPO could complicate or delay your private health benefits.
- have a deductible greater than $0
Note that the 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.
How does the Monthly Deductible Payment Option work?
Here is an example of how the Monthly Deductible Payment Option might benefit a family:
Brenda and John's prescription costs are about $2,200 each year. Their Fair PharmaCare deductible, based on their combined annual income, is $1,200. Currently, Brenda and John pay the $1,200 deductible at the beginning of the year. Once they have paid the entire deductible for eligible prescription costs, PharmaCare begins contributing 70%.
Under the MDPO, Brenda and John would pay $100 towards their deductible each month. PharmaCare would begin paying 70% of eligible prescription costs from the date they enrol. Brenda and John would pay only 30% of their eligible prescription costs at the pharmacy until they reach their family maximum.
What will I pay at the pharmacy after I enrol?
Once you are enrolled, PharmaCare pays your prescription claims will be processed as though you have met your deductible. In most cases, this means PharmaCare pays 70% of eligible costs. (PharmaCare pays 75% of eligible costs for families with a family member born before 1940.) After you reach your family maximum, PharmaCare pays 100%.
Note: Individuals remain responsible for payment for non-benefit products.
Your monthly deductible payments do not show on pharmacy receipts. You will receive a tax receipt at the end of the year, so you can claim your monthly payments as medical expenses.
What if I get private health insurance with a drug benefit plan partway through the year?
You need to cancel your enrolment by contacting HIBC.
If I enrol but then discover the option is not to my benefit, can I cancel my enrolment?
Yes. You can cancel your enrolment at any time by contacting HIBC.
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.
What methods of payment can I use to make monthly payments?
You can choose to:
- receive a bill each month, (payable on the 15th of the month), or
- have your financial institution deduct your monthly payment.
If you receive a monthly bill, you can pay using the Revenue Services BC online payment service.
If I enrol, do I need to report changes in my family structure to PharmaCare?
Yes. In cases of marriage, separation or divorce, tell us of the change in your family. HIBC will review the options with you (for example, changes to your monthly payment amount or account reconciliation).
When should I enrol?
You may enrol for the current calendar year by contacting HIBC anytime up to the last business day of September.
After September 30, you can request enrollment for the following year.
How long does it take to enrol?
When you contact HIBC, staff will ensure that the MDPO is right for you. If it is, you will receive an enrollment package. After you receive and review the documents, you need to mail or fax the necessary form(s) to HIBC.
Your enrollment will be processed two to three business days after receipt of the forms.
How do I enrol?
For more information, or to enrol in the Monthly Deductible Payment Option, contact Health Insurance BC.