Drug Plan

The BC Fair Pharmacare program was developed to help ease the burden of high drug costs on lower income families. In order to qualify for the benefits of this program, you must apply.

How it works

Based on your net family income, Pharmacare determines a deductible (the amount at which Pharmacare begins paying 70% of your medication costs), and a ceiling (the maximum amount that your family will pay for all eligible medications in a single year).

To be eligible for Pharmacare you must:

• Be a BC resident for at least 3 months
• Be registered with Medical Services Plan (MSP)
• Be a resident of Canada for the last 12 months
• Be either a Canadian citizen or holder of permanent resident status (individuals here on student visas may be eligible for Pharmacare coverage if certain other criteria are met)
• Have filed a recent tax return

To register you can:

• Call toll-free (in BC) 1-800-387-4977, or
• Visit the web site at www.gov.bc.ca (and complete online registration)

When you register you will need to provide the following information (for all eligible family members):

• Social Insurance Number (SIN)
• Birth date
• Net family income from recent income tax return

What you need to know

• The Pharmacare system will automatically compute and track your deductible and ceiling.
• You can request a review of your deductible and ceiling if there has been a significant decrease in your net family income from the previous year.
• Pharmacare may review your deductible/ceiling at any time and adjust it if there has been a recent dramatic increase in your family income.
• If you have extended Health benefits, you can use these to offset the amount that you have to pay until you reach your yearly deductible/ceiling. Having extended health benefits does not affect your eligibility for Pharmacare in any way.

To obtain additional assistance with certain CF medications, individuals must have their diagnosis confirmed at a CF clinic, attend a CF clinic in BC at specified intervals, and have prescriptions written by a CF clinic physician. Once the above criteria are met, your clinic can register you as a person with CF (with BC Pharmacare) and the following additional coverage can be obtained:

• Pharmacare Plan D will cover 100% of the cost of pancreatic enzymes to a value of $100 per bottle of 100 enzymes.
• Some nutritional supplements and vitamins will be covered under your Fair Pharmacare coverage, subject to your family’s annual deductibles (a complete list of vitamins and nutritional supplements covered for individuals with CF can be found at www.healthservices.gov.bc.ca/pharme/plans and click on “Cystic Fibrosis Formulary”.

Some medications (such as TOBI®) that are not covered under BC Pharmacare, may be available to some individuals with CF through a process called “Special Authority”. To receive consideration for this coverage, a CF physician must justify the need through an application to BC Pharmacare. Each individual “Special Authority” application is assessed by Pharmacare and a decision for coverage is made on a case by case basis. Contact your CF physician or clinic coordinator for more information.

The BC Association administers the BC Association Provincial Government Grant For Reimbursement of CF Medication Costs. The grant can assist with the reimbursement of some of the patient costs of CF related, Pharmacare covered, prescription medications. The grant does not cover dispensing fees. The grant is considered a last option for individuals who have utilized all other opportunities for coverage and funding. To qualify, individuals must submit a Grant Reimbursement Application Form with the first claim for each individual with CF in each calendar year. Forms are available at the CF Clinics or through the Grant Administrator.

Completed forms should be returned to:

Grant Administrator 
c/o Cystic Fibrosis Clinic
BC Children's Hospital
Room K3-189
4480 Oak Street
Vancouver, BC V6H 3V4