Diabetes Assistance Program Q & A

Questions and Answers

 

Program Information

What is the Nova Scotia Diabetes Assistance Program?

The Nova Scotia Diabetes Assistance Program is a provincial drug plan that helps to pay for most prescribed medications and supplies used to manage diabetes. In addition to the drug plan, the Program includes information about the importance of managing your diabetes.

 

Eligibility

Who is eligible to enrol in the Nova Scotia Diabetes Assistance Program?

After March 31, 2010, the Nova Scotia Diabetes Assistance Program will not enrol any new patients. New patients will be offered enrollment in the Nova Scotia Family Pharmacare Program which provides assistance to all members of a family and is not only restricted to drugs for the treatment of diabetes.

If you were enrolled in the Nova Scotia Diabetes Assistance Program for the 2009-10 program year (ending March 31, 2010), you are eligible to re-enrol if you:

• are a permanent Nova Scotia resident
• have a valid Nova Scotia Health Card (MSI)
• Are under the age of 65 years
• Have a confirmed diagnosis of diabetes
• Agree to a family income verification through Canada Revenue Agency (Notice of Assessment) each year
• Agree to provide family size information each year
• Do not have drug coverage through Veterans Affairs Canada, NIHB, or any other drug insurance plan that covers medications and supplies for diabetes
• Agree to provide information about your diabetes when you re-enrol

 

Do I need a Nova Scotia Health Card (MSI) to re-enrol?

Yes, you have to apply for and receive a Nova Scotia Health Card before you can re-enrol with the Nova Scotia Diabetes Assistance Program. Only people with a valid Nova Scotia Health Card can receive benefits from the Nova Scotia Diabetes Assistance Program.

For more information on obtaining a Nova Scotia Health Card go to MSI site.

 

Cost

How much does it cost to receive benefits through the Nova Scotia Diabetes Assistance Program?

You pay no up-front fee, or premiums, when you re-enrol with the Nova Scotia Diabetes Assistance Program.

You will be required to pay a deductible and copayment (see next question) when you fill your prescriptions. The amount of your deductible will depend on your family income and the size of your family. The government provides more assistance to families with the greatest need.

 

What is a deductible? How is the Nova Scotia Diabetes Assistance Program deductible calculated?

A deductible is a specific dollar amount that a family must pay out-of-pocket each year before the Nova Scotia Diabetes Assistance Program coverage begins.

The twelve months used for calculating the family deductible starts on April 1st and ends on March 31st of the following year.

The family deductible is calculated based on your family income. To calculate your family deductible go to Nova Scotia Diabetes Assistance Program Calculator .

 

What is a copayment? How is the Nova Scotia Diabetes Assistance Program copayment calculated?

The copayment is the portion of the prescription price you pay to your pharmacy when you have your prescription filled.

The copayment for the Nova Scotia Diabetes Assistance Program is 20% of the prescription price.

You are required to pay 20% of the total cost of each prescription.

The balance of the total will be applied against the annual family deductible. Once your family has paid the total deductible for the year, you will pay only the copayment on your prescriptions.

Sometimes you may have to pay more than the 20% copayment. This could happen if:

• the drugs you are prescribed are not covered by Pharmacare
• you want the brand name drug which is more expensive than the generic
• the drug or supply costs more than the maximum amount Pharmacare will pay

In these situations, you may want to talk to the person who prescribed the medication or your pharmacist about alternative medications that are fully covered by Pharmacare.

 

Are my deductible and my copayment tax - deductible?

Program deductibles and copayments are considered medical expenses for taxation purposes.

For further information, please contact Canada Revenue Agency at 1-800-959-8281.

 

How does my pharmacist know when I meet my deductible?

When you have prescriptions filled at a Nova Scotia pharmacy and you reach your annual deductible, the Nova Scotia Diabetes Assistance Program sends a message to your pharmacy's computer letting them know that your deductible has been reached for the year.

 

Once I re-enrol in the Nova Scotia Diabetes Assistance Program, how do I get my medication?

When you take your prescription to the pharmacy you must present your Nova Scotia Health Card. The part of the prescription that is covered by the Nova Scotia Diabetes Assistance Program is billed directly to the Program.

 

Coverage

What medications are paid for by the Nova Scotia Diabetes Assistance Program?

The Nova Scotia Diabetes Assistance Program pays for certain prescribed drugs and supplies used in the treatment of diabetes which are listed as benefits in the Nova Scotia Formulary. A committee of experts keep the benefit list updated based on the latest evidence. Prescriptions must be filled by a Nova Scotia pharmacy to be paid for by Pharmacare.

For some drugs, your prescriber will need special approval from Pharmacare before you can have the drug paid for by the program. Your prescriber has a list of drugs that need special approval for coverage.

Get more information on Pharmacare benefits.

 

 

Other Programs

Can I switch from the Nova Scotia Diabetes Assistance Program to the Nova Scotia Family Pharmacare Program?

Yes, you can switch from the Nova Scotia Diabetes Assistance Program to the Nova Scotia Family Pharmacare Program. However, you can only switch when it is time to renew your application by April 1 of each year. You cannot switch at any other time during the year.

 

How do I decide which government program is better suited for my needs?

Each program is a little different in how much a person is required to pay and what drugs and supplies are covered as benefits under the Nova Scotia Diabetes Assistance Program, the Nova Scotia Seniors' Pharmacare Program, and the Nova Scotia Family Pharmacare Program.

Eligibility differs, too. You can look at each Pharmacare Program to see if you are eligible.

If you are eligible for more than one program, you must decide which program works better for your circumstances. Look at your current family income along with your drug-related expenses and decide what plan will work best for you.

Not all drug programs will benefit everyone and therefore the Department of Health provides you with all the information you need to make an informed decision that is best for you and your family. For information on specific programs, please refer to www.nspharmacare.ca

 

Other Questions

What happens if I forget my card and have to pay for my prescription?

If you forget your card, you will have to pay for the prescription at the pharmacy. You can then get reimbursed for the portion the Nova Scotia Diabetes Assistance Program would have paid.

To do this, you must send original receipts to the Nova Scotia Diabetes Assistance Program within six months of the purchase. If received after six months, receipts will not be considered for reimbursement.

To avoid processing delays, submit original receipts with a completed reimbursement form .

 

What if I travel outside Nova Scotia?

Be sure to take enough medication and supplies for your trip, plus extra in case of delays. Prescriptions filled at a pharmacy outside Nova Scotia , but inside Canada , will be reimbursed in medical emergencies only. Outside of Canada , there is no reimbursement. We recommend that you purchase health insurance before you depart on your trip.