Seniors' Pharmacare Q & A

Questions and Answers

 

Program Information

What is the Nova Scotia Seniors' Pharmacare Program?

The Nova Scotia Seniors' Pharmacare Program is a provincial drug insurance plan that helps seniors with the cost of their prescription drugs.

What's New?

There are no fee increases this year.

Eligibility

Who is eligible?

You are eligible to join the program if you:

• have a valid Nova Scotia Health Card (If you are a new resident of Nova Scotia , you have to apply for a Nova Scotia Health Card before applying to the Program.)
• are at least 65 years old
• do not have drug coverage through Veterans Affairs Canada, Non-Insured Health Benefits, Nova Scotia Family Pharmacare, or any other public or private plan that covers most of your medications and supplies after age 65.

What if I am a Public Service Health Care Plan (PSHCP) member?

PSHCP provides drug coverage to its Nova Scotia members who do not receive the Guaranteed Income Supplement (GIS). If you are a PSHCP member and receive the GIS, the Seniors' Pharmacare Program provides your drug coverage.

 

What if I have private or other public drug coverage?

If you have private or other public drug coverage, you are not eligible to join the Seniors' Pharmacare Program. However, if that coverage ends for any reason and you provide proof that you had other drug coverage since turning 65, the late entry penalty does not apply. You should contact the Seniors' Pharmacare Program immediately if your drug coverage ends to avoid the late entry penalty.

Note: Some private insurance companies reduce coverage for people once they turn 65. Please check with your private drug plan to see if your coverage has been reduced to help you make the decision that is right for you.

 

Once I have joined the Seniors' Pharmacare Program, how do I get my medications?

If you join the Seniors' Pharmacare Program, your coverage will start on the first day of the month of your 65th birthday. When you take your prescriptions to the pharmacy you must show your Nova Scotia Health Card. The part of the prescription cost that is covered by the Seniors' Pharmacare Program is billed directly to the Program.

 

Enrollment

Who is eligible?

If you are a Nova Scotia resident, you will receive a Seniors' Pharmacare Program information package two to three months before you turn 65. If you wish to join the Seniors' Pharmacare Program, you must return the completed application within 90 days of the first day of the month of your 65 th birthday.

If you just moved to Nova Scotia , you have to apply for and receive a Nova Scotia Health Card before you can apply for the Seniors' Pharmacare Program.

What if I do not apply when I am Eligible?

If you do not apply for Seniors' Pharmacare Program coverage within 90 days of the first day of the month of your 65 th birthday; or if you decide to leave the Program but then want to join again later, you may have to pay a late entry penalty. This means you:

• Must wait 90 days for your coverage to start once you are accepted into the Seniors' Pharmacare Program; and
• Must pay one and a half times the premium for your coverage for five (5) years.

As a new resident to Nova Scotia , you will not be charged the late entry penalty if you are applying to the Program after turning age 65.

 

Cost

What does the Program cost me?

Seniors contribute to the Seniors' Pharmacare Program in two ways - through a "premium" and a "copayment".

The premium is the fee you must pay each year to join the Seniors' Pharmacare Program. Some seniors may have their premium reduced or waived entirely depending on their income level, or if they receive the Guaranteed Income Supplement (GIS).

The "copayment" is the portion of the prescription cost that you must pay each time you have a prescription filled at the pharmacy.

 

How much premium do I have to pay?

When you enroll, your premium will be calculated based on your income and the number of months remaining in the program year (April 01 - March 31). Currently, the maximum annual premium a senior would pay is $424.

If you receive the Guaranteed Income Supplement (GIS), you do not have to pay a premium, unless you have an outstanding balance from the previous year. An outstanding balance would appear on your Seniors' Pharmacare statement. Pharmacare will contact Human Resources and Social Development Canada to determine if you receive the Guaranteed Income Supplement. You do not have to contact them to request any information. Pharmacare will do this for you.

If you are single and your income is below $18,000; or, if your income and your spouse's income add up to less than $21,000 you do not have to pay a premium. You may qualify for a reduced premium if you are single and your annual income is less than $24,000; or, if your income and your spouse's annual incomes add up to less than $28,000. Your eligibility for a reduced premium will automatically be determined when the Seniors' Pharmacare Program verifies your income with the Canada Revenue Agency.

Premium for people who apply late:
If you do not apply for the Seniors' Pharmacare Program within 90 days of the date you are eligible, or decide to leave the Program but then want to join again later, you will have to pay a late entry penalty. This means you:

• Have to wait 90 days for your coverage to start once you are accepted into the Seniors' Pharmacare Program; and
• Have to pay one and a half times the premium for your coverage for five (5) years.

 

Why is there a late entry penalty?

The Seniors' Pharmacare Program is a valuable program and the premiums that seniors pay help with the cost of delivering the Program and help keep it sustainable over the years. Without the late-entry requirements, seniors might not join the Program until they need insured drugs. This would not be fair to those seniors who joined at age 65 and have continued to contribute towards the cost of the Program.

To balance the need to be fair to seniors who are in the Program and to ease the burden of late entry penalty on seniors who join late, effective April 2004, the late entry penalty was dropped from a lifetime penalty to five years from the time of joining the Program.

 

How can I pay my premium?

There are two ways to pay your premium:

• Yearly payment can be made by cheque, electronic funds withdrawal from your bank account, Visa or MasterCard.
• Monthly payments can be made by electronic funds withdrawal from your bank account.

 

Can my premium be reimbursed, if requested?

If a senior moves out of the province or dies, premiums will be refunded for any full months prepaid by the senior. The Seniors' Pharmacare Program must be notified in writing within one year of the senior's death or relocation for you to receive a refund.

How much Copayment do I have to pay?

The copayment is the portion of the cost you must pay toward your prescriptions. You are required to pay 30% of the total cost of each prescription. Currently, the annual maximum copayment a senior would pay is $382. Once your copayments reach a total of $382 for the year, the Seniors' Pharmacare Program will pay the full cost of your prescriptions that are covered under the Program until the end of the program year, which is March 31.

Sometimes, you may have to pay more than the $382 annual maximum copayment. This could happen when:

• you want the brand name drug which is more expensive than the generic; or,
• the drug or supply you are prescribed costs more than the maximum amount the Seniors' Pharmacare Program will pay; or
• the drug you are prescribed is not covered by the Seniors' Pharmacare Program. In this case you would be responsible for the entire cost of the prescription.

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

Note: The additional amount you pay for these prescriptions does not count toward reaching your annual maximum copayment.

You can contact the Seniors' Pharmacare Program office to get your copayment balance anytime during the year by calling 429-6565 or toll free 1-800-544-6191. You can also inquire by email at SeniorsPharmacare@medavie.bluecross.ca

How can I pay my Copayment?

Seniors have the option to pay the 30% copayment on every prescription to the pharmacy at the time of purchase; or, to pay the $382 annual maximum copayment directly to the Senior's Pharmacare Program.

If you do not pay a premium, and wish to pay the $382 annual maximum copayment directly to the Seniors' Pharmacare Program, you must complete the Copayment Options Form to indicate your payment method and schedule.

If you pay a premium and choose to pay the $382 annual maximum copayment directly to the Seniors Pharmacare Program, you must also complete the Copayment Options Form, and use the same payment method as you use to pay your premiums. For example, if you pay your premiums on a monthly basis, you must pay your copayments on a monthly basis.

Note: If you choose to pay the annual maximum copayment of $382 for the program year, you will not be reimbursed any portion of the $382 that you do not use in the year. You should review your prescription costs from last year to help choose the option that works best for you.

 

Can I be reimbursed for copayments paid under my private insurance?

If you have private or other public drug coverage, you are not eligible to join the Seniors' Pharmacare Program. However, you can have certain costs reimbursed through the Seniors' Pharmacare Program. If you paid copayments to your drug insurance that add up to more than $806 (maximum premium of $424 plus maximum annual copayment of $382 under the Seniors' Pharmacare Program), you can apply to have the difference reimbursed. You do not have to be enrolled in the Seniors' Pharmacare Program to be reimbursed for those costs.

To be reimbursed, you must send the original receipts or a statement confirming your prescription receipts from your private insurance plan, to the Seniors' Pharmacare Program. Please include your name, Health Card number, phone number and address so the reimbursement can be processed as quickly as possible. For more information on how to apply for reimbursements, please call 429-6565 or toll free 1-800-544-6191.

You can also inquire by email at SeniorsPharmacare@medavie.bluecross.ca

 

Are my premiums and my copayments tax-deductible?

Program premiums and copayments are considered medical expenses for taxation purposes. For further information, please contact Canada Revenue Agency at 1-800-959-8281. Tax receipts for the previous calendar year are sent to seniors in January.

 

Coverage

What Benefits are covered?

The Nova Scotia Seniors' Pharmacare Program pays for certain prescribed drugs, supplies, and related services dispensed by pharmacies in Nova Scotia . Drugs and supplies covered by the program are listed in the Nova Scotia Formulary . A committee of experts keeps the list up-to-date based on the latest evidence.

For some drugs, your prescriber will need to obtain special approval from the Seniors' Pharmacare Program to have the drug covered. Our customer service representatives, your prescriber, or your pharmacist can answer questions about this process.

For more information on Pharmacare benefits read Q&A about Pharmacare Benefits and Reimbursement.

 

 

Other Programs

Can a person over the age of 65 enroll in both the Seniors' Pharmacare Program and the Nova Scotia Family Pharmacare Program?

No, a person over the age of 65 must choose between the two programs as they cannot be enrolled in both at the same time.

If a person over the age of 65 decides to enroll in the Family Pharmacare Program instead of the Seniors' Pharmacare Program, can that person switch to the Seniors' Pharmacare Program later in life if they become sick and have more drug costs?

Yes, a person enrolled in the Family Pharmacare Program can switch to the Seniors' Pharmacare Program. However, this switch can only take place at application renewal time (April 1st of the year).

 

Other Questions

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

If you forget your Nova Scotia Health Card, you will have to pay for the prescription at the pharmacy. You can then get reimbursed for the portion the Seniors' Pharmacare Program would have paid.

To do this, you must send the original receipt to the Seniors' Pharmacare Program within six months of the purchase. If received after six months, receipts will not be considered for reimbursement.

To avoid processing delays, include your:

• name
• address
• phone number
• Nova Scotia Health Card number

 

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. There is no reimbursement, emergency or otherwise, for prescriptions filled outside Canada . We recommend that you purchase health insurance before you depart on your trip.