Nova Scotia Family Pharmacare Q & A

Questions and Answers

 

Program Information

What is the Nova Scotia Family Pharmacare Program?

The Nova Scotia Family Pharmacare Program is a provincial drug plan that helps Nova Scotia families with the cost of their prescription drugs. The program is designed to assist Nova Scotians who do not have drug coverage or, find the high drug cost a financial burden.

 

Eligibility

Who is eligible to register for the Nova Scotia Family Pharmacare Program?

You may register for this Program if you:

• are a permanent Nova Scotia resident AND
• have a valid Nova Scotia Health Card (MSI)

 

Is anyone NOT eligible to register for the Nova Scotia Family Pharmacare Program?

You are not eligible to register if you are currently receiving drug coverage through:

• the Nova Scotia Seniors' Pharmacare Program
• the Nova Scotia Diabetes Assistance Program
• a long-term care facility
• any Department of Community Services Pharmacare Benefits

However, you can switch between programs (see Other Programs section of this Q & A). You can only be enrolled in one of these programs at any time.

 

Do I need a Nova Scotia Health Card (MSI) to register?

Yes, you have to apply for and receive a Nova Scotia Health Card before you can register with the Nova Scotia Family Pharmacare Program. Only people with a valid Nova Scotia Health Card can receive benefits from the Nova Scotia Family Pharmacare Program.

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

 

Enrollment

If I have private drug coverage, can I still register with the Nova Scotia Family Pharmacare Program?

Yes, you can still register with the Nova Scotia Family Pharmacare Program if you have private insurance.

The Nova Scotia Family Pharmacare Program is the payer of last resort. This means that your private insurance would be the first to pay the claim. Some private drug plans will require you to pay a portion of the cost of each prescription. These ‘out-of-pocket' expenses are commonly known as deductibles or copayments.

If the drug is a Family Pharmacare benefit, any portion unpaid by your private insurance would count towards your Family Pharmacare deductible and a portion of it may be paid for once the deductible has been met.

 

How do I register for the Nova Scotia Family Pharmacare Program?

Complete a registration form and mail or fax it to

Nova Scotia Family Pharmacare Program
Nova Scotia Pharmacare Programs
PO Box 9322
Halifax NS , B3K 6A1
Fax: (902) 468-9402

Get a copy of the Nova Scotia Family Pharmacare Program Registration Form (PDF).

Does each person register individually or can you register as a family?

You must register as a family. Each family is required to complete only one registration form. A family could be:

• a single adult (18 years of age or older)
• an adult and spouse
• an adult and all children under 18 years of age OR
• an adult, spouse, and all children under 18 years of age

 

Do I have to include all of my family members on the registration form?

Yes, you must include all family members on the Nova Scotia Family Pharmacare Program registration form. Do this even if the family member is receiving benefits from another government drug program, such as the Seniors' Pharmacare or Diabetes Assistance Program. Each family member registered will decrease your family deductible.

 

What if I am older than 18 years of age and still live at home with my parents?

At the age of 18 you must register as your own family, even if you still live at home. You can no longer register with your mother, father, or both. Two or more families registered under the Nova Scotia Family Pharmacare Program can live at the same address.

 

On the registration form it asks for one member of the family to be the family applicant. Who should be the family applicant?

The family applicant must be an adult. The family applicant will receive all correspondence relating to the program.

 

Privacy

Will the family applicant have access to all medication records?

No. The medication record for each person is kept confidential. It is not shared with the family applicant. Information regarding each individual will not be disclosed at any time.

 

Why do I have to provide my Social Insurance Number (SIN) on the form?

To calculate your family's deductible and maximum annual copayment, the Nova Scotia Department of Health must verify your income with the Canada Revenue Agency. To verify your income, the Nova Scotia Department of Health must have your Social Insurance Number (SIN).

This information will be used solely to determine and verify eligibility for the Nova Scotia Family Pharmacare Program. It will not be disclosed to anyone.

 

Cost

How much does it cost to receive benefits through the Nova Scotia Family Pharmacare Program?

You pay no up-front fee, or premiums, when you register with the Nova Scotia Family Pharmacare Program.

You will be required to pay a deductible and copayment (see next two questions) when you fill your prescriptions. The amount of your deductible and copayment 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 Family Pharmacare Program deductible calculated?

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

The "year" 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 Family Pharmacare Calculator.

What is a copayment? How is the Nova Scotia Family Pharmacare 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 Family Pharmacare 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:

• 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

Note: If the drugs you are prescribed are not covered by Pharmacare, you will be responsible for the entire cost of those drugs and the amount you pay will not be applied towards your deductible or copayment under Family Pharmacare.

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 Pharmacare.

To assist families with very high drug costs, the annual maximum family copayment is based on your family's income. Once your family reaches the annual maximum copayment, the government will pay for 100 per cent of drug costs that are benefits under the Nova Scotia Family Pharmacare Program.

You can contact the Pharmacare office to find out what your copayment annual maximum is and to get your copayment balance anytime during the year.

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 Family Pharmacare Program sends a message to your pharmacy's computer letting them know that your deductible has been reached for the year.

 

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.

 

If I join the Nova Scotia Family Pharmacare Program part way through the year, will my deductible and copayment maximums be adjusted or pro-rated?

No, your annual deductible and maximum annual copayment are the same for the year no matter when you join. The program runs from April 1st to March 31st each year.

 

If I believe that my annual family income is actually lower than what is used to determine my deductible and copayment maximums for the year, is it possible to have them reassessed?

If, at the time of registration or renewal into the Program, you believe that your total family income (as indicated in Line 150 of the Canada Revenue Agency's Notice of Assessment for each family member) does not accurately reflect what your annual family income may be, you can request a reassessment of your deductible and copayment maximums. You may be asked to submit bank statements for up to three months, pay stubs, or other documents in order for a reassessment to be completed.

 

If my annual family income decreases during a coverage period, is it possible to have my deductible and copayment maximums reassessed?

Special consideration will be given to reassessment of your deductible and copayment maximums if, during a coverage period, it is clearly documented that your annual family income has decreased by 20% or more. You may be asked to submit bank statements for up to three months, pay stubs, or other documents in order for a reassessment to be completed.

 

Once I join the Nova Scotia Family Pharmacare Program, how do I get my medication?

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

 

 

Coverage

The Nova Scotia Family Pharmacare Program pays for certain prescribed drugs and supplies 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 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.

 

How do I submit a claim to Nova Scotia Family Pharmacare for the amount not covered under my private drug coverage?

If your pharmacy is able to bill your private insurance company online through their computer, the pharmacy can add your Family Pharmacare information to their computer and bill it online as well.

This is called coordination of benefits . Ask your pharmacy if you are able to have coordination of benefits between the two drug plans.

If your pharmacy is unable to bill your private insurance company online, then you must submit your receipt to the Family Pharmacare Program.

The amount you would submit is the portion you paid out-of-pocket after your private insurance company paid. You need to submit a photocopy of the original receipt (the original must be sent to your private insurance company) along with the private insurance company's explanation of benefits that they send back to you.

Example:
Mr. Smith's prescription costs: $100
Private insurance pays: $80
Mr. Smith's copayment: $20

This copayment from the private insurance company is sent to Family Pharmacare: Amount sent to Family Pharmacare for reimbursement: $20 Copayment: $4 (20% of $20)

The remaining $16 is either

• applied towards Mr. Smith's deductible-Mr. Smith's total out-of-pocket expense for this prescription would be $20
  
  OR
• paid by Family Pharmacare if Mr. Smith's deductible has been reached - Mr. Smith's out of pocket expense for this prescription would then be $4.

 

Other Programs

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

Yes, you can switch back and forth between the Diabetes Assistance Program and the Family Pharmacare Program. However, you can only switch when it is time to renew your application - April 1 of each year. You cannot switch at any other time during the year.

 

Can I switch from the Nova Scotia Seniors' Pharmacare Program to the Nova Scotia Family Pharmacare Program?

Yes, you can switch back and forth between the Seniors' and Family Pharmacare Programs. However, you can only switch when it is time to renew your application - April 1 of each year. You cannot switch at any other time during the year.

 

Can I switch from the Department of Community Services Pharmacare benefits - Income Assistance, LIPC, Special Drug Needs, Services for Persons with Disability - to the Nova Scotia Family Pharmacare Program?

Yes. You can switch at any time and as often as needed throughout the year. However, most Pharmacare Benefits under the Department of Community Services result in less out-of-pocket expenses for the client when compared to Family Pharmacare.

Once your medications are no longer covered under the Department of Community Services, you can register with Family Pharmacare. After you register, the switch from Department of Community Services to Family Pharmacare happens automatically.

 

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

Each of the three programs is a little different in how much a person is required to pay and what drugs and supplies are covered as benefits - 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.gov.ns.ca/health/pharmacare.

 

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 Family Pharmacare would have paid.

To do this, you must send original receipts to the Family 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 (MSI)

 

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.