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June 6, 2003
Fair Pharmacare arrives
The new provincial drug plan is based on income.
CYNTHIA RAMSAY SPECIAL TO THE JEWISH BULLETIN
On May 1, 2003, the provincial drug program changed dramatically.
The old Pharmacare plan had fixed deductibles and covered all British
Columbians. Under the new plan, called Fair Pharmacare, coverage
is based on a family's income and British Columbians must register
in order to receive any benefits. For those of you who are confused
as to how Fair Pharmacare works and how the changes will affect
you, here is an overview.
What is PharmaCare?
PharmaCare, which began operations in 1974, is a provincially funded
program that provides financial assistance to B.C. residents for
certain prescription drugs and medical supplies.
The drug plan covers medications prescribed by a physician, surgeon,
dentist, midwife or podiatrist that have been designated as approved
PharmaCare benefits; insulin, needles and syringes for people with
diabetes; certain ostomy supplies; and designated permanent prosthetic
appliances and children's orthotic devices (braces).
It does not cover drugs prescribed by a physician, dentist, midwife
or podiatrist that have not been approved as benefits; herbal medicine
products; antacids, laxatives and other over-the-counter drugs;
artificial sweeteners; bandages; eyeglasses; hearing aids or hearing
aid batteries; wheelchairs, walkers and other medical devices; drug
costs that have been fully reimbursed by another insurer; drugs
or supplies obtained while outside of British Columbia; drugs prescribed
by a veterinarian; or mail-order prescriptions requested from companies
located outside the province.
As well, if you move away from British Columbia, your PharmaCare
coverage ends the day you leave the province. And PharmaCare does
not pay for vacation supplies of medications or for repeat prescriptions
required by patients for an extended absence from the province.
Medications to treat cancer are provided through the British Columbia
Cancer Agency and associated hospital pharmacies. Medications for
treating transplant patients are provided through the British Columbia
Transplant Society. Medications for treating kidney dialysis patients
are provided through the B.C. Renal Agency.
Meet Fair PharmaCare
Previously, for the basic Pharmacare plan, the deductible was a
flat $1,000. Under Fair Pharmacare, the lower your income, the more
assistance the government will provide toward your prescription
drug costs. According to the government, under the new approach,
up to 280,000 families will pay less than they did before the changes
were implemented.
In addition to providing what they call fair access to prescription
drugs, the government hopes to save money by only subsidizing those
people with lower incomes. Over the last decade, PharmaCare costs
increased by 147 per cent and they are projected to grow by 487
per cent over the next two decades.
To be eligible for Fair PharmaCare financial assistance, you must
be a resident of British Columbia for at least three months, be
registered with the Medical Services Plan of British Columbia and
have filed an income tax return for the relevant taxation year.
Once your registration with Fair PharmaCare has been processed,
a temporary deductible is established for you. A letter confirming
this deductible is then sent to you once your income information
has been verified with the Canada Customs and Revenue Agency. The
government warns that this verification process may take several
months.
As in the past, under the new plan, families pay their full prescription
drug costs until they reach their deductible, which is based on
a family's net income. Once the deductible is reached, PharmaCare
assists families in paying for their eligible drug costs for the
remainder of the year.
Each time you have a prescription filled, PharmaNet – a computerized,
province-wide database – advises your pharmacist about your
Fair PharmaCare coverage. For seniors who are 65 years or older,
the program pays 75 per cent of the cost of a prescription, once
the deductible is reached. For families who are non-seniors, it
pays 70 per cent of the family's drug costs for the year, once they
have reached their deductible. Once the family maximum has been
reached, Fair PharmaCare covers 100 per cent of the family's eligible
drug costs for the remainder of the year.
Any amounts that a family has paid for eligible prescription costs
between Jan. 1, 2003, and May 1, 2003, when Fair PharmaCare began,
will count towards your new deductible. If you have already exceeded
your deductible, PharmaCare will be contributing to your prescriptions
immediately.
If you have an extended health plan that covers some of your prescription
drug costs, you should contact your insurer to find out what, if
any, changes there may be in your extended health coverage.
In addition to Fair PharmaCare, British Columbians will continue
to have access to the same coverage under the following plans:
1. Plan B – Permanent residents of licensed long-term care
facilities.
2. Plan C – People receiving financial assistance from the
provincial government.
3. Plan D – Individuals registered with a provincial cystic
fibrosis clinic.
4. Plan F – Children eligible for medical or full financial
assistance through the At Home Program of the Ministry for Children
and Family Development.
5. Plan G – People eligible for financial assistance through
mental health centres.
6. Patients eligible for financial assistance under the Palliative
Care Drug Plan.
However, many of these plans now require registration for additional
financial assistance for the drugs not included in the plans.
The change to Fair Pharmacare should not not affect drugs provided
through the B.C. Cancer Agency, the B.C. Centre for Excellence in
HIV/AIDS, the B.C. Renal Agency or the B.C. Transplant Society.
Income information
You must register for Fair PharmaCare as a family. If you do not
wish to register, you will not be eligible to receive the maximum
financial assistance. As well, your spouse will also not be able
to register.
The level of financial assistance provided by the government for
2003 will be based on the income you reported to the Canada Customs
and Revenue Agency in 2001. In subsequent years, the relevant tax
year will be that from two years previous. For example, your 2002
income will be used to determine your level of financial assistance
for 2004.
Each year, your income will be taken from your filed income tax
return and any required adjustments to your Pharmacare coverage
will be made. The government is able to do this because of the consent
form that applicants must sign. This consent allows PharmaCare to
collect and use the following information from your tax form: line
236 (net income), line 303 (married amount) and the GST/HST credit
application. The agency is only permitted to use this information
to determine a family's level of financial assistance.
If your family income changes by 10 per cent or more after you have
registered for Fair PharmaCare, you can ask that your file be reviewed.
Before the government will make any adjustments, you must provide
them with documentation for the year in question, such as a record
of employment, letter from your employer, copy of Employment Insurance
payments or Canadian Pension Plan payments.
To apply for an income review, send the necessary information and
documentation to: PharmaCare, Administrative Review, P.O. Box 9658,
Stn Prov Govt, Victoria, B.C., V8W 9P5.
Pharmacare registration
The initial registration deadline of May 1 has been extended indefinitely.
To register, you need B.C. CareCard numbers for you and, if applicable,
your spouse and dependent children; 2001 net family income for you
and, if applicable, your spouse; social insurance numbers for you
and your spouse; birthdates for you, your spouse and dependent children.
You can register by phone at 800-387-4977 or online at https://pharmacare.moh.hnet.bc.ca.
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