Family Pharmacare Program - FAQ

Nova Scotia Pharmacare

Family Pharmacare Program 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 if the cost of the prescription drugs becomes a financial burden to them.

Eligibility

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

You may register for this Program if you:

  • are a Nova Scotia resident, and
  • have a valid Nova Scotia Health Card

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
  • the under 65-Long Term Care Pharmacare Plan
  • 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, go to the Nova Scotia Health Card page.

Application

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. It is important that you let your pharmacy know you have both private insurance and Family Pharmacare so they can coordinate benefits between the two insurances.

The Nova Scotia Family Pharmacare Program is the payer of last resort. This means that your private insurance would be the first to pay any claim. Any portion unpaid by your private insurance would then be sent to Family Pharmacare for coverage.

How do I apply 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 500
Halifax NS , B3J 2S1
Fax: (902) 468-9402

You may also call 902-496-5667 or 1-877-330-0323 for additional copies of the Registration Form.

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 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 maximum annual deductible and maximum annual copayment amounts, the Nova Scotia Department of Health and Wellness must verify your income with the Canada Revenue Agency. To verify your income, the Department 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.

The Program will calculate your family's maximum annual deductible and maximum annual copayment amounts which will depend on your family income and the size of your family.

When you fill your prescriptions, you will be required to pay a deductible and copayment (see next two questions). 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.

Your maximum annual family deductible is calculated based on your family income and the size of your family. The "year" used for calculating this deductible amount starts on April 1st and ends on March 31st of the following year. To calculate an estimate of your maximum annual family deductible, go to the Family Pharmacare Calculator.

What is a copayment? How is the Nova Scotia Family Pharmacare Program copayment calculated?

A 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 until you reach your maximum annual family copayment amount.

Your maximum annual family copayment is calculated based on your family income and the size of your family. The "year" used for calculating this copayment amount starts on April 1st and ends on March 31st of the following year. To calculate an estimate of your maximum annual family copayment, go to the Family Pharmacare Calculator.

How are the deductible and copayment amounts applied when I fill a prescription?

The first 20 percent of every prescription is applied towards your maximum annual copayment amount. The remaining 80 percent of the total will be applied against your maximum annual deductible amount.

When your maximum annual deductible amount is paid, you will continue to pay 20 percent per prescription until your maximum annual copayment amount is also paid in full.

When you have paid both the maximum annual deductible and copayment amounts in full, Family Pharmacare will pay the approved cost of your medications that are covered under the Program until the end of the Program year, which is March 31st. You can contact the Pharmacare office for your deductible and copayment balance at any time.

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.

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. Your pharmacy can provide you with more information on your out-of-pocket prescription expenses.

For further information on how to claim these expenses, 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

What benefits are covered?

The Nova Scotia Family Pharmacare Program helps pay for certain prescribed drugs and devices dispensed by pharmacies in Nova Scotia, as well as for some related services. Drugs and devices 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.

Please see Pharmacare Benefits and Reimbursement for more information.

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.

Other Programs

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

Yes, if you are enrolled in Seniors’ Pharmacare, you can switch to Family Pharmacare but only when it is time to renew your application – April 1 of each year. Please be aware that beneficiaries enrolled in Seniors’ Pharmacare who leave for any reason and then decide to rejoin at a later date may have to pay a late entry penalty.

Can I switch from Department of Community Services Pharmacare Benefits 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 covered under the Department of Community Services result in lower 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 Pharmacare Program differs in terms of eligibility, how much a person is required to pay, and what drugs, devices, and related services are covered as benefits.

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.

If you have further questions or require additional information to help you decide what program is best for you, please call Pharmacare at 902-429-6565 or 1-800-544-6191.

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

What if I travel outside Nova Scotia?

If you plan to travel outside the province, you must make sure you have enough medication and supplies for your trip. We recommend you purchase health insurance before you depart. The Family Pharmacare Program will not pay for prescriptions filled in a pharmacy outside Nova Scotia. Exceptions may be considered on a case by case basis. For prescriptions filled outside of Canada, there is no reimbursement, emergency or otherwise.