"Why isn't this covered?"

Ask the Pharmacist

By Jason E Cridge R.Ph. B.Sc. (Pharm)

Why isn't this covered?” is one of the most common phrases you'll hear at a pharmacy counter. Prescription drug expenditures are growing year after year, and a large portion of those expenditures are coming out of patient's pockets. Pharmacare (the provincial plan), private drug plans (usually through work), and cash payers are the main ways prescriptions are paid for in British Columbia. In this article I hope to shed some more light on how Pharmacare works.

Pharmacare is the provincial drug program and every British Colombian is eligible for coverage. Does this mean that Pharmacare is going to cover every prescription that you fill at a drug store? Absolutely not. In the best interest of the tax paying population there is a panel of experts (pharmacists and physicians) that weigh the pros and cons of each medication to determine whether or not it should be covered. Things that are taken into consideration are cost and effectiveness. If medication A is similar in action and effect to medication B, but medication B costs half as much as medication A; the powers that be will determine that medication B is a better deal for the province, and thus be covered. There will always be "new and improved" medications out there, but since the province doesn't have an infinite amount of money to spend on medication, they carefully choose what they will cover. Unfortunately, that means they probably aren't going to cover your hair regrowth spray or your wrinkle cream, and only medical necessities usually make the cut.

Although everyone is eligible for Pharmacare coverage, you're still required to opt in. Give them a call at 1-866-663-7100, and make sure you've filed your tax return. Pharmacare uses a deductible system based on your income. The reason they do this is to establish need for coverage. If a family makes $100,000 a year, they are expected to shoulder more of the medication cost than a family making $50,000. There are two deductibles for Pharmacare: the annual deductible (1st one) and your family maximum (2nd one). Your annual deductible is calculated as 3% of your net income, and your family maximum is 4% of your net income that year. Using the example of a family that makes $50,000 a year, their annual deductible will be $1500 and their family maximum will be $2000. After they have reached their first deductible, Pharmacare will pay for 70% of their eligible medication costs, and after their family maximum Pharmacare will pay for 100% of eligible medication costs. Eligible is the key word, remember Pharmacare isn’t going to pay for anything they deem medically unnecessary, or when there is a cheaper alternative.

After Pharmacare pays their portion of your prescription, it is then submitted to any third party payer (e.g. Pacific Blue Cross), after that the consumer is expected to pay any difference left over. This is only a snap shot of how Pharmacare works; get your pharmacist to help you get the most out of Pharmacare. Things like low cost alternatives and special authorities will help you save money and make your drug therapy more affordable.

The James Bay Beacon receives monthly contributions from the following pharmacists:

Jason Cridge - Cridge Family Pharmacy
Stefani Tagg - Thrifty Foods Pharmsacy;
and Robert Wojtas - James Bay Pharmasave