What is Pharmacare?

Broadly, Pharmacare is an insurance program to help eligible Canadians with the cost of prescription medication. There is no Canada-wide Pharmacare program (although a national solution continues to be discussed.) Nova Scotia, New Brunswick, Newfoundland, and Prince Edward Island all have established Pharmacare programs. They vary a bit between provinces.

Who is Eligible for Pharmacare?

For all Atlantic provinces, to be eligible for program benefits you must:

  • Be a resident of that province
  • Be aged 65 or over

In NB, PEI, and NS you must have a valid provincial Health Card. Newfoundland and Labrador makes no mention of a health card, but states that you must receive GIS and OAS.

Enrolling in the Program

In Nova Scotia and New Brunswick, if you have a valid Health Card, you’ll be mailed a program information and enrolment package before your 65th birthday (about 90 days in NS, 60 days in NB). In Prince Edward Island and Newfoundland and Labrador a drug card is sent to you automatically when you turn 65 and start to receive Federal Guaranteed Income Supplement (GIS) and Old Age Security (OAS).

If you’re a senior who doesn’t receive the GIS from Employment and Social Development Canada, but your income falls below a certain amount may be eligible for coverage under the New Brunswick Prescription Drug Program (NBPDP). Alternatively, you can enrol in the New Brunswick Drug Plan, an income-based plan that covers uninsured New Brunswickers, including seniors.

Can You Have Private Health Insurance Too?

In NB and NS, if you have drug coverage through a group or private plan, you cannot have Pharmacare. However if you lose or cancel the third party drug coverage you can enroll in Pharmacare.

NL and PEI describes their program as a last resort plan. This means that the province will pay when no other third parties will. So you could have private insurance in place, and if they won’t pay and the medication is listed on the provincial formulary, they will.

What is Covered by Pharmacare

The Seniors’ Pharmacare Programs pay for some drugs, devices and medical supplies. You can find a full list of what’s covered in each province’s formulary; there are links at the end. (A formulary is a massive list intended for physicians. It’s easiest to download the list and then search for the name of your medication or device.) Regardless of the drug or province:

  • Both generic and brand name drugs may be covered
  • They must be prescribed by a licensed healthcare professional, such as a doctor, dentist, pharmacist, midwife, optometrist or nurse practitioner
  • The prescription must be filled at a pharmacy in your province

What is Not Covered by Pharmacare in NS, NB, NL, and PEI?

For NS and PEI here is a sample of items that are not covered by provincial Pharmacare.

  • Supportive or physical aids like compression socks or wrist wrap
  • Wound care like bandages and non-prescription ointments
  • Over the counter cough, cold and flu medications
  • Medicated soaps and shampoos
  • Convalescent aids such as a cane, shower support, or feeding cup

The information for NL and NB is hard to come by. Best to check their formularies and see if your needs are listed.

What Does Pharmacare Cost?

Again, this varies by province. In PEI and Newfoundland you’ll still pay pharmacy dispensing fees for each prescription you have filled. In New Brunswick and Nova Scotia you’ll pay an annual premium based on your household income plus a co-pay for each prescription.

Is it Best to Have Pharmacare or Private Health Insurance?

For the most part, these Pharmacare programs only cover prescription drugs. The decision should be based on your unique situation. Here are a few considerations:

  • Are you or your spouse currently on medications and what is their cost?
  • Do you have pre-existing conditions? Does your spouse?
  • How old is your spouse when you turn 65?
  • If your employer benefits expire when you turn 65, what happens to your spouse’s coverage?
  • Do you currently have dental, physio, vision or other healthcare needs?

Perhaps your spouse is a better fit for private insurance. Maybe your medications aren’t covered in your province’s formulary. Maybe you are both in excellent health at the moment.

It’s a comfort to know that most seniors will be eligible for drug benefits offered by their province, for little cost. But prescriptions are a fraction of potential health care expenses. So for most seniors, integration of private insurance with a government drug plan is a reasonable strategy. However, understanding the complexities and fine print requires expertise. It’s also a good idea to not wait until you’re 65 to sort out. Planning health insurance before you retire can be an integral part of your financial plan.

Contact one of our advisors to help navigate these important decisions.

More Pharmacare resources for your province:

Provincial regulations and legislation may have changed since the time of writing. Your province’s website is the most accurate source of information.

Pharmacare or Private Health Insurance for Seniors