Pension Life - Summer 2023
BC PharmaCare – what you need to know
With health care costs climbing, now is the time to ensure you have explored all the paths to savings. One of those paths is BC PharmaCare, which helps BC residents pay for many prescription drugs, dispensing fees and some medical devices and supplies. We are taking this opportunity to provide a refresher on how it works and integrates with your GreenShield (GSC) health benefits plan.
BC PharmaCare – what you need to know
- The level of financial support PharmaCare provides is based on family income: the less a family earns, the more help they get. It is important to register with Fair PharmaCare to allow PharmaCare to access your income information from the Canada Revenue Agency (CRA) because your coverage is based on net income information from 2 years prior.
- PharmaCare uses your family net income to calculate your deductible which is the amount you and your family need to spend each year on eligible drug costs before PharmaCare starts to help with these costs. Once your family reaches their deductible, PharmaCare pays 70% of eligible costs, or 75% of eligible costs for families with at least one registrant born before 1940 for the rest of the year. The deductible amount is approximately 3–4% of your family net income. There is no deductible for household incomes $30,000 and less for individuals born 1940 and later and no deductible for household incomes $33,000 and less for those born before 1940.
- Once your family reaches their family maximum (the established upper limit for out-of-pocket eligible costs per year), PharmaCare will pay 100% of eligible costs for the rest of the year.
- The PharmaCare drug formulary is a comprehensive list of drugs that are commonly prescribed; however, it does not include all prescription drugs that your doctor can prescribe. This means that some of your drug claims may not be eligible to help you reach your PharmaCare deductible.
How GSC connects with BC Pharmacare – what you need to know
- GSC’s extended health benefits are fully integrated with PharmaCare. The plan pays your PharmaCare deductible which is the portion of your family’s eligible health care costs not covered by PharmaCare.
- There’s one extra layer to keep in mind. Your extended health plan also has a $250 annual deductible unrelated to BC PharmaCare’s deductible that is applied to most health claims (excluding auto injector, insulin gun, insulin pen injector, Hearing Care and Vision). The deductible is the amount that must be paid by you and/or your dependent(s) in any calendar year before an eligible expense will be reimbursed.
- Once the annual health deductible for your GSC plan is satisfied, eligible health and drug expenses are reimbursed at 80% of the eligible cost (90% for drugs dispensed at Costco Pharmacy) until $1,000 of paid claims (combined with other Health claims) under the Plan is reached. Once $1,000 in paid eligible health expenses is reached, the Plan’s reimbursement increases to 100%.
How you can use BC PharmaCare to help reduce drug costs for you and your plan
- Make sure you register for Fair PharmaCare to allow PharmaCare to set your deductible based on your family income.
- Ask your physician to prescribe you a drug covered by BC PharmaCare.
- If your drug is higher cost, it will likely require Special Authority approval before it is covered by BC PharmaCare. Ask your physician to apply to BC PharmaCare for Specialty Authority approval on your behalf. By securing approval from BC PharmaCare, significant savings can be achieved for both you and your health benefits plan.
GreenShield (GSC) provides retired plan members access to optional extended health care and dental coverage. For more information on your plan coverage or online services, please contact GSC directly at 1-888-711-1119.