Pharmacare

Question 1

What is Plan I?

Answer 1

fair pharmacare

• income-based, most BC residents
• covers many prescription drugs, some medical devices and supplies

Question 2

What is Plan B?

Answer 2

permanent residents of licensed residential care facilities

• 100% coverage of eligible prescription drugs and medical supplies

Question 3

What is Plan C?

Answer 3

receiving income assistance through the Ministry of Social Development and Poverty Reduction

• 100% coverage of eligible prescription costs

Question 4

What is Plan D?

Answer 4

registered with a provincial cystic fibrosis clinic

• covers digestive enzymes, nutritional supplements and vitamins, hypertonic saline solutions

Question 5

What is Plan F?

Answer 5

children receiving assistance (At Home Program)

• drugs plus prosthetics and orthtotics, needles and syringes, continuous glucose monitors and blood glucose test strips, insulin pump supplies, ostomy supplies

Question 6

What is Plan G?

Answer 6

mental health clients for whom medication costs are a barrier to treatment

• medications listed in Plan G formulary (ie. psychiatric medications and drugs to treat opioid use disorder)

Question 7

What is Plan P?

Answer 7

palliative care (at home)

• medications listed in Plan P formulary – ie. analgesics, anticoagulants and coagulants, anticonvulsants, antidiarrheals, antiemetics, anti-infectives, antipruritics, antispasmodics, bone metabolism regulators, central nervous system stimulants, congestive heart failure therapy, diabetic agents, diuretics, H2 blockers and proton pump inhibitors, hemorrhoid therapy (ointment and suppositories), laxatives, psychiatric medication, respiratory system therapy, steroids, wound care, other)

Question 8

What is Plan W?

Answer 8

First Nations health benefits plan (provincial)

• not income-based
• no deductibles
• no family maximums
• covers prescription drugs
• covers some OTC supplies (ie. lancets, blood and urine ketone strips, alcohol wipes/pads, inhaler spacers, needles and syringes (not restricted to those for insulin injection), intrauterine devices (IUDs)
• covers some OTC drugs with a prescription or recommendation from pharmacist (ie. analgesics, topical antibiotics, laxatives, vitamins, antidiarrheals, antihistamines, lice treatment)

Question 9

What is Plan Z?

Answer 9

provides full coverage for all BC residents with active Medical Services Plan (MSP) coverage, for any drug on the Plan Z formulary

• ie. mifegymiso® (mifepristone/misoprostol), contraceptives, opioid agonist treatment (OAT), paxlovid® (nirmatrelvir/ritonavir), TPOXX® (tecovirimat), and medical assistance in dying (MAiD) medications

Question 10

Coverage for families with at least one registrant born before 1940:

Question 11

How much does pharmacare and the patient pay?

Answer 11

• pharmacare: 0%
• patient: 100%

Question 12

How much does pharmacare and the patient pay when the deductible is reached?

Answer 12

regular:

• pharmacare: 70%
• patient: 30%

enhanced:

• pharmacare: 75%
• patient: 25%

Question 13

How much does pharmacare and the patient pay when the maximum is reached?

Answer 13

• pharmacare: 100%
• patient: 0%

Question 14

What is the LCA program?

Answer 14

brand vs. generic

Question 15

What is the RDP program?

Answer 15

different drugs within the same therapeutic class

Question 16

What is the RDP price?

Answer 16

$/30 days

Question 17

How do you calculate the amount that will be credited towards the client’s family deductible if they have not yet reached their deductible?

Answer 17

• determine LCA price ($/mL)
• pharmacare’s maximum allowable fee ($10)
• determine cost for drug based on LCA unit price
• add together

Question 18

How do you calculate the amount that pharmacare will pay the pharmacy if the deductible has been reached?

Answer 18

• determine LCA price ($/mL)
• pharmacare’s maximum allowable fee ($10)
• determine cost for drug based on LCA unit price
• add together
• determine 70% of this cost

Question 19

How do you calculate the amount that will be credited towards the client’s family deductible if the deductible has been reached?

Answer 19

• determine LCA price ($/mL)
• pharmacare’s maximum allowable fee ($10)
• determine cost for drug based on LCA unit price
• add together
• determine 30% of this cost