Prescription Drug Coverage and PharmaCare Guide for Newcomers in Canada
By WelcomeAide Team
Quick Summary
- Prescription drugs are not fully covered by provincial health insurance in Canada. You may need to pay out of pocket, through employer insurance, or through government drug programs.
- BC PharmaCare Fair PharmaCare is an income-based program that helps BC residents with the cost of eligible prescription drugs once they reach their annual deductible.
- Federal programs like the Non-Insured Health Benefits (NIHB) and the Interim Federal Health Program (IFHP) cover prescription drugs for specific populations.
- Employer-sponsored health benefits are the most common source of prescription drug coverage for working Canadians.
- Choosing generic drugs over brand-name drugs can save you 50% to 80% on prescription costs.
- You can transfer prescriptions between pharmacies in Canada by simply asking your new pharmacy to arrange the transfer.
How Prescription Drug Coverage Works in Canada
Canada's universal healthcare system covers doctor visits and hospital stays, but prescription medications are a different story. Unlike countries with fully public drug coverage, Canada has a patchwork system where prescription drug costs are shared between provincial government programs, employer-sponsored insurance, and out-of-pocket payments by individuals. Understanding how this system works is critical for newcomers, especially if you take medications for chronic conditions or need to fill prescriptions regularly.
When a doctor writes you a prescription, you take it to a pharmacy to be filled. The pharmacist dispenses the medication, and the cost is determined by the drug itself, the pharmacy's dispensing fee, and any applicable markup. Without insurance, a month's supply of a common medication can range from $10 for simple generics to hundreds of dollars for specialty drugs. This is why having some form of drug coverage is so important.
BC PharmaCare Fair PharmaCare
If you live in British Columbia, the Fair PharmaCare program is one of the most important benefits to register for. Fair PharmaCare is an income-based program that helps families and individuals with the cost of eligible prescription drugs, medical devices, and pharmacy services. Unlike employer insurance where you pay premiums, Fair PharmaCare has no monthly premiums. Instead, it uses a deductible and family maximum based on your net household income from your tax return.
How Fair PharmaCare Works
Each year, Fair PharmaCare calculates your deductible and family maximum based on your reported net income. Once you have spent enough on eligible prescription drugs to meet your deductible, PharmaCare begins to cover 70% of eligible costs. After you reach your family maximum, PharmaCare covers 100% of eligible costs for the rest of the year. For low-income families, the deductible can be very low or even zero, meaning coverage kicks in right away. You must be registered with the Medical Services Plan (MSP) and file a Canadian tax return to be eligible.
Tip
Register for Fair PharmaCare as soon as you have your BC Services Card and MSP coverage. You can register online at gov.bc.ca/pharmacare or by calling Health Insurance BC at 1-800-663-7100. If you do not register, you will not receive PharmaCare coverage even if you would otherwise be eligible.
What Fair PharmaCare Covers
Fair PharmaCare covers drugs listed on the BC PharmaCare formulary, which is a list of approved medications. Not all drugs are covered. If your doctor prescribes a drug that is not on the formulary, you may need to pay the full cost or ask your doctor about a covered alternative. PharmaCare also covers certain medical supplies like diabetic testing strips, ostomy supplies, and some prosthetics.
Federal Prescription Drug Programs
The federal government operates several drug coverage programs for specific populations. The Interim Federal Health Program (IFHP) provides temporary health coverage, including prescription drugs, for refugees, refugee claimants, and other protected persons. If you arrived in Canada as a refugee, you may be eligible for IFHP drug coverage until you qualify for provincial health insurance.
The Non-Insured Health Benefits (NIHB) program covers prescription drugs for eligible First Nations and Inuit people. Veterans Affairs Canada provides drug coverage for eligible veterans. These federal programs have their own formularies and coverage rules separate from provincial programs.
Employer-Sponsored Drug Coverage
The most common source of prescription drug coverage for working Canadians is through employer-sponsored group benefits. If your employer offers health benefits, your plan almost certainly includes prescription drug coverage. Employer drug plans typically cover 80% to 100% of the cost of eligible prescription medications, subject to the plan's formulary and any annual or per-prescription maximums.
When you fill a prescription, you present your benefits card at the pharmacy. The pharmacy submits the claim electronically, and you pay only your portion (the co-pay) at the point of sale. If your employer plan has a $5 co-pay per prescription, you pay $5 regardless of whether the drug costs $20 or $200. Some employer plans have percentage-based co-pays (for example, you pay 20% and the plan pays 80%), and some have annual maximums after which you pay the full cost.
Info
If you have both employer drug coverage and provincial PharmaCare, your employer plan is considered the first payer. PharmaCare may cover some of the costs that your employer plan does not, but you must register for PharmaCare separately to receive this coordination of benefits.
Generic vs. Brand-Name Drugs
One of the most effective ways to reduce your prescription drug costs is to choose generic drugs when available. A generic drug contains the same active ingredient, in the same dosage and form, as the brand-name drug. Health Canada requires that generic drugs meet the same standards of safety, quality, and effectiveness as brand-name drugs. The only difference is the price: generic drugs typically cost 50% to 80% less than their brand-name equivalents because the manufacturer does not need to recoup the costs of original research and development.
How to Request Generics
When your doctor writes a prescription, you can ask whether a generic version is available. In most provinces, pharmacists are required or encouraged to substitute the generic version unless the doctor specifically indicates that the brand-name drug is medically necessary. Many provincial drug plans, including BC PharmaCare, reimburse at the generic price. If you insist on the brand-name drug, you may need to pay the difference out of pocket.
How to Transfer Prescriptions
If you want to switch pharmacies, transferring your prescriptions is straightforward. Simply visit your new pharmacy and provide them with your name, date of birth, and the name and location of your previous pharmacy. The new pharmacist will contact your old pharmacy and arrange the transfer. You do not need to visit your doctor for a new prescription. You can also ask your new pharmacy to transfer all of your active prescriptions at once. There is no cost for transferring prescriptions in Canada.
Warning
If you are bringing medications from another country to Canada, be aware that some drugs available over the counter or by prescription in other countries may be controlled or restricted in Canada. Always declare your medications at the border. Bring them in their original packaging with the prescription label if possible. For ongoing medications, see your Canadian doctor to get a local prescription as soon as possible.
Tips for Managing Prescription Costs
Beyond choosing generic drugs, there are several strategies for managing your prescription costs. Ask your pharmacist about the cost before filling a prescription. Pharmacies can vary in their dispensing fees, so compare prices. Some big-box retailers and grocery store pharmacies have lower dispensing fees than independent pharmacies. If you take multiple medications, ask your pharmacist about blister packing, which can help you stay organized and may reduce waste. For expensive specialty medications, ask your doctor or pharmacist about patient assistance programs offered by drug manufacturers. Many pharmaceutical companies offer programs that provide free or reduced-cost medications to patients who cannot afford them.
Resources and Next Steps
Prescription drug coverage in Canada can be complex, but understanding your options ensures you can access the medications you need without undue financial burden. Here are key resources:
- BC PharmaCare: Register at gov.bc.ca/pharmacare or call 1-800-663-7100
- Fair PharmaCare estimator: Use the online calculator at gov.bc.ca to estimate your deductible
- Health Canada Drug Product Database: Search for approved drugs at canada.ca/drugproductdatabase
- Interim Federal Health Program: canada.ca/ifhp for refugee health coverage
- Provincial formularies: Check your province's drug formulary to see which medications are covered
WelcomeAide is here to help you navigate healthcare and every other aspect of settling in Canada. Our AI Newcomer Navigator can help you find pharmacy and drug coverage resources in your area. Explore our blog for more newcomer guides, learn about our mission, or see how to get involved in supporting newcomer communities across Canada.