British Columbia residents automatically qualify for PharmaCare coverage by registering with the Medical Services Plan. Pharmacare has seven different plans which target specific sub-sets of the population.
Plan A - Senior Citizens
Plan A provides assistance to BC seniors. Residents aged 65 and older who are registered with the Ministry of Health are provided with a gold CareCard. New senior residents to BC receive gold care cards once medical coverage is in effect.
As of April 1st, 1994, the senior is charged 100% of the dispensing fee for each prescription up to a maximum of $200 per calendar year. Once the $200 maximum has been reached, PharmaNet automatically adjudicates so the patient pays nothing for the remainder of the calendar year. PharmaCare provides direct payment to the pharmacy for 100% of the acceptable drug cost.
Plan B - Long Term Care
Since 1977, plan B has provided 100% reimbursement to all individuals who are permanent residents of licensed long term care facilities and private care hospitals in BC. Each residential facility is served by a contracted pharmacy and paid on a per diem basis. Bylaw 38 of the Pharmacists, Pharmacy and Drug Scheduling Act defines the standards for services provided to continuing care facilities.
Plan C - Social Services
Plan C provides 100% coverage for residents (excluding seniors and those covered under plan B), who have active Ministry of Social Services or Refugee Status medical coverage. Eligibility is determined by Social Services staff. PharmaCare provides direct payment to the pharmacy for 100% of the acceptable drug cost, and 100% of the acceptable dispensing fee. Since the introduction of the interface with the Ministry of Social Services in September, 1995, social workers enter H1/H3 information on-line, and as of November 1, 1995, CareCards no longer display unit codes H2 or X2.
Plan D - Cystic Fibrosis
Effective April 1st, 1995, plan D provides pancreatic enzymes at no cost to Cystic Fibrosis sufferers approved by one of the Cystic Fibrosis clinics. As of January 2nd, 1996, PharmaCare provides reimbursement, consistent with the individual's eligibility, for a limited list of nutritional products and some vitamin and vitamin/mineral preparations. See Pharmacare Newsletter Number 95-21, dated December 20, 1995 for more details on the list of eligible products and their DINs.
Plan E - Universal
Since 1977, Plan E provides coverage for all residents of the province who are not receiving benefits under other PhamaCare plans (except plan D and Plan G). The coverage for this plan is based on the total eligible expenses of a family, rather than on an individual basis.
The current annual deductible for universal PharmaCare is $800. When the total expenses for eligible prescription drugs and other beneftis for a family have reached this annual deductible, PharmaCare will automatically cover 70 per cent of the cost of any further eligible benefit items. Once a family has paid a total of $2,000 in costs recognized by Pharmacare, any further costs in that year are covered 100 per cent.
If a family receives Premium Assistance or Temporary Premium Assistance through the Medical Services Plan of BC, the current annual deductible is $600 and the family would qualify for 100 per cent coverage after the decutible has been met.
Plan F - At Home/Associate Family
Starting in 1989, the At Home program was implemented to provide assistance to families caring for severely handicapped children at home. This plan covers selected medical supplies and products, prescription drug cost, and provides assistance with respite care. The Associate Family program provides community based family style care for children with multiple disabilities who reside in institutional settings. All children who are elibible for either of these programs receive 100% Pharmacare coverage. Application for plan F is made through the Ministry of Social Services.
Plan G - Mental Health
As of February 24th, 1997, plan G provides patients of Mental Health Centres psychiatric medications at no charge. Eligibility is determined by the Mental Health Centres.