Under Nova Scotia’s new Seniors’ Pharmacare Regulation,
effective April 01, 2008 beneficiaries enrolled in the
Seniors’ Pharmacare program will have two options for paying their
annual maximum co-payment.
Option 1: Seniors will pay the full prescription co-payment
of 33 per cent of the prescription
cost at the pharmacy at the time of purchase (the
$30.00-per-prescription co-payment
maximum has been eliminated)
Option 2: Seniors may pay the annual maximum co-payment
amount ($382) in
monthly, quarterly or annual installments directly to
Pharmacare, similarly to how their premium
payments are remitted.
The $30 cap on the co-payments for prescriptions has been
eliminated. Patients with
prescriptions that cost more than $90 may pay more per
individual prescription. For
those who reach the
maximum annual co-pay of $382, it will mean they will reach
that maximum more
quickly but they will not pay more over the course of the
year.
Mandatory Retirement
On
April 12, 2007, the Nova Scotia
government passed legislation stating that provincially
regulated employees are no longer required
to retire solely because they have reached age 65. This legislation was originally
scheduled to take effect in 2008, but the effective date has
been changed to no
earlier than July 1, 2009 in order to allow employers and other affected
parties time to make any necessary changes.
Elimination of mandatory retirement does not
affect any age 65
restrictions in employee benefit plans.
Nova Scotia launches new public drug program as of
March 1st 2008
As of
March 1st,in Nova Scotia, Family
Pharmacare will assist the 19% of Nova
Scotians, who do not
have drug insurance in the province. The program is
designed to provide the greatest benefit to low
income families and will not bring any changes to
existing public programs.
Its program design is unique whereby everyone is
eligible to enroll, however
deductibles and co-payments both apply. Here is a
highlight of the eligibility criteria:
-
In order to be eligible, individuals need to be a
permanent resident of Nova Scotia
and have a valid N.S. health card.
-
Individuals will NOT be eligible if already receiving
drug coverage through the other
government programs in the province (ie. The Seniors
Plan)
-A 20%
co-payment rule will apply to every prescription
dispensed.
What is unique, is that to “benefit” from the province’s
plan there are two steps – the first is an annual
deductible is required to be met based on your annual
gross income
with a $3000 adjustment per family member (referred to
as the “adjusted annual
family income”). Then once this has been satisfied you
will continue to pay a co-payment up to a maximum on an
annual basis as defined based by your adjusted annual
family income.
Household deductible will also be based on family income
as per the table below:
Deductible Details
Adjusted Annual Family Income[1]
Deductible as a Percentage of Adjusted
Annual Family Income
Annual
Deductible Amount (minimum – maximum)
Less than $10,000
1.0%
0 - $100
$10,000 to < $20,000
1.0% - 2.0%
$100 - $400
$20,000 to < $30,000
2.5% - 3.0%
$500 - $900
$30,000 to < $40,000
3.5% – 4.0%
$1,050 - $1,600
$40,000 to < $50,000
4.5% - 5.0%
$1,800 - $2,500
$50,000 to < $60,000
5.5% - 8.0%
$2,750 - $4,800
$60,000 to < $70,000
8.5% - 11.0%
$5,100 - $7,700
$70,000 to < $80,000
11.5% - 14.0%
$8,050 - $11,200
$80,000 to < $90,000
14.5% - 17.0%
$11,600 - $15,300
$90,000 to < $98,000
17.5% - 19.5%
$15,750 -
$ 19, 110
$98,000 or greater
20%
$19,600+
[1] To take family
size into consideration, the total family income is
reduced by
$3 000 for a spouse and for every dependent under 18
years of age.
Co-payment for the program is 20% and the yearly maximum is
based on the adjusted
annual family income as per the following table:
Co-Payment Maximums
Adjusted
Annual Family Income
Annual Co-payment Maximum as a Percentage of
Adjusted Annual Family Income
Annual Co-payment Maximum
Less
than $10,000
4.0%
0 -
$400
$10,000 to <$20,000
5.0%
$500
- $1,000
$20,000 to <$30,000
6.0%
$1,200 -
$1,800
$30,000 to <$40,000
8.0%
$2,400 -
$3,200
$40,000 to <$50,000
9.5%
$3,800 -
$4,750
$50,000 to <$60,000
11.0%
$5,500 -
$6,600
Although deductibles and co-payments will be considered
medical expenses for taxation purposes, it is only once both
the yearly family deductible and co-pay
maximum have been reached that the cost of prescriptions
will be paid at 100%.
Family Pharmacare and Private Insurance
People can be enrolled in Family Pharmacare and have private
insurance. Individuals
with private coverage can benefit when:
-
Drug costs are extremely high and co-payment to private
insurance exceeds the Family
Pharmacare deductible
-
Drug costs greatly exceed a maximum allowable annual claim
amount of private insurance
-Drug costs
would not be covered by private insurance due to excluded
benefits at the time of enrolment
The Department of Health does not expect Family Pharmacare
to significantly impact
private plans as it has been designed to assist uninsured
and underinsured families and
individuals, with lower incomes.
It is also important to note that there are many differences
between the provincial formulary
and that of private plans. In some cases there are costly
catastrophic drugs covered by group health plans that are
not eligible through government.
