Eligibility for Pharmacare programs
Nova Scotia has Pharmacare programs to assist seniors, cancer patients, and Community Services clients with the cost of prescription medication.
Seniors Pharmacare
To be eligible for this program, you must meet the following four requirements:
- Nova Scotia resident
- valid NS Health Card holder
- 65 years or older
- no drug coverage from Veterans’ Affairs Canada, First Nation and Inuit Health or a private drug plan
The premium for Seniors Pharmacare is a maximum of $400 a year. Some seniors with low incomes may qualify for reduced premiums and should contact Pharmacare for details. The co-pay for Seniors is 33% of the total prescription cost, with a minimum of $3 and a maximum of $30. The annual (April 1 - March 31) maximum is $360, at which point Pharmacare covers 100% of remaining costs.
Community Services Drug Program
The Department of Community Services covers drug costs for:
- Income Assistance clients
- Community Support for Adults clients
- Extended Pharmacare clients
- Transitional Pharmacare clients
- children in the care of child welfare
Drug Assistance for Cancer Patients
To apply for benefits under this program, a patient must be
- a resident of Nova Scotia
- have a gross family income of $15 720 or less per year
- not be eligible for coverage under another drug program
If approved, the program will provide approved cancer-related drug benefits.
Coverage by Pharmacare
Pharmacare covers drugs and supplies prescribed by a doctor, dentist, or authorized nurse practitioner and filled at a Nova Scotia pharmacy.
The following are some of the services NOT covered by Nova Scotia Pharmacare:
- prescriptions filled outside Nova Scotia
- proprietary medicines, household remedies and non-prescription preparations
- artificial sweetening agents, dietary supplements and food products
- soaps, cleaners and shampoos, medicated or otherwise
- supportive or physical aids/devices, mechanical or otherwise
- prescription accessories, convalescent aids or other non-drug items of a similar nature
Coverage of Ostomy Supplies by Pharmacare
Pharmacare in Nova Scotia covers certain ostomy supplies and products. The covered products are limited to certain brands. You can search online to see which products are covered. Note that there is no coverage of ostomy supplies by MSI. Private insurance may cover costs, instead.
Supply Limits
Pharmacies will only fill claims up to 100 days supply, if prescribed. Seniors on the Seniors’ Pharmacare Program can fill up to 180 days supply, if prescribed (this is mostly intended for snowbirds who will be out of the country for more than 100 days). Any cost associated with a quantity greater than 100 days supply (180 days for seniors) will be the responsibility of the patient.
Pharmacy reimbursements
Pharmacare pays the Actual Acquisition Cost for drugs submitted, except in cases where the drug is assigned a Maximum Allowable Cost. In the case of injectable drugs and ostomy supplies, a mark-up and professional fee are also allowed.
Generic vs. Name Brand Drugs
Under Pharmacare, generic drugs are dispensed due to their lower cost. If a patient or doctor chooses a more expensive brand when there is a comparable generic version, the patient is responsible for the price difference. An exception to this is a proven allergic or other reaction to the generic requiring the use of a particular brand.
Maximum Allowable Cost (MAC)
A MAC is applied to drugs which are interchangeable benefits and have multiple suppliers; for example, a brand name drug and its equivalent generics. Within an interchangeable group, the MAC per unit is set by comparing costs from various manufacturers and determining the lowest price available.
If patients require or request a drug product which has a higher price than the MAC, they must pay the difference, and that difference will not count towards the co-pay. If a patient has experienced side effects or negative reactions to the lowest cost drug(s), they may be allowed an exception to the MAC rules with a request from their physician.
Special MAC
For some categories of drugs and supplies, a special MAC is assigned. The special MAC may be related to dosage forms, daily amounts, interchangeable products, etc.
As with regular MAC drugs/products, if patients choose a form that exceeds the special MAC price, they are responsible for the extra cost.
Exception Status Drugs
To request coverage of a drug not listed in the Formulary, physicians can appeal on behalf of their patients for Exception Status. Patients must either meet criteria for each drug or make an appeal for exceptional circumstances. Requests are processed on an urgency basis, and are usually processed within 7 days.
If a physician writes a prescription with a “criteria code,” the EDS application can be skipped. This code verifies that the drug is prescribed for an approved indication.
Contact Information
Nova Scotia Pharmacare
PO Box 9322, Station “A”
Halifax, NS
B3K 6A1
Phone: 429 6565
Toll-Free: 1 800 544 6191
Fax: 468 9402
Forms and Links
Pharmacare
Pharmacare FAQs
Exception Status Drug criteria
