MSP & PHARMACARE

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MSP & PHARMACARE

We all hear the words “MSP” and “Pharmacare” one way or another. So what exactly does it mean? Confused about how PharmaCare or MSP works? When you go to the pharmacy, how does your insurance plan pay for your diabetes supplies? Why do you have to pay sometimes, but other times supplies are free? This information might help shed some light.

Medical Services Plan of B.C. (MSP): Public health insurance is available to all eligible residents of Canada. In B.C., public health insurance is called the Medical Services Plan. It covers the cost of medically-necessary insured doctor services (like endo appointments and A1c tests!)

B.C. residents pay monthly MSP rates (premiums), which help meet a portion of the costs of B.C.’s health-care system. Premiums are set based on your family’s income level (see Table 1)

Stay up to date!

Did you know that effective January 1, 2018 MSP premiums will be reduced by 50% for British Columbians with annual family net income up to $120,000?! This is the first step as BC begins the process of eliminating MSP premiums. For more info and to register for updates check out: https://bcbudget2017.gov.bc.ca/phasing-out-msp/

REGISTER FOR MSP: https://my.gov.bc.ca/msp/application/prepare

PharmaCare: B.C. residents with active MSP coverage are eligible for drug/medical supply coverage under a PharmaCare plan. The most common plan is called Fair PhamaCare which covers items based on your family net income (see Table 2)

Deductible: Each year, your family is responsible for paying 100% of your diabetes supply costs until you reach your deductible (your deductible depends on your family net income – Table 2).

Fair PharmaCare portion: PharmaCare pays 70% of your eligible costs after you reach your deductible. You pay the remaining 30% until the end of the year OR until you reach your family maximum.

Family Maximum: The family maximum protects you (and, if applicable, your family) from high expenses. If your contributions towards eligible costs reach this amount, PharmaCare pays 100% of your eligible costs for the rest of the year (family maximum also depends on your family net income – Table 2)

Eligible costs: If PharmaCare does not cover an item, you are responsible for the full cost. (some diabetes items that are not covered by PharmaCare = certain types of lancets, new products like Fiasp Insulin, insulin pumps for people over age 25, etc).

If PharmaCare does cover an item, it sets a maximum amount it will cover for the item. If a pharmacy or medical provider charges more than that maximum, you pay the difference in cost. (HINT: make sure your pharmacy is not charging more than the maximum amount PharmaCare will cover!!)

Only eligible costs count towards your annual deductible and family maximum.

REGISTER FOR PHARMACARE: https://pharmacare.moh.hnet.bc.ca/PPIBroker…

Other insurance plans: Many people will have another insurance plan in addition to Fair PharmaCare (Pacific Blue Cross, SunLife, ManuLife, etc). These plans are provided by places of employment, schools, or parents and are unique to each person. Check with your specific provider to see what your coverage is (ideally they would cover any of the remaining costs not already paid for by PharmaCare!)

* Expert Tip: Stock up on diabetes supplies at the end of the year (Nov or Dec) because by that time you will have likely paid off your deductible and reached your family maximum which means that 100% of your supplies will be covered by PharmaCare 😉

For more information about MSP and PharmaCare please check out:http://www2.gov.bc.ca/g…/content/health/health-drug-coverage

 

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