High Cost Drug Program
If you need assistance paying for medications, you may be eligible for coverage of approved medication costs through the High Cost Drug Program.
Am I eligible?
- are a PEI resident as defined by the Drug Cost Assistance Act;
- have a valid PEI Health Card;
- you have filed your Prince Edward Island tax returns and agree to household income verification through Canada Revenue Agency.
You may be eligible for coverage for approved medication costs for several medical conditions, including but not limited to:
- Ankylosing Spondylitis;
- Cancer;
- Crohn's Disease;
- Multiple Sclerosis;
- Plaque Psoriasis;
- Pulmonary Hypertension;
- Psoriatic Arthritis;
- Rheumatoid Arthritis; and
- Wet Age-Related Macular Degeneration
How do I apply?
- Submit a completed High Cost Drug Program Application form [PDF | 33 KB].
- Your physician or diagnosing specialist must submit a completed Special Authorization Request form, and any appropriate medical information on your behalf. If the High-Cost drug program application has been received by Pharmacare, program enrolment date will be effective the date the special authorization request is received.
- You must re-apply for coverage two months prior to your expiry date.
- Your eligibility for coverage and level of co-payment will be confirmed in writing.
How much of the medication cost will be covered?
Your cost of the medication will depend on your household income. You must also pay a pharmacy professional fee, which may vary with each pharmacy. The remainder of the medication cost will be paid to the pharmacy directly.
How do we define “Household”?
A household is:
- a single adult
- an adult and spouse (refer to definition below)
- an adult and all dependent children (refer to definition below)
- an adult, spouse, and all dependent children
How do we define “Spouse”?
A spouse is:
- is married to the other person
- is common law with the other person, or
- is living with the other person in a conjugal relationship
How do we define “Dependent”?
A dependent is:
- a child or a legal ward of you or your spouse
- under the age of 18 years or under the age of 25 and attending a post-secondary institution on a full-time basis - confirmation of enrolment from the post-secondary institution is required.
- not married and not living in a marriage-like relationship
How do we define “Household Income”?
For each household member, use Line 236 (Net income) from the preceding year’s tax return, and deduct any amounts reported on lines # 210 (Split–Pension Amount), # 214 (Child Care Expenses), # 220 (Support Payments Made). This amount represents each individual’s income for the purpose of drug program coverage. Add together the individual amounts for each household member identified above to determine total household income.
How do we calculate “Copayment”?
Take the household income you just calculated and determine which income range you fall under.
| Household Income Ranges | Co-Payment |
|---|---|
| $0 – $14,000 | $7 |
| $14,001 - $15,999 | $25 |
| $16,000 – $17,999 | $32 |
| $18,000 - $19,999 | $40 |
| $20,000 - $21,999 | $48 |
| $22,000 - $23,999 | $57 |
| $24,000 - $25,999 | $68 |
| $26,000 - $27,999 | $79 |
| $28,000 - $29,999 | $91 |
| $30,000 - $31,999 | $103 |
| $32,000 - $33,999 | $117 |
| $34,000 - $35,999 | $131 |
| $36,000 - $37,999 | $146 |
| $38,000 - $39,999 | $162 |
| $40,000 - $41,999 | $179 |
| $42,000 - $43,999 | $197 |
| $44,000 - $45,999 | $216 |
| $46,000 - $47,999 | $235 |
| $48,000 - $49,999 | $255 |
| $50,000 - $51,999 | $287 |
| $52,000 - $53,999 | $320 |
| $54,000 - $55,999 | $355 |
| $56,000 - $57,999 | $392 |
| $58,000 - $59,999 | $430 |
| $60,000 - $61,999 | $470 |
| $62,000 - $63,999 | $512 |
| $64,000 - $65,999 | $555 |
| $66,000 - $67,999 | $600 |
| $68,000 - $69,999 | $647 |
| $70,000 - $71,999 | $695 |
| $72,000 - $73,999 | $745 |
| $74,000 - $75,999 | $797 |
| $76,000 - $77,999 | $850 |
| $78,000 - $79,999 | $905 |
| $80,000 - $81,999 | $962 |
| $82,000 - $83,999 | $1,020 |
| $84,000 - $85,999 | $1,080 |
| $86,000 - $87,999 | $1,142 |
| $88,000 - $89,999 | $1,205 |
| $90,000 - $91,999 | $1,270 |
| $92,000 - $93,999 | $1,337 |
| $94,000 - $95,999 | $1,405 |
| $96,000 - $97,999 | $1,475 |
| $98,000 - $99,999 | $1,547 |
| $100,000 - $109,999 | $1,684 |
| $110,000 - $119,999 | $1,893 |
| $120,000 - $129,999 | $2,109 |
| $130,000 - $139,999 | $2,334 |
| $140,000 - $149,999 | $2,568 |
| $150,000 - $159,999 | $2,825 |
| $160,000 - $169,999 | $3,108 |
| $170,000 - $179,999 | $3,418 |
| $180,000 - $189,999 | $3,760 |
| $190,000 - $199,999 | $4,136 |
| $200,000 - $399,999 | $6,204 |
| $400,000 - $599,999 | $7,755 |
| $600,000 - $799,999 | $9,048 |
| $800,000 - $999,999* | $10,179 |
| ≥ $1,000,000* | $11,310 |
* If you have an income greater than $800,000, manual billing may be required due to IT system capabilities.
What if I have private insurance?
You or your pharmacy must submit all claims to your private insurer first. The remaining out-of-pocket eligible expense can then be submitted to PEI Pharmacare for assessment.
Where can I get my medication?
You can fill your prescription at any community retail pharmacy located in Prince Edward Island. You will receive up to a 30-day supply of medication.
Will I get a refund for medication I already purchased?
Coverage is not retroactive, you will not be reimbursed for medications you have already purchased.
Will my medications be eligible for coverage if they are filled at an out of province pharmacy?
Claims are eligible for manual submission only if the medication or any formulation of the medication cannot be dispensed through a PEI pharmacy.
What if I move away from PEI?
Your eligibility for this program will end the day you leave PEI to take up residency elsewhere.
How can I contact PEI Pharmacare?
PEI Pharmacare
16 Fitzroy Street
Sullivan Building
Charlottetown, PE C1A 7N8
Telephone: 902-368-4947
Toll free: 1-877-577-3737