Catastrophic Drug Program
If the cost of your prescription medication is making it hard for you to pay other essential life expenses, you may qualify for coverage of certain medications through the Catastrophic Drug Program.
Am I eligible?
You and members of your household are eligible for this program if you:
- are a permanent PEI resident as defined by the Drug Cost Assistance Act;
- have a valid PEI Health Card; and
- filed your most recent income tax return in PEI.
When am I eligible for coverage?
Once approved, your eligibility will start from the date noted in your approval letter, and will continue until June 30. To avoid interruption in coverage, you must re-apply each year.
How do I apply?
Submit a completed Catastrophic Drug Program Application form [PDF | 305 KB] to PEI Pharmacare.
What if I’m already in a government drug program?
Islanders who currently have coverage through other public drug programs such as the Seniors’ or Diabetes programs also qualify for benefits through the Catastrophic Drug Program, should they spend more than their household cap on eligible prescription costs.
How is cost assistance calculated?
Your annual out-of-pocket costs for eligible prescription medications will be capped at an amount not to exceed a set percentage of your household income. Eligible prescription medication costs for the remainder of the year from July 1 to June 30 will be paid through the Catastrophic Drug Program.
If your total annual household income is:
- Up to $20,000 you will pay 3% of your annual income on prescription medication costs before assistance;
- Greater than $20,000 to $50,000 you will pay 5% of your annual income on prescription medication costs before assistance;
- Greater than $50,000 to $100,000 you will pay 8% of your annual income on prescription medication costs before assistance;
- Greater than $100,000 you will pay 12% of your annual income on prescription medication costs before assistance.
Annual household income: $25,000 x 5% = $1,250 cap
Once you have spent $1,250 for eligible prescription medications, you will be covered by the Catastrophic Drug Program for additional approved medication costs for the remainder of the year (July 1 – June 30).
If you apply past the program start date of July 1, your cap will be pro-rated to reflect the percentage of time remaining until June 30.
$1,250 household cap for a household applying September 15 would be reduced to $987.50 (79% remaining in the program year).
What is considered a household?
A household may consist of an:
- adult over the age 18 (unless enrolled full-time at a post-secondary institution and under the age of 26);
- adult and a spouse (married or common-law);
- adult and any dependent children (under the age of 19 or under the age of 26 and attending a post-secondary institution full-time); or
- adult, a spouse, and any dependent children.
How much of the medication cost will be covered?
All costs of eligible medications are covered by the program after the household cap amount has been reached. Eligible medications are listed on the PEI Pharmacare Formulary.
Medication available over-the-counter, or funded through another public drug program, are not covered through this program.
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.
The portion you pay out-of-pocket at your pharmacy for eligible medications will still count toward your household accumulator. The annual premium you pay your insurance company may be used to reduce your household income by up to $2,500 when calculating the household cap amount.
What if my medication is not listed in the PEI Pharmacare Formulary?
Some medications in the PEI Pharmacare Formulary are approved on a special authorization basis only. If your physician prescribes a drug in this category, he or she can submit a Standard Special Authorization Request form [PDF | 34 KB] to have a medication considered for coverage.
If your medication is not included in the PEI Pharmacare Formulary, it will not be eligible for coverage.
Where can I get my medication?
You can have your prescription filled at any community retail pharmacy located in Prince Edward Island.
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.
How can I contact PEI Pharmacare?
16 Fitzroy Street
Charlottetown, PE C1A 7N8
Telephone: (902) 368-4947
Toll free: 1-877-577-3737