Family Health Benefit Drug Program
If you are a low-income family, you may qualify for the Family Health Benefit Drug Program which helps cover the cost of approved prescription medications for you and your children if they are under the age of 19 or under the age of 25 and a full-time student.
Who is eligible?
You, your spouse, and dependents are eligible for the program if you meet ALL the following criteria:
- 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
- are a low-income family supporting at least one child in the approved age categories.
How do I apply?
- Submit a completed Family Health Benefit Application form [PDF | 471 KB].
- If you are including a dependant under the age of 25 who is a full-time student, proof of enrolment from the educational institution must accompany your application.
- If joint custody of the qualifying child exists, both parents may apply to the program.
How do we define "Applicant"?
An applicant must be an adult (defined as a person 18 years of age and older) and will be the person to whom all correspondence relating to the program will be sent.
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
Note: Include all family members on the Catastrophic Drug Program application form, even if some family members have drug coverage through other programs. All family members are include in the calculation of the household cap.
How do we define "Spouse"?
A spouse is:
- married to the other person
- common law with the other person, or
- living with the other person in a conjugal relationship
How do we define "Dependent"
A dependent is:
- a child or legal ward of you or your spouse
- under the age of 18 years old or under the age of 26 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
A dependent can only be registered with one family at any given time.
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 Line 210 (Split-Pension Amount), Line 214 (Child Care Expenses), and Line 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 determine who qualifies and how much of the medication will be covered?
Assistance is based on family size and household income. While the program will cover the full cost of medication, you must pay the pharmacy dispensing fee.
- If you have 1 dependent, your net annual family income to qualify must be less than $24,800
- If you have 2 dependents, your net annual family income to qualify must be less than $27,800
- If you have 3 dependents, your net annual family income to qualify must be less than $30,800
- If you have 4 dependents, your net annual family income to qualify must be less than $33,800. If you have more than 4 dependents, add $3,000 for each additional dependent
When will coverage begin?
If approved, your coverage will begin on the date noted in your approval letter, and will continue until September 30. You must re-apply each year before your coverage expires.
Coverage ends when you have no children under the age of 19 or under the age of 25 who are full-time students.
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.
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.
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.
Who can I contact for more information?
16 Fitzroy Street
Charlottetown, PE C1A 7N8
Telephone: (902) 368-4947
Toll free: 1-877-577-3737