Medication Coverage – PEI Pharmacare Formulary
The prescription medications and some diabetic supplies covered by PEI Pharmacare are identified on the PEI Pharmacare Formulary (search tool), including those that require special authorization. Medications must be dispensed at a PEI community pharmacy to be eligible for coverage under PEI Pharmacare. Oncology medications dispensed and administered at PEI oncology sites may be eligible for coverage under the Oncology Formulary.
View the full formulary in PDF format:
Am I eligible for coverage through PEI Pharmacare?
To be eligible for coverage, you must:
- Be a PEI resident as defined by the Drug Cost Assistance Act;
- Have a valid PEI Health Card;
- Qualify for one of the drug programs;
- Have your medication listed on the PEI Pharmacare Formulary (linked above); and
- Have your medication dispensed at a participating PEI community pharmacy.
What if the medication I need is not currently on the formulary?
If the current formulary does not include your medication, it is not eligible for coverage.
What are special authorization medications?
Some medications in the PEI Pharmacare Formulary are approved on a special authorization basis only. These medications are only covered if your condition meets the funding criteria outlined on the PEI Pharmacare Formulary. If your condition is not included in the PEI Pharmacare Formulary, the medication will not be eligible for coverage. If your physician prescribes a drug in this category, he or she should complete and submit a Standard Special Authorization Request form (linked above).
Can I substitute a brand-name drug for the generic drug listed on the formulary?
Unless the drug you request is granted special authorization, you must pay the established co-pay amount plus the cost difference between your requested product and the less expensive product on the formulary. However, brand-name drugs are not eligible for coverage under the Generic Drug Program.
Is there a limit to the amount of medication government will cover at one time?
Yes, there is a maximum allowable supply of drugs that will be covered at one time. These limits are in place to reduce medication waste and to prevent potential risks associated with storing large quantities of medication at home.
How do medications get added to the formulary?
The Drug Cost Assistance Act (linked above) sets out governance for formulary establishment and maintenance.
Scientific and economic information, as well as recommendations from the Atlantic Common Drug Review (ACDR), the Canadian Drug Expert Committee (CDEC), the Pan Canadian Oncology Drug Review Committee (P-CODR) or PEI Provincial Drugs and Therapeutics can influence whether a drug should be listed or recommended as a program benefit.
The drugs are listed according to the therapeutic categories developed by the American Society of Hospital Pharmacists.
What type of medications are excluded from the formulary?
The following product classes are excluded from the PEI Pharmacare Formulary (exceptions are listed in the formulary):
- Over-the-counter (OTC) or non-prescription medications (with some exceptions);
- Weight-loss products;
- Soaps, cleansers and shampoo;
- Oral ergoloid mesylates (Hydergine);
- Peripheral vasodilators (Arlidin);
- Combination anti-spasmodic/sedative products (Donnatal,Librax, Stelabid);
- Combination sedative/analgesic products (Fiorinal, Tecnal);
- Allergy serums;
- Impotence and infertility treatments;
- Diagnostic agents (excluding diabetes);
- Prostheses, medical devices, appliances and supplies including first aid supplies and syringes; and
- Medications not dispensed by a community pharmacy.
Who keeps track of my medications?
Information about your prescription medications is recorded and securely stored in the PEI Drug Information System. Each time you have a new prescription filled, your medication list is updated, helping health professionals determine if a new drug therapy is appropriate based on your past medication history.
Your medication profile on the electronic system is linked to health care sites such as pharmacies, physicians’ offices, health centres, and emergency departments. Only physicians, nurses, pharmacists, and other authorized health care professionals can access it when they need it, allowing them to make safer and more informed decisions about your care.
Who do I contact about medication coverage?
16 Fitzroy Street
Charlottetown, PE C1A 7N8
Toll free: 1-877-577-3737