Improved coverage for most prescription drugs

We have made changes to improve coverage for most prescription drugs starting January 1, 2022. Eligible retired members will have a grace period to transition to the new drug plan.

Modified drug plan with a tiered formulary

A formulary is a list of drugs that are covered by a plan. Currently, 70 per cent of the cost of prescription drugs is reimbursed by the retirement group health benefits program. The new tiered formulary will group drugs into two levels of reimbursement:

• Tier 1—drugs covered by BC PharmaCare: reimbursement will increase from 70 to 80 per cent
• Tier 2—drugs not covered by BC PharmaCare: reimbursement will decrease from 70 to 60 per cent

BC PharmaCare helps BC residents pay for a broad range of cost-effective prescription drugs. Visit the BC PharmaCare formulary search page to find more information on which drugs are covered. If you haven’t already done so, you can register for BC PharmaCare at any age before or after retirement through a simple process on its registration web page.

BC PharmaCare deductible

You are required to satisfy an annual BC PharmaCare deductible based on your net family income before BC PharmaCare starts paying for eligible drugs. You can find more information about the levels of BC PharmaCare coverage on its website. Your claims for tier 1 drugs will accumulate toward this deductible, which Green Shield Canada (GSC), your health care carrier, will pay for on behalf of the Public Service Pension Plan. Once the deductible is paid, you will be reimbursed for eligible drug claims for you and your family by BC PharmaCare—this will save you and the plan money.

Your health benefits program deductible

Your health benefits program deductible is different from the BC PharmaCare deductible. Each individual covered under the plan’s health benefits program pays a $250 deductible starting with their first claims of each calendar year for any health expenses.

After you satisfy the annual health benefits program deductible, you will be reimbursed for prescription drugs and other health expenses until you accumulate $2,000 in paid health claims in a calendar year. (Note: tier 2 drugs are not eligible to accumulate to the $2000 threshold.)

Once you reach the $2,000 in paid claims, you are reimbursed 100 per cent of all eligible extended health care expenses, which include tier 1 drugs, for the remainder of the calendar year. Coverage for tier 2 drugs will remain at 60 per cent.

Example

The table below gives an example of how the BC PharmaCare and health benefits program deductibles are paid and how drug costs are reimbursed under the changes.

The BC PharmaCare deductible is calculated based on your net family income, so everyone’s situation will be different. As an example, let’s say your net family income is $50,000, which means your deductible is $1,500. When you accumulate $1,500 in eligible drug costs, BC Pharmacare begins to reimburse a portion of your drug costs until you accumulate your family maximum amount, which is $2,000, after which you will receive 100 per cent coverage of eligible drug costs.

Starting on January 1, as you fill your prescriptions, eligible costs will accumulate toward your BC PharmaCare (PHC) deductible and family maximum amount.

Notes:

• BC PharmaCare starts paying 70 per cent of eligible costs after $1,500 deductible reached
• BC PharmaCare starts paying 100 per cent of eligible costs after $2,000 family maximum amount reached
• Tier 1—drugs covered by BC PharmaCare: reimbursement will be 80 per cent
• Tier 2—drugs not covered by BC PharmaCare: reimbursement will be 60 per cent