Before I began working as a part-time pharmacy assistant, I had no idea how to navigate the health-care system in B.C. as a young adult. All that was important was that I walked into a doctor’s office and came out without paying. Health care is easy if you’re still being covered under your parents’ benefits, but when making the transition to the SUS Health and Dental plan, it becomes a different story altogether. Deductibles? Plan G? Special authority? Young adults have a massive learning curve if they aren’t familiar with the health-care system of B.C.
With the COVID-19 pandemic fresh on everyone’s mind, health care has quickly become a source of public concern. However, have no fear; your friendly guide to all things B.C. health care is here! Whether you’re a seasoned pro at prescriptions or a confused newbie who’s never been in a pharmacy before, chances are there are resources you aren’t taking advantage of or money you could be saving.
What’s MSP?
MSP stands for Medical Services Plan and is the provincial health insurance in B.C. that allows for Canadian and permanent residents of the province to access medical services. This covers things like diagnostic tests and visiting hospitals, physicians, or surgeons, and it’s mandatory that residents of B.C. enrol themselves.
When residents turn 19 years of age, they’re no longer eligible for coverage under a guardian’s account as a dependent and must register themselves. The exception to this are full-time students aged 19-24 who can choose to remain on a parent’s MSP coverage. Registration can be done by filling out forms on the MSP website, mailing a paper application form, or visiting a Service B.C. office. After registering, a B.C. Services Card can be picked up at an ICBC driver licensing office.
As of Jan. 1, 2020 there is no longer a monthly cost (called premiums) to pay for MSP coverage.
What’s PharmaCare?
Whereas MSP covers medical services, PharmaCare covers eligible prescription drugs and medical supplies for B.C. residents. To be eligible for most PharmaCare plans, active MSP coverage is required. There is no charge to register or to have this service, and all eligible drugs are laid out in the PharmaCare formulary.
Depending on your situation, you’ll be eligible for different PharmaCare plans. The most widely used plan is Fair PharmaCare. This plan is income-based, and, like MSP, people over the age of 19 should generally register for their own account. Registration can take place online, by phone (1-800-663-7100), or by mail. However, those that are unmarried and full-time students aged 19-24 can contact Health Insurance B.C. to remain on their family’s PharmaCare plan.
PharmaCare works on a tiered system of deductibles and plan maximums, both depending on your income. A deductible is the amount that will need to be paid in full by the patient before getting any coverage; after meeting a deductible, prescriptions will be 70 per cent covered. A plan maximum is the next tier and is similar to a deductible, but after this is met there will be 100 per cent coverage for any eligible prescriptions. Only drugs that are a benefit to PharmaCare (meaning they’re eligible for coverage) will count towards this deductible. Ineligible drugs must be paid at the full cost by the patient.
There is a calculator online that will give you an idea of what financial assistance you’ll receive through Fair PharmaCare. An example of this is if you’re unmarried with a net income of $31,000. The annual deductible is slated to be $650, meaning you’ll need to cover 100 per cent of the costs of your prescription drugs until you reach this amount. Thereafter, any prescriptions will be 70 per cent covered, with the remaining 30 per cent to be paid by the patient and going toward the next tier, which is the family maximum of $900. This means that if prescription costs for the year exceed $900 paid by the patient, PharmaCare will cover all eligible drugs until deductibles reset Jan. 1.
Other coverage plans include Plan W for Indigenous residents, Plan C for recipients of B.C. Income Assistance, and Plan G for psychiatric medications. Most eligibility for plans will be determined without you having to apply, but if you do require coverage of psychiatric medication, speak with your physician to have an application form filled out on your behalf. The list of drugs that are covered by this plan is available on the PharmaCare website under the Plan G Formulary. Once accepted, Plan G lasts for one year before it will need to be renewed.
If you have third-party coverage (through work or school), after registering with PharmaCare you’ll need to get in touch with your plan and let them know your PharmaCare registration number. Plans want to be certain that they’re paying the lowest possible cost on prescriptions, and you can have your coverage suspended if you aren’t able to confirm you have PharmaCare coverage to them. Don’t risk it!
What’s special authority and how does it work?
Getting special authority for a drug is an application process that involves a doctor and is for patients unable to afford treatment but who have no other therapeutic options. An example would be if you’ve tried multiple different inhalers for your asthma and find that the only one that works for you is an expensive option like Advair — but you find out it’s not a PharmaCare benefit and you can’t afford it.
Applying for special authority involves your doctor filling out forms and sending them off on your behalf. These applications can be either approved or refused, and they often expire after a specific period and need to be renewed.
Where before a drug was not a benefit to PharmaCare, having special authority means it now will be. This doesn’t mean it will automatically be 100 per cent covered though. It means that it’ll follow PharmaCare deductibles where, if you’ve reached your family maximum, you’ll receive full coverage. If you haven’t met your deductible or plan maximum, you will still be required to pay for special authority medications until you have.
What can I do if I can’t afford my medication?
If your medication is not a benefit to PharmaCare, you can apply for special authority to have it become a benefit. However, even if a medication is eligible to be covered by PharmaCare it could still be costly depending on your deductible and level of coverage. One possibility is to talk to your physician (or pharmacist since they’re more familiar with pricing) about a cheaper alternative. You can also ask your pharmacy if there’s a generic drug available to bring down the cost.
Or, if you require a brand-name prescription and it’s not covered, you can fill out personal information for a coverage card (it acts like an insurance card that you present at a pharmacy) through RxHelp or Innovicares. These coverage cards bring down the cost of certain brand-name drugs to what they would cost if they were generic. Other brand names have savings cards on their websites, such as the ADHD drug Vyvanse, or phone numbers to call to request payment assistance, like Humira.
Depending on your medication, you could also request your pharmacy to pill split. This means filling a higher strength of your medication and cutting the pills for your dose. An example is if you take 10 mg of a tablet daily but request the 20 mg and split the pill in half. That way you get two doses with one tablet. However, this can’t be done for some medication, including those in capsules or that are timed-release.
What’s brand name versus generic? Is there a difference?
When a new drug is released on the market, there is a period of time where it will be protected by patents, giving the sole right to sell the drug to the company who developed it. This allows for drug companies to gain back some of the enormous cost that goes into research, development, and clinical trials to test the drug. Once these patents expire, generic versions of the name brand can be approved.
A generic is a chemically equivalent alternative to a brand-name product that often costs much less (because much of the testing for safety has already been done). The FDA states that generics are “the same as brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality” along with having the same active ingredients that work the same way. To be sold on the market, generics must prove that their drug is just as safe and effective as the brand name.
However, it’s always possible to react better to one than the other. Although active ingredients may be identical between brand and generic, they could still differ in their non-medicinal ingredients (although companies are required to show these are up to standard too). These can cause allergies or adverse effects in some patients. Don’t let this deter you though; hospitals widely use generics, and when doctors write prescriptions they rarely (if ever) prescribe specifically the brand name.
I’m a busy student, and I always forget to take my medication. Is there something I can do?
There’s always the possibility of using apps to remind you with alarms (which is especially great for oral contraceptives that have to be taken at the same time daily), but there are other pharmacy-related resources too!
Most drug stores offer pill organizers that are arranged into days of the week and can be discrete and portable. A step further than that is to have your pharmacy blister pack your medication. This service is normally free of charge. Blister packs are packages organized into times of day (breakfast, lunch, dinner, bedtime) and days of the week where you pop out your medications as you proceed through the day. This is ideal if you’re on multiple medications that make things hard to keep track of or if you find it hard to take your medication at the correct time. If they interest you, discuss things further with your pharmacy and blister packs can be arranged to be made weekly or monthly.
I can’t see a doctor before I run out of medication. What do I do?
Pharmacists are authorized to give patients emergency supplies depending on the rationale and drug in question. If you run out of medication before an appointment, this is a great way to ensure you have enough before your renewal. This can be requested over the phone or in-person at your pharmacy. Or, if you’ve been on a stable dose of a chronic medication for over six months, pharmacists are authorized to adapt prescriptions to renew them for a short period of time.
Patients can also request pharmacies to contact their doctors via fax to request renewals if they’re unable to see them for some reason. During the COVID-19 pandemic this is especially relevant because many offices that normally don’t accept fax requests are making exceptions.
There’s never been a better time to jump onto the bandwagon for telecommunication medical services. Many offices are adopting this technology to offer remote phone and online consultations for both walk-in and family doctors.
Otherwise, virtual doctors can be convenient and help bridge the gap between appointments with a family doctor. They also offer health care on the weekends where many walk-in clinics might be closed. Apps and services like Access Virtual, Babylon Health, and Vivacare allow you to make appointments for a video consultation with a physician over a webcam or smart device. They’re able to handle simple renewals, prescription antibiotics, and referrals.
I don’t have an appointment with my doctor, but I need medical advice. What do I do?
Rest assured, Google isn’t the only answer! 8-1-1 (or toll-free at 1-800-567-8911) is a phone line that provides free-of-charge provincial health information and advice operated by HealthLink B.C. This hotline connects you to a health service navigator who will take in your information and direct you to the appropriate health-care professional.
This phone service offers registered nurses, registered dietitians, qualified exercise professionals, and pharmacists during hours where a community pharmacist might not be available.
This is especially useful for international or ESL students who might not be able to communicate their health concerns in English, as there are translational services for more than 130 languages.
For those who know of 24-hour pharmacies or locations that are open late, pharmacists are available in person or over the phone to answer questions about medications and give recommendations for over-the-counter products.
What’s the SUS Health & Dental plan?
This is extended health and dental coverage for full-time students of UFV and is compulsory to enrol in unless you can prove you have coverage under a different and equivalent third-party coverage plan. This is paid semesterly and has extensive information for what it covers on the SUS and Studentcare websites. It focuses on vision, dental, prescriptions, and health practitioner services like chiropractors and psychologists. Any questions can be directed to the Studentcare Member Services Centre at 1-866-358-4437 from Monday to Friday.
To have this health insurance plan cover prescriptions directly without having to pay first and be reimbursed, print off or take a picture of the pay-direct card to present to your pharmacy. Your student number will be required as one of the ID numbers.
Through partnerships, you can get the most coverage from your SUS Health & Dental plan by visiting health-care professionals that are part of the Studentcare Network. Rexall also has some additional coverage for Rexall brand products and out-of-pocket drug costs. You’ll still have coverage regardless of whether you choose to go to a practice that’s part of the network or not, but you’ll be able to get additional coverage if you do.
I had to pay upfront for a health care cost. How do I get reimbursed by UFV’s student plan?
Prescription costs can be directly covered by presenting your pay-direct card at a pharmacy. Otherwise payment will need to be upfront (like with vision and dental costs) and reimbursed by filling out and sending a claim form in the mail along with receipts. Or, more conveniently, Studentcare also has an app where the pay-direct card can be accessed, claims can be submitted, and coverage can be checked. This also allows for direct deposit of your reimbursements to your bank account, which is easier than sending an authorization form in the mail.
Can I claim prescriptions on my taxes?
Absolutely. Anyone paying for medical expenses of any kind should be including them on their taxes to receive tax credit. Printouts are available at individual pharmacies for income tax purposes and can be presented to anyone performing your tax return. If you’ve been to multiple pharmacies throughout the year, make sure to receive a printout from each. Receipts saved from dental care and medical supplies can also be claimed.
Where can I get a flu shot? Does it cost money?
Flu shots are released annually based on the strain that is predicted to affect the general public. There are criteria to receive your flu shot for free with a valid personal health number (PHN), but they’re so widely encompassing that not having it covered is a rarity.
It’s important to get a flu shot annually, even if you don’t often get sick, to avoid transmitting it to others — especially those that are immunocompromised or are unable to receive a flu shot themselves. Flu clinics will reliably have vaccines stocked from October to December in preparation for the flu season that begins in February. The reason why pharmacies have an incentive to give flu shots is because for each shot they administer, they’re paid a set fee by PhamaCare. However, as mentioned before, flu shots are essentially free for all B.C. residents.
What are my options if I want to stop smoking?
B.C. has a Smoking Cessation Program that allows anyone with active MSP coverage to receive three consecutive months of nicotine replacement therapy products for free. This is available once per year, resetting on Jan. 1. Products that can be received for free include patches, nicotine gum, lozenges, and inhalers. All that’s needed is to walk into a participating pharmacy and fill out an authorization form that acts as a prescription for a 28-day supply.
Otherwise, other smoking cessation drugs can be prescribed by a doctor (like Champix or Zyban). Once per calendar year, these drugs will be a benefit to PharmaCare similar to those above for up to 12 consecutive weeks — meaning if you’ve reached your deductible or plan maximum, they’ll be partially or fully covered.
During this COVID-19 pandemic, it’s becoming as important as ever to learn how to navigate British Columbia’s health-care system. Whether you’re new to navigating the system in general, new to the province, or just want to learn how to cut costs, getting ahead of the curve and educating yourself can drastically reduce your stress during these unusual circumstances.
Illustration: Mikaela Collins/ The Cascade
Chandy is a biology major/chemistry minor who's been a staff writer, Arts editor, and Managing Editor at The Cascade. She began writing in elementary school when she produced Tamagotchi fanfiction to show her peers at school -- she now lives in fear that this may have been her creative peak.
