Find information about extended health care benefits and Pharmacare for seniors

The Pharmacare card confirms your eligibility for all insured physician, hospital and seniors' benefits. The program is the insurer of last resort.

If you receive health insurance benefits through your employer or a third-party insurance agency, you must first submit your claim to the other insurance prior to submitting your claim to Pharmacare. 

Pharmacare coverage

Benefits under the Pharmacare program include partial or 100 per cent coverage.

Medical surgical supplies or equipment require pre-approval

You may be able to get:

• walking aids;
• artificial eyes and limbs;
• respiratory equipment;
• commodes; and
• manual wheelchairs.

Hearing aids

• 1 hearing aid is allowed in a 4-year period.
• Repair and adjustment of 1 hearing aid with a 12-month warranty.
• No charge for adjustments.
• Batteries are not covered.

Dental care

• The plan is administered by Pacific Blue Cross on behalf of Pharmacare.
• You'll automatically receive you Pacific Blue Cross insurance card once you're eligible and enrolled in Pharmacare.
• Present this card to your dental provider at each visit.
• The plan pays for dentures or rebases once in a 5-year period.
• Coverage is limited to $1,400 in any 2-year period.

Vision care

If you're eligible for Pharmacare, you can get help paying for vision care once every two years. This includes:

• Eye exam: up to $124.10
• Frames: up to $100
• Lenses, depending on the type:
  • Single vision: up to $160
  • Bifocals: up to $185
  • Trifocals: up to $260
  • Progressive lenses: up to $325

If you have private insurance that covers vision care, you must submit your claim to that insurance first. Pharmacare will only cover any remaining amount that is not paid by your insurance, up to the maximum allowed by the program.

How it works

If you have private insurance, you must submit your claim there first. Pharmacare will only cover the remaining amount, up to the maximum allowed.

Example 1: Glasses (lenses and frames)

You buy new glasses that cost $350.

• Your private insurance pays $200.
• Pharmacare allows up to $285 for bifocal lenses and frames.
• Pharmacare may reimburse you for $85, which is the difference between what your insurance paid and the maximum allowed.

If your private insurance pays more than $285, Pharmacare will not provide any reimbursement.

Example 2: Eye exam

You get an eye exam that costs $140.

• Your private insurance pays $100.
• Pharmacare allows up to $124.10 for eye exams.
• You may receive $24.10 from Pharmacare, which is the difference between what your insurance paid and the maximum allowed.

If your insurance already pays the full amount, there is no reimbursement from Pharmacare.

What is not covered

• Repair of glasses.
• Purchase of tinted or contact lenses is not covered.

Prescription medications

Prescription medication coverage

The Pharmacare program will pay the total costs of the lowest priced generics of all prescription drugs. You can find a list of drugs and costs in the Yukon Pharmacare Formulary. The cost includes the dispensing fee. The cost covered includes:

• The drug benefit price
• A wholesale markup (up to 14 percent)
• A pharmacy markup (up to 17.5 per cent, capped at $100)
• A dispensing fee (up to $11)

If you have private insurance

You must submit your claim to your insurer first. Pharmacare acts as the insurer of last resort and will reimburse only the remaining eligible amount.

If you do not have the Pharmacare card with you when making a purchase, you may be charged for the cost of drugs. The program may refund this amount, but you must submit the original prescription receipt.

How it works

If you have private insurance, you must submit your claim there first. Pharmacare will only cover the remaining amount, up to the maximum allowed.

Example 1: Prescription filled with no private insurance

You are prescribed a medication that is on the Yukon Drug Formulary. The cost of the generic version is $50, with $7 added for wholesale markup, $8 for pharmacy markup, and an $11 dispensing fee.

• The total cost is $76.
• You do not have private insurance.
• Pharmacare will cover the full $76, because the drug is listed in the formulary and the added costs fall within the allowed limits.

Example 2: Prescription filled with private insurance

You are prescribed the same medication. The total cost is $76.

• Your private insurance pays $60.
• Pharmacare can cover up to $76 for this prescription.
• Since your insurance paid $60, Pharmacare may reimburse you for $16.

If your insurance had already covered the full $76, there would be no reimbursement from Pharmacare.

Note: Pharmacare only covers the lowest-cost version of a medication. If you choose a more expensive brand when a lower-cost option is available, you may have to pay the difference.

What Pharmacare does not cover

Pharmacare does not cover the cost of products that do not require a prescription, such as:

• vitamins;
• personal care items;
• laxatives; and
• antacids.