General Pharmacare Questions
What is the Manitoba Pharmacare Program?
Pharmacare provides drug cost assistance to eligible Manitobans who do not have coverage under a federal or other provincial program. Pharmacare is income based, which means a deductible is calculated based on the total adjusted family income. Once the yearly deductible has been reached through the purchase of eligible prescription drugs at a pharmacy, Pharmacare will pay 100 per cent of eligible prescription costs for the remainder of the benefit year. The Pharmacare benefit year is April 1 to March 31 of the following year. In order to be eligible for benefits, an application must be received in our office on or before March 31 of the current benefit year. For information on how to apply to Pharmacare please visit "Applying for Pharmacare".
What is an eligible prescription drug?
An eligible drug is one that is covered by Pharmacare. Not all drugs are eligible. To determine if a drug is eligible for coverage under Pharmacare, please ask a pharmacist or doctor, visit the online Drug Formulary Look Up or contact the Pharmacare office directly at 204-786-7141 or toll free at 1-800-297-8099.
What is an eligible prescription cost? Will my entire prescription count towards my deductible or be paid by Pharmacare?
Eligible prescription costs are used to determine when the yearly deductible has been reached. Once the deductible is reached, Pharmacare will pay 100 per cent of eligible prescription costs for the remainder of the benefit year.
Eligible prescription costs is the ingredient cost of the drug plus any distribution costs plus the costs associated with the dispensing of the drug (the professional fee). Beginning August 18, 2017, the Pharmacare, Home Cancer Drug Program, and Palliative Care Drug Access Programs will accept a professional fee no more than $30.00 or up to $60.00 if the specified drug is a sterile compound.
Can a pharmacy charge me a professional fee more than the amounts listed above? Are there other fees that I may be required to pay for pharmacy services?
Yes, there is no existing legislation that would prohibit a pharmacy from charging a professional fee higher than the amount permitted under Section 1.1 of the Regulation or for other fees that are not reimbursed by Manitoba's public drug plans.
All clients should talk to their pharmacy provider and make an educated decision about what they are willing to pay out-of-pocket. Pharmacists or a pharmacy owner must disclose the total price of the drug and professional fee: (a) to a patient at the patient's request; or (b) to a person responsible to pay for the drug if the person is authorized by law to obtain the information. The requirements were intended to support transparency in professional fees to enable informed decisions by consumers in choosing a pharmacy. In many cases, the professional fee charged by the pharmacy provider may change depending on the medication dispensed.
The following demonstrates how pharmacy fees are applied towards your deductible or which amounts the pharmacy may charge you directly:
Total Ingredient Cost |
Professional Fee |
Amount Applied to your deductible or paid by Pharmacare |
Amount paid by the client out-of-pocket |
$100.00 |
$25.00 |
$125.00 |
$0.00 |
$100.00 |
$30.00 |
$130.00 |
$0.00 |
$100.00 |
$45.00 |
$130.00 |
$15.00 |
Please refer to the definition of “eligible prescription cost” above to understand the maximum amounts that are accepted by the Pharmacare, Home Cancer Drug Program, and Palliative Care Drug Access Programs.
What is a deductible?
A deductible is a specific dollar amount that must be paid each year before Pharmacare coverage begins. The minimum deductible for Pharmacare is $100, with no maximum deductible. Once an application has been processed, Pharmacare will send a notification letter indicating the deductible amount. To calculate a family deductible, please go to the online Pharmacare Deductible Estimator.
What year’s income is used to calculate the 2024/2025 deductible?
The deductible is based on Canada Revenue Agency income information from two years ago. Example: for the 2024/2025 Pharmacare benefit year, Pharmacare would use income information from the 2022 tax year.
How will the Pharmacist know when a deductible has been reached?
The amount paid towards a deductible is tracked by the Drug Programs Information Network (DPIN) computer system. The system will automatically notify the pharmacist once a deductible is met. There is no requirement to submit prescription receipts or send payment for the deductible amount to Pharmacare. The DPIN system also checks each prescription against drug history to help protect Manitobans from adverse drug interactions.
Can a Pharmacare deductible be changed if a family income has dropped this calendar year?
A provision is included in The Prescription Drugs Cost Assistance Act, which allows for an adjustment to be made to the Pharmacare deductible if a family's income is reduced by more than 10 per cent in the 2024 calendar year.
Families with an income change of more than 10 per cent should complete a 2024/2025 Pharmacare Benefit Year Projected Income Worksheet
and return it to our office along with required supporting documentation verifying the change in income. For more information, please call the Pharmacare office at 204-786-7141 or toll free at 1-800-297-8099.
Can a Pharmacare deductible be paid in monthly instalments?
The Deductible Instalment Payment Program for Pharmacare is an option for eligible Manitobans to pay their annual Pharmacare deductible in monthly instalments. This option will give Manitobans who have high monthly drug costs a way to pay their Pharmacare deductible in interest-free monthly instalments as part of their Manitoba Hydro energy bill.
The Deductible Instalment Payment Program for Pharmacare Guideand Application, Consent and Authorization Formare available online, by contacting the program at 204-945-1733 (in Winnipeg) or toll free at 1-888-519-3492 (outside Winnipeg), or at Manitoba pharmacies.
What happens when a Manitoba resident turns 18 years of age?
Manitobans 18 and older are assigned their own Manitoba Health Registration number and will receive a registration certificate in the mail. A Pharmacare Application and Consent Authorization Formshould be completed and sent to the Pharmacare office for processing. Once the application has been processed, Pharmacare will send a notification letter indicating the deductible amount.
How will pension income splitting affect the Pharmacare deductible for one-time enrolment (Option A) clients?
For Option A clients, Pharmacare deductibles will not be affected by pension income splitting. Pharmacare deductibles for the 2024/2025 benefit year are calculated using income from line 150 of the 2022 Canada Revenue Agency Notice of Assessment. When receiving income information from the Canada Revenue Agency, consideration has been given to pension income splitting and procedures are in place to allow for automatic line 210 deductions when applicable.
In the event that you have any questions or concerns please do not hesitate to contact us. Please Note: when contacting us via e-mail, please DO NOT include your Personal Health Information Number (PHIN) for security reasons.
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