Ostomy Supply Reimbursement In Nova Scotia

Pharmacare Programs and boarding, Transportation & Ostomy Program

The Government of Nova Scotia sponsors various Pharmacare programs; however, ostomy coverage is limited to the following programs:

Seniors’ Pharmacare Program: a provincial drug insurance plan that helps members with the cost of their prescription drugs.
Community Services Pharmacare Program: provides prescription drug coverage, known as Pharmacare, to:
1. Income Assistance clients (which includes Extended Pharmacare and Transitional Pharmacare clients)
2. Disability Support Program clients
3. Children in the care of child welfare through either a district office of the Department of Community Services or a Children’s Aid Society/Family and Children’s Services agency
4. Low-Income Pharmacare for Children clients
Boarding, Transportation and Ostomy Program: a provincial program that helps eligible Nova Scotia residents undergoing cancer treatment with assistance for costs related to boarding, transportation, and ostomy supply needs.

The Nova Scotia government offers no other ostomy supply coverage for the general public.

Am I Eligible?

In general, you may be eligible for the above programs if you:

live in Nova Scotia
have a valid Nova Scotia Health Card

Types of Ostomies Covered:

Permanent functioning colostomy, ileostomy or urostomy

Specific eligibility requirements for each program include:

Seniors' Pharmacare Program

available to all Nova Scotia seniors 65 years or older who do not have private drug coverage (ie. Veteran’s Affairs, NIHB, Family Pharmacare, private insurance)

Community Services Pharmacare Program

provides drug benefits as part of the Income Assistance Programs (including Special Needs Pharmacare and Transitional Pharmacare), the Low Income Pharmacare Program for Children, Services for Persons with Disabilities and the Children in Care Programs. The Department of Community Services determines eligibility.

Boarding, Transportation and Ostomy Program

have a gross family income no greater than $35,000 per year and do not have private insurance that covers the cost of transportation or accommodation.

What is Covered?

The Nova Scotia Formulary lists ostomy supplies covered by these programs. It only covers particular brands of ostomy products. If you are eligible for the above programs, you will receive 100% coverage, unless you are a senior.

SENIORS PHARMACARE PROGRAM:

Members pay for the Seniors Pharmacare Program in two ways: through an annual premium paid directly to the Program, and a co-payment paid at the pharmacy or directly to the Program.

The maximum annual premium any senior will pay is $424. Depending on your income, you may pay a reduced premium or no premium at all. If you receive the Guaranteed Income Supplement (GIS), you do not have to pay a premium unless you have an outstanding balance from the previous year.

Single Seniors

If your annual income is below $22,986, you will not pay a premium. If your annual income is between $22,986 and $35,000, your premium will be reduced from the annual maximum of $424.

Couples

If your joint annual income is below $26,817, you will not pay a premium. If your yearly joint income is between $26,817 and $40,000, your premium will be reduced from the annual maximum of $424. Please use the online calculator to learn more about what your premium will cost:

COST CALCULATOR

How to Apply for Nova Scotia Coverage

SENIORS PROGRAM

You should automatically receive a Seniors’ Pharmacare Program information package two to three months before your 65th birthday.
To join the Program, complete and return the application no later than 90 days of the first day of the month you turned 65. For example: if your birthday is January 19, you must complete and return your forms before April 1.
Once you are enrolled, your Nova Scotia Health Card becomes your Pharmacare Card.

Cancer Program: complete the following form, which you can find online:
https://novascotia.ca/dhw/pharmacare/cancer-assistance.asp

Authorizers

You will need an assessment & authorization by a physician, nurse practitioner or pharmacist.

Purchasing Ostomy Supplies

Ostomy supplies are purchased through third-party suppliers.
You must purchase ostomy supplies listed on the government’s approved supply list.
Please look at the following link for more details on the covered products: https://novascotia.ca/dhw/pharmacare/formulary.asp

Reimbursement Procedure

All members in the Senior’s Program must pay a co-payment, even if you don’t pay a premium or if you have a reduced premium. The co-payment is 30 percent of the total cost of each prescription. For example, if the total cost of your prescription is $50, you will pay 30 percent, which would be $15. The balance is charged directly to the Program.

The maximum annual co-payment is $382. Once you have paid that much in a year, you will not have to pay any more until the next Program year. The Program year is from April 1 to March 31.

Contact Information:

NOVA SCOTIA PHARMACARE PROGRAMS

PO Box 9322
Halifax NS B3K 6A1

Phone: 902-429-6565
Toll-free: 1-800-544-6191
Fax: 902-468-9402

Disclaimer: The information contained in this page have been researched and sourced from a variety of provincial and federal sites. However information may change and we encourage individuals to check for updates of policies, plans and forms.

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