Newfoundland and Labrador Prescription Drug Program

Note: If you are already entitled to benefits under any other public program (for example, the Department of Veteran’s affairs), you are not eligible for coverage under our Seniors Plan.

However, if you have the senior citizens drug subsidy card and coverage under a Private Health Insurance Plan, you may be able to use both the drug subsidy card and your insurance plan to co-ordinate your benefits. However, NLPDP is the payor of last resort. This means  that if you do have private insurance, you are required to bill your private insurance first. In these situations, NLPDP will cover up to the amount of any benefit product that is not covered by the private plan, provided the balance does not exceed the amount NLPDP would have paid if you did not have another insurance plan.

HOW DO I APPLY FOR THE GUARANTEED INCOME SUPPLEMENT?

There are two ways to apply for the Guaranteed Income Supplement:

• You can request an application form from Income Security Programs, Federal Government by calling the toll free number   1-800-277-9914.

• You can indicate on your application for the Old Age Security pension that you want to apply for the Guaranteed Income Supplement.

Please note: If you did not qualify for the Guaranteed Income Supplement in the past, but think you might be eligible now, you should apply as soon as possible.

HOW WILL I KNOW IF I QUALIFY FOR A DRUG CARD?

If you qualify for the Supplement, you will automatically receive a Seniors Drug Card in the mail. You will be eligible for benefits under the Seniors Drug Plan from the effective date shown on the card. You must present your card to your pharmacist with your prescription.

WHAT ITEMS ARE COVERED BY THE SENIOR CITIZEN DRUG SUBSIDY PLAN?

The Plan covers most drugs which by law require a prescription. Some drugs require special authorization from the Pharmaceutical Services Division of the Department of Health and Community Services. If special authorization is required, your pharmacist, physician, dentist, or nurse practitioner must complete a “Special Authorization Request Form”, on your behalf, and forward it by mail or fax, to the Pharmaceutical Services Division,  for review. Once the review has been completed, the pharmacist, physician, dentist, or nurse practitioner will be advised whether the request has been approved or denied.

The Plan will also cover a small number of other items which do not legally require a prescription. This small number of items will be covered by the Plan only when prescribed by a physician or nurse practitioner.

Your pharmacist has a list of the benefit items. This list can be found on our website at:   www.health.gov.nl.ca/health/nlpdp/

WHAT ITEMS ARE NOT COVERED UNDER THE SENIOR CITIZENS DRUG SUBSIDY PLAN?

The following items are not considered for coverage under the Plan:

• Most non-prescription drugs which may be purchased over the counter without a prescription (for example, vitamins and laxatives).

• Prescription cough syrups and medicines for coughs and cold symptoms.

• Single doses of injectables or other medications provided or administered by a

• doctor, dentist or nurse practitioner in a  home or office visit.

• Smoking cessation products.

• Anti-obesity agents..

• Prosthetics such as hearing aids, eye glasses, dentures, splints or orthotics.

• First aid supplies and dressings.

• Dietary supplements and food products.

• Cosmetics, soaps and beauty aids.

• Delivery, postal or C.O.D. charges.

WHAT PART OF THE PRESCRIPTION COST DOES GOVERNMENT PAY?

Normally the cost of a prescription consists of two parts - a charge for the drug ingredient plus a charge for professional services. Government will pay for the cost of the drug ingredient.

WHAT PART OF THE PRESCRIPTION COST DOES THE PATIENT PAY?

When you get a prescription filled, you are required to pay the pharmacist:

• Surcharge - applied to the drug cost, this can be up to a maximum of 10% of the drug cost and can only be charged by the pharmacy if the drug cost exceeds $30.00.

• The professional services fee. This charge covers the dispensing fee, the pharmacy’s expenses and professional services.

• Any difference in cost between the lowest priced generic and any other generic drug in a particular category.

ARE DRUGS PURCHASED OUTSIDE THE PROVINCE COVERED UNDER THE SENIOR CITIZENS DRUG SUBSIDY PLAN?

NO: The Plan only applies to benefits purchased within the province of Newfoundland and Labrador. If you plan to be out of the province, take a supply of your medications with you.

Since the Newfoundland and Labrador Prescription Drug Program does not pay for prescriptions that you get outside of Newfoundland and Labrador, you should consider obtaining insurance coverage before you leave, in the event that you require additional/new medications during the course of your travel.

If an individual is medically referred, by their physician, out of province for medical treatment, coverage of medications may be considered. Prior approval must be sought from the Pharmaceutical Services Division of the Department of Health and Community Services, in these cases, so that appropriate arrangements can be made.

INFORMATION ON THE PROGRAM

Questions concerning claims or benefits should be directed to:

Questions and comments about the policies of the program should be referred to the:

Ostomy Subsidy Program

Your Senior Citizen’s Drug Subsidy Plan card also entitles you to receive benefits of the Ostomy Subsidy Program. The Ostomy Subsidy Program will reimburse eligible seniors for 75% of the retail cost of certain ostomy supplies with the remaining cost being the responsibility of the senior.

If you require general information or have questions concerning claims or benefits, please contact: