Deductible reduced

Authority PharmaCare
Details

Leigh called our Office to complain that PharmaCare had raised her deductible to $10,000 because her income could not be verified due to a late tax return caused by a bankruptcy. She had a low income and high prescription costs and was unable to pay for her necessary medications.

Leigh’s bankruptcy trustee had filed her income tax forms late because he thought there may be additional documents to submit to the Canada Revenue Agency (CRA). Leigh was concerned because her prescription costs were $4,500 per month, which she could not afford as she earned around $24,000 per year. Leigh had been unable to resolve her concerns with PharmaCare.

We investigated to determine if PharmaCare’s process was reasonable. PharmaCare informed us that it uses income tax data from two years prior to calculate the coverage a family receives in situations such as this. A family pays their full prescription costs until they reach a level known as a deductible. Once their deductible is reached, PharmaCare begins assisting with eligible costs for the rest of the year. British Columbians with the lowest incomes receive assistance immediately.

PharmaCare told us that Leigh’s deductible had already been extended for 90 days and that her deductible had now defaulted to $10,000 because it was unable to verify her income for 2008. PharmaCare said it was not prepared to consider a further extension as there did not appear to be exceptional circumstances and it had advised Leigh to file a tax return if she wanted to continue to receive assistance.

Leigh told us she did not receive any letters advising her that her deductible would default to $10,000 if she didn’t file her tax return. Leigh explained it was the responsibility of her bankruptcy trustee to file her return. She indicated that the 2008 return had now been filed but she said it would take several weeks for CRA to process it. In the interim Leigh said she could not afford the cost of her prescription drugs.

In response to our investigation, PharmaCare agreed to accept, on an exceptional basis, a copy of Leigh’s 2008 T1 General along with written confirmation from her bankruptcy trustee that the return had now been filed. PharmaCare advised that this would be used to determine Leigh’s financial assistance until her net family income could be verified by CRA. As PharmaCare had extended Leigh’s interim coverage by 60 days, we considered the matter settled.

Category Health
Type Case Summary
Fiscal Year 2010
Location The Lower Mainland