Newfoundland and Labrador
Prescription Drug Program
65 Plus Plan
WHAT IS THE 65 PLUS PLAN?
The 65 Plus Plan is a provincially funded drug program that
pays for approved benefits for eligible seniors.
Only the person named on the card is eligible for benefits purchased within the
province of Newfoundland and Labrador.
WHO IS ELIGIBLE FOR BENEFITS UNDER THE 65 PLUS PLAN?
You are eligible for the Newfoundland and Labrador Prescription Drug Program (NLPDP) card if:
- You are a resident of Newfoundland and
Labrador; and
- You are 65 years of age and older; and
- You are registered with Old Age Security,
Division of Income Security Programs, and receive the Guaranteed Income
Supplement (GIS).
If you have limited residency in Canada, and do not qualify for Old Age
Security, you may apply for coverage. You may request a special application form
from:
NLPDP Assessment Office
P.O. Box 510
Stephenville, NL
A2N 3B4
Tel: 1-888-859-3535 Fax: 1-888-272-2444
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 the NLPDP.
However, if you have 65 Plus Coverage and
coverage under a
Private Health Insurance Plan, you may be able to use both the NLPDP 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 coverage you will automatically receive a letter from NLPDP
in the mail. Once you return the completed response portion of the letter which indicates you wish to participate in the plan, a card will be mailed to you. You will be eligible for benefits from the effective date indicated in the letter you will receive with your card.
WHAT ITEMS ARE COVERED BY THE 65 PLUS 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 65 PLUS 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 65 PLUS 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 NLPDP Assessment Office of the Department of
Health and Community Services at 1-888-859-3535, in these cases, so that appropriate arrangements
can be made.
INFORMATION ON THE PROGRAM
Questions concerning claims or benefits should be directed to:
Newfoundland and Labrador Prescription Drug Program
65 Plus Plan
P.O. Box 8070, Postal Station A
St. John's, NL
A1B 4A6
Telephone: (709) 753-3615 Facsimile: (709) 739-2929
Questions and comments about the policies of the program should be referred to
the:
Pharmaceutical Services Division
Department of Health and Community Services
Government of Newfoundland & Labrador
P.O. Box 8700
St. John's, Newfoundland
A1B 4J6
Telephone: (709) 729-6507 Facsimile: (709) 729-5824
Ostomy Subsidy Program
The 65 Plus Plan 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:
Ostomy Subsidy Program
Newfoundland and Labrador Prescription Drug Plan
P.O. Box 8070, Postal Station A
St. John’s, NL
A1B 4A6
Telephone: (709) 753-3615
Toll Free: 1-888-724-7760
Fax: (709) 739-2929
Detailed information on this Program can also be found on our webpage at
www.health.gov.nl.ca/health/nlpdp “Prescription Drug Program Overview”.
|
