Daily Living
The PEI Seniors' Drug Program: Automatic Coverage at 65
PEI automatically enrolls every resident 65+ with a valid Health Card into the Seniors' Drug Program, no application needed. Here is the exact co-pay, what the Pharmacare Formulary covers, and how special authorization works.
1. You Don't Apply, You Just Turn 65
There is no application form and no separate enrollment step. If you're a PEI resident under the Drug Cost Assistance Act, hold a valid PEI Health Card, and turn 65, you're automatically enrolled in the Seniors' Drug Program the day you become eligible.
2. What You Actually Pay
| Cost component | Amount |
|---|---|
| Dispensing fee co-pay | $8.25 per prescription |
| Pharmacy professional fee portion | $7.69 per prescription |
| Remaining cost of the medication | Covered by the program |
Every time you fill an eligible prescription at any community retail pharmacy in PEI, you pay that combined amount out of pocket, the government covers the rest directly.
3. What's Actually Covered
- Medications listed in the PEI Pharmacare Formulary, prescribed by a licensed doctor
- Certain drugs only through the Diabetes Program or the High Cost Drug Program, both administered alongside the main Seniors' Drug Program
| Not covered | What to do instead |
|---|---|
| Medication not listed in the Formulary | It stays fully out-of-pocket unless your prescriber requests special authorization |
| Already-purchased medication | Coverage is not retroactive; you won't be reimbursed for a prescription you paid for before enrollment or before a special authorization was approved |
4. If Your Medication Needs Special Authorization
Some Formulary drugs are only approved case-by-case. Your prescriber or pharmacist submits a Special Authorization Request form directly, you don't file this yourself. Approval isn't automatic, and it isn't backdated, so start this process as early as possible if your doctor prescribes something outside the standard list.
5. If You Have Private Insurance Too
If you also carry a private drug plan, either from a former employer or purchased separately, you or your pharmacy must submit the claim to that private insurer first. Whatever remains unpaid can then go to PEI Pharmacare for assessment. Don't submit to Pharmacare first; claims processed out of that order can be rejected.
6. One Rule That Catches Newcomers Off Guard
Eligibility ends the day you leave PEI to take up residency elsewhere, it isn't a national program, and it doesn't follow you to another province. If you're splitting time between PEI and another country or province, confirm your primary residency status with Health PEI before assuming continuous coverage.