Drug Benefit: Understanding Eligibility and Exclusions

11 April 2022

Did You Know?

Acupuncture services provided by a registered acupuncturist are eligible under the Public Service Health Care Plan. No prescription is required.
Read more about the Medical Practicioners Benefit
This article was published before the transition to the new Plan Administrator, Canada Life. If you have any questions, contact the PSHCP Member Contact Centre at 1-855-415-4414 (toll-free anywhere in North America) or 1-431-489-4064 (call collect if you are outside North America).

The PSHCP provides reimbursement to Plan members for eligible expenses as defined under the Plan. To be reimbursed, expenses for drugs must first meet the following conditions under the Drug Benefit:

  • The expenses must be the reasonable and customary charges,
  • Prescribed by a physician, dentist, or other qualified health professional if the applicable provincial/territorial legislation permits them to prescribe the drugs, and
  • Dispensed by a pharmacist or physician.

It is recommended that you consult the Plan Directive for more information on the eligible expenses for drugs and related devices. The document also identifies specific exclusions under the Drug Benefit.

Exclusions

No benefit is payable for:

  • Expenses identified in the General Exclusions and Limitations of the Plan (please refer to the Plan Directive)
  • Experimental drugs
  • Items or products considered to be household remedies
  • Vitamins, minerals, and protein supplements, unless they qualify under Eligible expenses
  • Therapeutic nutrients, unless they qualify under Eligible expenses
  • Diets and dietary supplements, infant foods, and sugar or salt substitutes, unless these qualify under Eligible Expenses
  • Lozenges, mouthwashes, non-medicated shampoos, contact lens care products, and skin cleansers, protectives or emollients
  • Drugs used for cosmetic purposes
  • Drugs used for conditions not recommended by the drug manufacturer (off-label indications)
  • Expenses payable under a provincial/territorial drug plan, regardless of whether the participant is covered by that plan.

Viscosupplement Devices

While viscosupplement devices such as Synvisc and Durolane are injections, they are classified by Health Canada as devices and have not been approved as a drug. Therefore, they are not eligible under the Plan’s Drug Benefit or any other provision of the PSHCP

If you have questions regarding your PSHCP benefits, please contact the PSHCP Call Centre at 1-888-757-7427 (toll-free) or 613-247-5100 (in the National Capital Region). We also encourage members to keep an eye on the PSHCP website for current and important information related to your health care plan.