Prescription Drugs Regulations, 1993, P-23 Reg 3

1 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 The Prescription Drugs Regulations, 1993 being Chapter P-23 Reg 3 (effective March 19, 1993) as amended by Saskatchewan Regulations 23/1997, 60/1998, 87/1998, 63/1999, 47/2000, 53/2002, 65/2003, 39/2004, 56/2004, 63/2004, 51/2005, 54/2007, 53/2008 and 25/2017. NOTE: This consolidation is not official. Amendments have been incorporated for convenience of reference and the original statutes and regulations should be consulted for all purposes of interpretation and application of the law. In order to preserve the integrity of the original statutes and regulations, errors that may have appeared are reproduced in this consolidation. 2 P-23 REG 3 PRESCRIPTION DRUGS, 1993 Table of Contents 1 Title 10.17 Commencement of benefits 2 Interpretation 10.2 Alternative calculation – senior benefit 2.1 Application of regulations 10.3 Children’s drug benefit 3 Restriction 10.4 Alternative calculation – children’s drug benefit 3.1 Application re designated medical supplies 11 Special conditions 3.2 Maximum allowable cost groups 12 Income-based general coverage 4 Recognized drug price calculation 12.1 Calculation of benefits 5 Child-related benefits 12.2 Calculation of threshold co-payment factor 5.1 Alternative calculation– child-related benefits 12.3 Determination of threshold co-payment benefit 6 Saskatchewan Income Plan 12.4 Calculation of threshold co-payment 6.1 Alternative calculation – Saskatchewan Income Plan 12.5 Calculation of family unit income 7 Guaranteed Income Supplement 12.6 Request for recalculation 7.1 Alternative calculation – Guaranteed Income 12.7 Recalculation initiated by minister Supplement – general 12.8 Repealed 7.2 Alternative calculation – Guaranteed Income 12.81 Repealed Supplement – special care homes 12.9 Repealed 8 Incremental Drug Price Difference 13 Out of province and non-participating pharmacies 9 Saskatchewan Assistance Plan Supplementary 13.1 Benefits where Hepatitis C Settlement Agreement Health Benefits applies 10 Special assistance 13.2 Database re drugs 10.1 Senior benefit 14 R.R.S c.P-23 Reg 2 repealed 10.11 Eligibility for senior benefit 10.12 Application for senior benefit Appendix 10.13 Verification of income 10.14 Whether further application required 10.15 Request for reconsideration 10.16 Recconsideration initiated by minister 3 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 CHAPTER P-23 REG 3 The Prescription Drugs Act Title 1 These regulations may be cited as The Prescription Drugs Regulations, 1993. Interpretation 2(1) In these regulations: (a) “Act” means The Prescription Drugs Act; (b) “benefit period” means: (i) any period commencing on January 1 in one year and ending on June 30 in the same year; or (ii) any period commencing on July 1 in one year and ending on December 31 in the same year; (b.1) “children’s drug benefit” means the benefit that may be provided pursuant to subsection 10.3(2) with respect to a child as defined in clause 10.3(1) (a); (c) Repealed. 12 Jly 2002 SR 53/2002 s3. (d) Repealed. 3 Jly 98 SR 60/98 s3. (e) “family unit” means: (i) a resident; (ii) the spouse of the resident mentioned in subclause (i), if any, if the spouse is a resident; and (iii) any dependent child of the resident or the resident’s spouse: (A) whose principal residence is the same as that of the resident or the resident’s spouse; and (B) who is less than 18 years of age; (f) “Guaranteed Income Supplement” means the program established pursuant to the Old Age Security Act (Canada); (g) “interchangeable group” means a group of drugs that: (i) are interchangeable pharmaceutical products as defined in section 2 of The Pharmacy Act, 1996; and (ii) are identified in the formulary as being interchangeable with each other. (h) Repealed. 13 Aug 99 SR 63/1999 s3. 4 P-23 REG 3 PRESCRIPTION DRUGS, 1993 (h.1) “maximum allowable cost group” means a group of drugs designated as a maximum allowable cost group by the minister pursuant to subsection 3.2(1); (h.2) “maximum allowable cost per unit” means the maximum allowable cost per unit designated by the minister pursuant to subsection 3.2(2) for drugs in a maximum allowable cost group; (i) “participating pharmacy” means a pharmacy with respect to which there is an agreement mentioned in section 5 of the Act between the minister and a person operating a participating pharmacy; (j) “prescription charge” means an amount that a person who operates a participating pharmacy is charging persons in accordance with the agreement mentioned in clause (i); (k) “recognized drug price” with respect to a drug, means the amount calculated for the drug pursuant to section 4; (l) “Saskatchewan Assistance Plan” means the program established pursuant to The Saskatchewan Assistance Act; (m) Repealed. 7 Apr 2017 SR 25/2017 s3. (m.1) “senior” means a resident who is 65 year of age or older; (m.2) “senior benefit” means the benefit that may be provided pursuant to subsection 10.1(2) to a senior; (m.3) “Seniors Income Plan” means the program established pursuant to The Saskatchewan Income Plan Act; (n) Repealed. 13 Aug 99 SR 63/1999 s3. (2) Notwithstanding clause (1)(e), a spouse may elect to be treated as a family unit composed of only the spouse. (3) For the purposes of section 3.3 of the Act, a preparation of drugs containing codeine phosphate as described in subsection 36(1) of the Narcotic Control Regulations (Canada) is designated. 11 Jne 93 cP-23 Reg 3 s2; 3 Jly 98 SR 60/98 s3; 13 Aug 99 SR 63/1999 s3; 12 Jly 2002 SR 53/2002 s3; 9 Jly 2004 SR 56/2004 s3; 6 Jly 2007 SR 54/2007 s3; 27 Jne 2008 SR 53/2008 s3; 7 Apr 2017 SR 25/2017 s3. Application of regulations 2.1(1) Subject to subsections (2) and (3), these regulations apply only to drugs that are listed in the formulary. (2) With respect to drugs listed in Appendix A of the formulary, these regulations apply if: (a) a practitioner who is authorized pursuant to an Act to prescribe the drug or a pharmacist applies, on behalf of a person who is a member of a family unit, for coverage for that drug pursuant to the Exception Drug Status Program; and (b) the person on whose behalf an application mentioned in clause (a) is made is approved for coverage for that drug by the minister applying the criteria set pursuant to section 5.1 of the Act. 5 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (3) Section 13.2 and the Appendix apply: (a) to all drugs that are prescribed or dispensed to subject individuals as defined in section 3.3 of the Act in Saskatchewan; and (b) to all designated drugs that are sold to subject individuals as defined in section 3.3 of the Act in Saskatchewan. 12 Jly 2002 SR 53/2002 s4; 6 Aug 2004 SR 63/2004 s3; 7 Apr 2017 SR 25/2017 s4. Restriction 3(1) A family unit is not eligible for benefits pursuant to the program established by the Act if it is eligible to receive or to have payment made for drugs the family unit requires from: (a) the Government of Saskatchewan or any agency of it, other than pursuant to the Act; (b) the Government of Canada or any agency of it; or (c) the government of any other province or territory of Canada or any agency of it. (2) A senior is not eligible for the senior benefit if the senior is eligible to receive or to have payment made for drugs that the senior requires from: (a) the Government of Saskatchewan or any agency of it, other than pursuant to the Act; (b) the Government of Canada or any agency of it; or (c) the government of any other province or territory of Canada or any agency of it. 11 Jne 93 cP-23 Reg 3 s3; 6 Jly 2007 SR 54/2007 s4. Application re designated medical supplies 3.1(1) If a member of a family unit that is eligible for benefits pursuant to these regulations is an eligible person as defined in The Drug Plan Medical Supplies Regulations, all amounts to be calculated pursuant to these regulations with respect to that person are to be calculated as if designated medical supplies, as defined in The Drug Plan Medical Supplies Regulations, obtained from a pharmacy were drugs. (2) Without limiting the generality of subsection (1), if a senior who is eligible for the senior benefit is an eligible person as defined in The Drug Plan Medical Supplies Regulations, all amounts to be calculated pursuant to these regulations with respect to the senior or the senior’s family unit are to be calculated as if any designated medical supplies obtained by the senior from a pharmacy were drugs to which the senior benefit applies. 18 Jly 2003 SR 65/2003 s3; 6 Jly 2007 SR 54/2007 s5. 6 P-23 REG 3 PRESCRIPTION DRUGS, 1993 Maximum allowable cost groups 3.2(1) The minister may, from time to time, in the formulary designate groups of drugs as maximum allowable cost groups if, on the advice of persons with relevant expert knowledge, the minister is satisfied that each of the drugs in the group is of similar therapeutic effect. (2) The minister shall, in the formulary, designate a maximum allowable cost per unit for drugs in a maximum allowable cost group designated pursuant to subsection (1). 9 Jly 2004 SR 56/2004 s4. Recognized drug price calculation 4(1) If a drug dispensed is not part of an interchangeable group or a maximum allowable cost group, the recognized drug price for the drug dispensed is the amount RDP calculated in accordance with the following formula: RDP = (N x AP) + M + ADF where: N is the number of units of the drug dispensed; AP is the actual price per unit charged by the person operating the participating pharmacy for the brand of drug dispensed, to a maximum of the price per unit indicated for that drug in the formulary; M is the maximum mark-up that a person operating a participating pharmacy may charge, in accordance with an agreement mentioned in section 5 of the Act, on the number of units of the brand of drug dispensed; and ADF is the actual dispensing fee charged by the person operating the participating pharmacy for the brand of drug dispensed, to a maximum of the maximum dispensing fee that may be charged in accordance with an agreement mentioned in section 5 of the Act. (2) If a drug dispensed is part of an interchangeable group and is not part of a maximum allowable cost group, the recognized drug price for the drug dispensed is the amount RDP calculated in accordance with the following formula: RDP = (N x APB) + MIC + ADF where: N is the number of units of the drug dispensed; APB is the actual price per unit charged by the person operating the participating pharmacy for the brand of drug dispensed, to a maximum of the price per unit for the lowest priced brand of drug in the same interchangeable group as the drug dispensed; MIC is the maximum mark-up that could be charged by a person operating a participating pharmacy, in accordance with an agreement mentioned in section 5 of the Act, if, rather than dispensing the brand of drug dispensed, the person operating the pharmacy had dispensed the lowest priced brand of drug in the same interchangeable group as the drug prescribed in the same number of units as the drug prescribed; and 7 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 ADF is the actual dispensing fee charged by the person operating the participating pharmacy, for the brand of drug dispensed, to a maximum of the maximum dispensing fee that may be charged in accordance with an agreement mentioned in section 5 of the Act. (3) If a drug dispensed is part of a maximum allowable cost group, the recognized drug price for the drug dispensed is the amount RDP calculated in accordance with the following formula: RDP = (N x APC) + MMAC + ADF where: N is the number of units of the drug dispensed; APC is the actual price per unit charged by the person operating the participating pharmacy for the brand of drug dispensed, to a maximum determined in accordance with subsection (4); MMAC is the maximum mark-up that could be charged by a person operating a participating pharmacy, in accordance with an agreement mentioned in section 5 of the Act, if, rather than dispensing the brand of drug dispensed, the person operating the pharmacy had dispensed, in a quantity having the same therapeutic effect as the number of units of the drug prescribed, a drug that did not exceed the maximum allowable cost per unit for the maximum allowable cost group to which the drug prescribed belongs; and ADF is the actual dispensing fee charged by the person operating the participating pharmacy, for the brand of drug dispensed, to a maximum of the maximum dispensing fee that may be charged in accordance with an agreement mentioned in section 5 of the Act. (4) For the purposes of subsection (3), the maximum value of APC is the lowest of the following values, as of the date on which the drug was dispensed: (a) the maximum allowable cost per unit for drugs in the maximum allowable cost group to which the drug dispensed belongs; (b) the maximum price per unit indicated in the formulary for the drug dispensed; (c) if the drug dispensed is also a member of an interchangeable group, the maximum price per unit for the lowest priced brand of drug in the interchangeable group to which the drug dispensed belongs. 9 Jly 2004 SR 56/2004 s5. 8 P-23 REG 3 PRESCRIPTION DRUGS, 1993 Child-related benefits 5(1) For any benefit period commencing on or after August 1, 1998 but before August 1, 1999, a family unit receiving benefits pursuant to The Child Benefit Regulations, The Employment Supplement Regulations of The Benefit Adjustment Regulations is eligible to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, in the amount B calculated in accordance with the following formula: B = 0.65 (ARDP – $100) where ARDP is the sum of all recognized drug prices for: (a) drugs obtained by a family unit during a benefit period from participating pharmacies; and (b) drugs obtained by the family unit during a benefit period for which the family unit is entitled to reimbursement pursuant to section 13. (2) Subject to section 5.1, for any benefit period commencing on or after August 1, 1999, a family unit residing in Saskatchewan is eligible to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, in the amount B calculated in accordance with the formula set out in subsection (1), if the family unit is receiving: (a) benefits pursuant to The Employment Supplement Regulations; (b) Repealed. 7 Apr 2017 SR 25/2017 s5. (b.1) benefits pursuant to The Rental Housing Supplement Regulations; (b.2) benefits pursuant to The Disability Housing Supplement Regulations, and the family unit includes a child who is an eligible individual within the meaning of those regulations; or (c) a refund of an overpayment deemed to have arisen pursuant to section 122.61 of the Income Tax Act (Canada), where the adjusted income, as defined in section 122.6 of that Act, for the taxation year of the eligible individual, as defined in section 122.6 of that Act, does not exceed: (i) for an eligible individual with one qualified dependant, $29,290.73; (ii) for an eligible individual with two qualified dependants, $29,290.73; (iii) for an eligible individual with three qualified dependants, $29,290.73; (iv) for an eligible individual with four qualified dependants, $30,682.16; (v) for an eligible individual with five qualified dependants, $32,073.57; (vi) for an eligible individual with six qualified dependants, $33,464.97; (vii) for an eligible individual with seven qualified dependants, $34,856.40; (viii) for an eligible individual with eight qualified dependants, $36,247.81; 9 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (ix) for an eligible individual with nine qualified dependants, $37,639.25; (x) for an eligible individual with 10 qualified dependants, $39,030.65; (xi) for an eligible individual with 11 qualified dependants, $41,487.27; (xii) for an eligible individual with 12 qualified dependants, $43,943.87; (xiii) for an eligible individual with 13 qualified dependants, $46,400.48; (xiv) for an eligible individual with 14 qualified dependants, $48,857.09; (xv) for an eligible individual with 15 or more qualified dependants, $51,313.70. (3) Repealed. 12 Jly 2002 SR 53/2002 s5. 13 Aug 99 SR 63/1999 s4; 12 Jly 2002 SR 53/2002 s5; 18 Jly 2003 SR 65/2003 s4; 18 Jne 2004 SR 39/2004 s2; 10 Jne 2005 SR 51/2005 s3; 7 Apr 2017 SR 25/2017 s5. Alternative calculation – child-related benefits 5.1(1) Subject to subsection (2), a family unit that is eligible pursuant to subsection 5(2) to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, may apply to have the family unit’s entitlement to benefits calculated in accordance with sections 12 to 12.7. (2) In applying sections 12 to 12.7 for the purposes of subsection (1), the threshold co-payment of a family unit is the lesser of: (a) the amount TC calculated in accordance with section 12.4; and (b) $200. (3) If a family unit’s entitlement to benefits calculated in accordance with sections 12 to 12.7 is greater than the amount determined pursuant to subsection 5(2), the family unit is entitled to receive benefits in the greater amount. 18 Jly 2003 SR 65/2003 s5. Saskatchewan Income Plan 6(1) to (4) Repealed. 13 Aug 99 SR 63/1999 s5. (5) Subject to section 6.1, for any benefit period commencing on or after July 1, 1993, a family unit: (a) that is receiving benefits pursuant to the Seniors Income Plan; and (b) to which clause 10(2)(e) does not apply; 10 P-23 REG 3 PRESCRIPTION DRUGS, 1993 is eligible to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, in the amount B calculated in accordance with the formula: B = 0.65(ARDP – $100) where ARDP is the sum of all recognized drug prices for: (a) drugs obtained by a family unit during a benefit period from participating pharmacies; and (b) drugs obtained by the family unit during a benefit period for which the family unit is entitled to reimbursement pursuant to section 13. 11 Jne 93 cP-23 Reg 3 s6; 13 Aug 99 SR 63/1999 s5; 12 Jly 2002 SR 53/2002 s6; 18 Jly 2003 SR 65/2003 s6; 7 Apr 2017 SR 25/2017 s6. Alternative calculation – Saskatchewan Income Plan 6.1(1) Subject to subsection (2), a family unit that is eligible pursuant to subsection 6(5) to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, may apply to have the family unit’s entitlement to benefits calculated in accordance with sections 12 to 12.7. (2) In applying sections 12 to 12.7 for the purposes of subsection (1), the threshold co-payment of a family unit is the lesser of: (a) the amount TC calculated in accordance with section 12.4; and (b) $200. (3) If a family unit’s entitlement to benefits calculated pursuant to sections 12 to 12.7 is greater than the amount determined pursuant to subsection 6(5), the family unit is entitled to receive benefits in the greater amount. 18 Jly 2003 SR 65/2003 s7. Guaranteed Income Supplement 7(1) to (8) Repealed. 13 Aug 99 SR 63/1999 s6. (9) Subject to section 7.1, for any benefit period commencing on or after July 1, 1993, a family unit that includes at least one member: (a) who is receiving the Guaranteed Income Supplement; and (b) to whom section 6 and clause 10(2)(e) do not apply; is eligible with respect to each benefit period to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, in the amount B calculated in accordance with the formula prescribed in subsection (10). (10) For the purposes of subsection (9): B = 0.65(ARDP – $200) 11 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 where ARDP is the sum of all recognized drug prices for: (a) drugs obtained by a family unit during a benefit period from participating pharmacies; and (b) drugs obtained by the family unit during a benefit period for which the family unit is entitled to reimbursement pursuant to section 13. (11) Subject to section 7.2, for any benefit period commencing on or after July 1, 1993, a family unit that includes at least one member: (a) who resides in a special-care home within the meaning of The Facility Designation Regulations; (b) who is receiving the Guaranteed Income Supplement; and (c) to whom section 6 and clause 10(2)(e) do not apply; is eligible with respect to each benefit period to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, in the amount B calculated in accordance with the formula prescribed in subsection (12). (12) For the purposes of subsection (11): B = 0.65(ARDP – $100) where ARDP is the sum of all recognized drug prices for: (a) drugs obtained by a family unit during a benefit period from participating pharmacies; and (b) drugs obtained by the family unit during a benefit period for which the family unit is entitled to reimbursement pursuant to section 13. 11 Jne 93 cP-23 Reg 3 s7; 13 Aug 99 SR 63/1999 s6; 12 Jly 2002 SR 53/2002 s7; 18 Jly 2003 SR 65/2003 s8; 7 Apr 2017 SR 25/2017 s7. Alternative calculation – Guaranteed Income Supplement – general 7.1(1) Subject to subsection (2), a family unit that is eligible pursuant to subsection 7(9) to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, may apply to have the family unit’s entitlement to benefits calculated in accordance with sections 12 to 12.7. (2) In applying sections 12 to 12.7 for the purposes of subsection (1), the threshold co-payment of a family unit is the lesser of: (a) the amount TC calculated in accordance with section 12.4; and (b) $400. (3) If a family unit’s entitlement to benefits calculated pursuant to sections 12 to 12.7 is greater than the amount determined pursuant to subsection 7(9), the family unit is entitled to receive benefits in the greater amount. 18 Jly 2003 SR 65/2003 s9. 12 P-23 REG 3 PRESCRIPTION DRUGS, 1993 Alternative calculation – Guaranteed Income Supplement – special care homes 7.2(1) Subject to subsection (2), a family unit that is eligible pursuant to subsection 7(11) to receive reimbursement from the minister, or to have payment made on the family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit, may apply to have the family unit’s entitlement to benefits calculated in accordance with sections 12 to 12.7. (2) In applying sections 12 to 12.7 for the purposes of subsection (1), the threshold co-payment of a family unit is the lesser of: (a) the amount TC calculated in accordance with section 12.4; and (b) $200. (3) If a family unit’s entitlement to benefits calculated pursuant to sections 12 to 12.7 is greater than the amount determined pursuant to subsection 7(11), the family unit is entitled to receive benefits in the greater amount. 18 Jly 2003 SR 65/2003 s9. Incremental Drug Price Difference 8 For the purposes of sections 9, 10, 10.1, 10.3 and 11, “incremental drug price difference” means any positive amount calculated in accordance with the formula: IDP = [(N x AP) + M + ADF] – RDP where: IDP is the incremental drug price difference; N is the number of units of the drug dispensed; AP is the actual price per unit charged by a person operating a participating pharmacy, for the brand of drug dispensed, to a maximum of the price per unit indicated for that drug in the formulary; M is the maximum mark-up that a person operating a participating pharmacy may charge, in accordance with an agreement mentioned in section 5 of the Act, on the number of units of the brand of drug dispensed; ADF is the actual dispensing fee charged by a person operating a participating pharmacy, for the brand of drug dispensed, to a maximum of the maximum dispensing fee that may be charged in accordance with an agreement mentioned in section 5 of the Act; and RDP is the recognized drug price for the drug dispensed. 11 Jne 93 cP-23 Reg 3 s8; 6 Jly 2007 SR 54/2007 s6; 27 Jne 2008 SR 53/2008 s4. 13 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 Saskatchewan Assistance Plan Supplementary Health Benefits 9(1) For the purposes of subsection (2), “family unit” does not include those persons who meet the criteria in subclause 2(1)(e)(iii). (2) Subject to subsection (3), a family unit that is receiving benefits pursuant to The Saskatchewan Assistance Plan Supplementary Health Benefits Regulations, being Saskatchewan Regulation 65/66, is eligible: (a) subject to clause (b), to obtain a drug from a participating pharmacy on payment to the pharmacy of $2 plus the incremental drug price difference, if any; and (b) to obtain from a participating pharmacy any insulin, oral hypoglycaemic, urine testing agent, injectable vitamin B-12 or birth control pill, that is a drug listed in the formulary, on payment to the pharmacy of only any incremental drug price difference and without payment of a prescription charge. (3) A family unit described in section 5 is not eligible to receive any benefits pursuant to this section. 11 Jne 93 cP-23 Reg 3 s9; 3 Jly 98 SR 60/98 s5; 18 Dec 98 SR 87/98 s4; 13 Aug 99 SR 63/1999 s7; 12 Jly 2002 SR 53/2002 s8. Special assistance 10(1) For the purposes of this section: (a) “intensive personal care” means assistance provided to a non- ambulatory person with respect to personal hygiene, dressing, grooming and other similar assistance; (b) “limited nursing care” means care, beyond the giving of personal care services, that an operator of a special-care home undertakes to provide to residents who are ambulant, semi-ambulant or non-ambulant, and includes bathing, giving enemas, giving minor treatments, administering medications, feeding, bed-positioning, ambulation and other simple activating procedures; (c) “limited personal care” means assistance provided to an ambulatory person with respect to personal hygiene, dressing, grooming and other similar assistance; (d) “long-term care” means care that, because of injury, illness or disability, is required over a prolonged period and is carried out under continuing medical supervision or nursing supervision. 14 P-23 REG 3 PRESCRIPTION DRUGS, 1993 (2) The following persons are entitled to obtain a drug from participating pharmacies on payment to the pharmacy of only any incremental drug price difference and without payment of a prescription charge: (a) a person who is receiving benefits pursuant to The Saskatchewan Assistance Plan Supplementary Health Benefits Regulations, being Saskatchewan Regulation 65/66, and who: (i) is a resident and is a member of a family unit that obtains five or more drugs per month on a continuing basis, as verified by a duly qualified medical practitioner, and is required to pay a corresponding number of prescription charges per month; or (ii) is not a resident; (b) Repealed. 3 Jly 98 SR 60/98 s6. (c) a dependent child of a family unit mentioned in subsection 9(2); (c.1) a dependent child who is a member of a family unit mentioned in section 5; (d) a resident who is receiving benefits pursuant to The Saskatchewan Assistance Plan Supplementary Health Benefits Regulations, being Saskatchewan Regulation 65/66, and who resides in: (i) a special-care home within the meaning of The Facility Designation Regulations; (ii) a private-service home or a residential-service facility for which a licence or certificate of approval is issued pursuant to The Residential Services Act; or (iii) a mental health approved home as defined in The Mental Health Services Act; (e) a resident who resides in a special-care home within the meaning of The Facility Designation Regulations and who: (i) requires: (A) limited personal care; (B) intensive personal care and limited nursing care; or (C) long-term care; (ii) either: (A) is receiving benefits pursuant to The Saskatchewan Income Plan Act; or (B) has no income or has income in an amount that would make the resident eligible to receive benefits pursuant to The Saskatchewan Income Plan Act; and (iii) in the opinion of the minister, requires the benefit described in this subsection; (f) a resident who: (i) is the subject of an agreement made pursuant to section 9 or 10 of The Child and Family Services Act; 15 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (ii) has been voluntarily committed to the Minister of Social Services pursuant to section 46 of The Child and Family Services Act; or (iii) is described in subsection 52(1) of The Child and Family Services Act; (g) a resident who is: (i) a person who is being provided with services pursuant to section 56 of The Child and Family Services Act; (ii) a person in relation to whom assistance is being provided pursuant to The Adoption Regulations, 2003; or (iii) an inmate of a correctional facility within the meaning of The Correctional Services Act, 2012. 11 Jne 93 cP-23 Reg 3 s10; 2 May 97 SR 23/97 s2; 3 Jly 98 SR 60/98 s6; 10 Jne 2005 SR 51/2005 s4; 7 Apr 2017 SR 25/2017 s8. Senior benefit 10.1(1) In this section: (a) “drug” includes designated medical supplies as defined in The Drug Plan Medical Supplies Regulations; (b) “senior co-payment amount” means: (i) for the period commencing on March 21, 2012 and ending on June 1, 2016, with respect to each instance in which a drug is dispensed to a senior, the total of $20 plus the incremental drug price difference, if any, with respect to the drug dispensed; and (ii) for the period commencing on June 2, 2016, with respect to each instance in which a drug is dispensed to a senior, the total of $25 plus the incremental drug price difference, if any, with respect to the drug dispensed. (2) Subject to subsections (2.1), (3) and (4) and sections 10.11 to 10.2, for any benefit period commencing on or after July 1, 2007, a senior is eligible to receive reimbursement from the minister, or to have payment made on the senior’s behalf by the minister to participating pharmacies from which drugs are obtained by the senior, in the amount SB calculated in accordance with the following formula: SB = ARDP – (SCA – AIDP) where: ARDP is the sum of all recognized drug prices for: (a) drugs obtained by the senior during a benefit period from participating pharmacies; and (b) drugs obtained by the senior during a benefit period for which the senior is entitled to reimbursement pursuant to section 13; SCA is the sum of all senior co-payment amounts paid by the senior in the benefit period; and AIDP is the sum of all incremental drug price differences paid by the senior in the benefit period. 16 P-23 REG 3 PRESCRIPTION DRUGS, 1993 (2.1) On and from July 1, 2008, a senior is entitled to receive reimbursement from the minister, or to have payment made on the senior’s behalf by the minister to participating pharmacies from which drugs are obtained by the senior, only with respect to any period for which the senior is determined to be eligible in accordance with section 10.11. (2.2) Notwithstanding subsection (2.1), section 10.11 or 10.12, a senior who is eligible to receive a benefit or payment pursuant to subsection 5(2), 6(5), 7(9) or 7(11) is eligible to receive the amount calculated in accordance with the formula set out in subsection (2). (3) Subject to subsections (4) and (5), if the senior benefit calculated pursuant to subsection (2) for a benefit period with respect to a senior is less than any of the benefits to which the senior would be entitled pursuant to section 5, 5.1, 6, 6.1, 7, 7.1 or 7.2 or pursuant to sections 12 to 12.7, the senior is entitled to receive the greatest benefit to which the senior would be entitled for that benefit period. (4) If a family unit includes one or more members who are seniors and one or more members who are not seniors: (a) the members who are not seniors are not entitled to the senior benefit; but (b) the members who are seniors shall be included in the number of members of the family unit for the purpose of calculating the benefits to which the family unit is entitled. (5) A senior or a family unit that includes a senior shall provide the minister with any information that the minister considers necessary for the purposes of calculating the benefits to which the senior or the family unit is entitled. 6 Jly 2007 SR 54/2007 s7; 27 Jne 2008 SR 53/2008 s5; 7 Apr 2017 SR 25/2017 s9. Eligibility for senior benefit 10.11(1) In this section and sections 10.12 to 10.17: (a) “age amount income threshold” means, with respect to a taxation year, the maximum amount of net income that a qualified individual could receive for the taxation year and be entitled to claim an age amount greater than zero on line 5808 of the individual’s Saskatchewan tax return for the taxation year; (b) “applicable taxation year”: (i) with respect to the transition period, means the 2006 taxation year; and (ii) with respect to a benefit year commencing after the transition period, means the taxation year that precedes the benefit year by two calendar years; (c) “benefit year” means a period commencing on January 1 in a year and ending on December 31 in the same year; 17 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (d) “net income” means, in relation to the income of an individual for a taxation year: (i) the amount of the individual’s net income as reported on line 236 of the individual’s return; or (ii) the amount of the individual’s income that would have been the individual’s net income reported on line 236 if the individual had filed a return for that taxation year; (e) “return” means a return of income as defined in section 122.6 of the Income Tax Act (Canada); (f) “transition period” means the period commencing on July 1, 2008 and ending on December 31, 2008. (2) Subject to section 10.2, on and from July 1, 2008, the senior benefit will not be provided to an individual unless: (a) the individual, or another person on behalf of the individual, applies to the minister in accordance with section 10.12; and (b) the eligibility of the individual pursuant to subsection (3) or (4) is established to the satisfaction of the minister. (3) On and from July 1, 2008, to be eligible for the senior benefit for the transition period or for any subsequent benefit year: (a) an individual must be a senior at the time when provision of the senior benefit is to commence; and (b) subject to subsection (4), the net income of the individual for the applicable taxation year must be less than the age amount income threshold for the applicable taxation year, whether or not the individual was 65 years of age or older in the applicable taxation year. (4) The minister may grant the senior benefit for the transition period or for any subsequent benefit year to a senior whose net income for the applicable taxation year is equal to or greater than the age amount income threshold for the applicable taxation year if it is established to the satisfaction of the minister that: (a) the net income of the senior for the complete taxation year following the applicable taxation year is less than the age amount income threshold for the applicable taxation year; or (b) the senior’s net income for the current taxation year is projected to be less than the age amount income threshold for the applicable taxation year. 27 Jne 2008 SR 53/2008 s6; 7 Apr 2017 SR 25/2017 s10. 18 P-23 REG 3 PRESCRIPTION DRUGS, 1993 Application for senior benefit 10.12(1) An application for the senior benefit for the transition year or for any subsequent benefit year must: (a) be made in writing in the form supplied by the ministry; (b) state the applicant’s net income for the applicable taxation year or the taxation year mentioned in clause 10.11(4)(a) or the applicant’s projected net income for the taxation year mentioned in clause 10.11(4)(b), as the case may be; (c) provide verification of the applicant’s net income or projected net income in accordance with section 10.13; (d) provide all other information required by the form; and (e) be signed by the applicant or another person on behalf of the applicant. (2) In addition to any other requirement, an application based on eligibility pursuant to clause 10.11(4)(b) must identify: (a) any new sources of income that the applicant reasonably expects to receive, or to be entitled to receive, in the current taxation year; (b) any sources of income from which the applicant reasonably expects to cease receiving income, or to cease being entitled to receive income, in the current taxation year; and (c) the deductions that the applicant reasonably expects to take, or to be entitled to take, in the calculation of net income on a return for the current taxation year, whether or not the applicant expects to file a return for the current taxation year. 27 Jne 2008 SR 53/2008 s6. Verification of income 10.13(1) An applicant for the senior benefit who has filed a return for the relevant taxation year may verify the applicant’s net income by providing the applicant’s written consent to the disclosure to the ministry by the Canada Revenue Agency of information in their records respecting the income of the applicant for the purpose of determining the eligibility of the applicant for the senior benefit. (2) An applicant who does not provide written consent to disclosure pursuant to subsection (1) must provide the minister with documentary evidence sufficient to verify, to the satisfaction of the minister, the net income or projected net income of the applicant as stated in the application. 27 Jne 2008 SR 53/2008 s6. Whether further application required 10.14(1) Subject to section 10.16, a senior who has provided the ministry with the senior’s written consent to disclosure pursuant to subsection 10.13(1) does not need to make further application for future benefit years as long as: (a) the consent remains valid; and (b) the senior continues to file a return. 19 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (2) A senior who does not provide written consent to disclosure pursuant to subsection (1) for a benefit year must submit a new application pursuant to section 10.12 for each subsequent benefit year. 27 Jne 2008 SR 53/2008 s6. Request for reconsideration 10.15(1) An individual whose application for the senior benefit has been denied may at any time request a reconsideration on the basis of a change in the individual’s net income that, if proven to the satisfaction of the minister, would establish the individual’s eligibility for the senior benefit in accordance with subsection 10.11(3) or (4). (2) A request for a reconsideration: (a) must be in writing; (b) must set out the grounds of the request; and (c) must be accompanied by all information and documents necessary to support the request. (3) The minister may require an individual who requests a reconsideration to provide any further information or documents that the minister considers necessary in order to determine the reconsideration. (4) If, on the basis of a reconsideration, the minister is satisfied that the individual is eligible for the senior benefit, the minister shall grant the senior benefit to the individual for the transition period or benefit year to which the request for reconsideration applies. 27 Jne 2008 SR 53/2008 s6. Reconsideration initiated by minister 10.16(1) The minister may, at any time, reconsider the granting of the senior benefit to an individual if: (a) the minister is satisfied that the individual was incorrectly determined to be eligible: (i) as a result of administrative error; or (ii) on the basis of incorrect information provided to the minister, whether by mistake or otherwise; or (b) the minister becomes aware of changes in the circumstances of the individual at any time after the submission of the individual’s application that affect the individual’s eligibility for the senior benefit. (2) If, on a reconsideration, the minister determines that the individual is not eligible for the senior benefit, the minister shall terminate the provision of the senior benefit to the individual: (a) in a case of administrative error, as of the day on which the error was discovered; 20 P-23 REG 3 PRESCRIPTION DRUGS, 1993 (b) in a case of incorrect information, as of the day on which the minister became aware of the incorrect information; or (c) in a case of changed circumstances, as of the day on which the minister became aware of the change in circumstances. 27 Jne 2008 SR 53/2008 s6. Commencement of benefits 10.17(1) Subject to subsections (2) and (3), an individual whose application for the senior benefit is accepted is entitled to receive the senior benefit: (a) commencing on July 1, 2008 if the individual’s application, together with all necessary information and documents, is received by the minister before July 1, 2008; or (b) if the individual’s application is received by the minister on or after July 1, 2008, commencing on the day on which the individual’s completed application, including all necessary information and documents, is received by the minister. (2) In the case of an individual whose eligibility for the senior benefit is determined on a reconsideration pursuant to section 10.15, the individual is entitled to receive the senior benefit from the day on which the minister receives the information that establishes the individual’s eligibility. (3) In the case of an individual whose eligibility for the senior benefit is determined on a reconsideration pursuant to clause 10.16(1)(b), the individual is entitled to receive the senior benefit from the day on the minister becomes aware of the change in the individual’s circumstances. 27 Jne 2008 SR 53/2008 s6. Alternative calculation - senior benefit 10.2(1) A senior who is eligible to receive the senior benefit may apply to have the entitlement of the senior’s family unit to benefits calculated in accordance with sections 12 to 12.7. (2) If, by applying the entitlement of a senior’s family unit to benefits calculated pursuant to sections 12 to 12.7, the senior is entitled to a greater benefit than the senior benefit calculated pursuant to section 10.1, the senior is entitled to receive benefits in the greater amount. 6 Jly 2007 SR 54/2007 s7. Children’s drug benefit 10.3(1) In this section: (a) “child” means a resident who is less than 15 years of age; (b) “child co-payment amount” means: (i) for the period commencing on March 21, 2012 and ending on June 1, 2016, with respect to each instance in which a drug is dispensed, the total of $20 plus the incremental drug price difference, if any, with respect to the drug dispensed; and 21 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (ii) for the period commencing on June 2, 2016, with respect to each instance in which a drug is dispensed, the total of $25 plus the incremental drug price difference, if any, with respect to the drug dispensed; (c) “drug” includes designated medical supplies as defined in The Drug Plan Medical Supplies Regulations. (2) Subject to subsection (3), and section 10.4, for any benefit period commencing on or after July 1, 2008, a child’s family unit is eligible to receive reimbursement from the minister, or to have payment made on the child’s behalf by the minister to participating pharmacies from which drugs are obtained on the child’s behalf, in the amount CDB calculated in accordance with the following formula: CDB = ARDP – (CCA – AIDP) where: ARDP is the sum of all recognized drug prices for: (a) drugs obtained on the child’s behalf during a benefit period from participating pharmacies; and (b) drugs obtained on the child’s behalf during a benefit period for which the child’s family unit is entitled to reimbursement pursuant to section 13; CCA is the sum of all child co-payment amounts paid by the child’s family unit in the benefit period; and AIDP is the sum of all incremental drug price differences paid by the child’s family unit in the benefit period. (3) If the children’s drug benefit calculated pursuant to subsection (2) for a benefit period with respect to a child is less than any of the benefits to which the child’s family unit would be entitled pursuant to section 5, 5.1, 9 or 10 or pursuant to sections 12 to 12.7, the child’s family unit is entitled to receive the greatest benefit to which the child’s family unit would be entitled for that benefit period. 27 Jne 2008 SR 53/2008 s7; 7 Apr 2017 SR 25/2017 s11. Alternative calculation – children’s drug benefit 10.4(1) A child’s family unit that is eligible to receive the children’s drug benefit may apply to have the entitlement of the child’s family unit to benefits calculated in accordance with sections 12 to 12.7. (2) If, by applying the entitlement of a child’s family unit to benefits calculated pursuant to sections 12 to 12.7, the family unit is entitled to a greater benefit than the children’s drug benefit calculated pursuant to section 10.3, the family unit is entitled to receive benefits in the greater amount. 27 Jne 2008 SR 53/2008 s7. 22 P-23 REG 3 PRESCRIPTION DRUGS, 1993 Special conditions 11 A resident is entitled to obtain a drug from participating pharmacies on payment to the pharmacy of only any incremental drug price difference and without payment of a prescription charge where that resident: (a) has cystic fibrosis, end-stage renal disease, a condition of paraplegia or any other illness or condition designated by the minister and has been designated by the minister as a person who is entitled to have payment for drugs made on his or her behalf; or (b) is under active palliative care and has been designated by the minister as a person who is entitled to have payment for drugs made on his or her behalf. 11 Jne 93 cP-23 Reg 3 s11; 7 Apr 2017 SR 25/2017 s12. Income-based general coverage 12(1) In this section and sections 12.1 to 12.7: (a) “applicable taxation year”: (i) with respect to an application for benefits: (A) if the application is made with respect to a benefit year ending before the transition period commences, means the taxation year preceding the taxation year in which the benefit year commences; (B) if the application is made with respect to the transition period, means: (I) the 2002 taxation year if the applicant is able to provide the information respecting that taxation year; and (II) the 2001 taxation year in any other case; (C) if the application is made with respect to a benefit year commencing after the transition period ends, means the taxation year that precedes the benefit year by two calendar years; (ii) with respect to a benefit period: (A) if the benefit period occurs in a benefit year that ends before the transition period commences, means the taxation year preceding the taxation year in which the benefit year commences; (B) if the benefit period is the transition period, means: (I) the 2002 taxation year if the applicant is able to provide the information respecting that taxation year; and (II) the 2001 taxation year in any other case; (C) if the benefit period occurs in a benefit year that commences after the transition period ends, means the taxation year that precedes the benefit year by two calendar years; 23 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (a.1) “benefits” means reimbursement from the minister for drugs obtained from participating pharmacies by a family unit, or payment made on a family unit’s behalf by the minister to participating pharmacies from which drugs are obtained by the family unit; (b) “benefit year”:

(i) with respect to the period ending on June 30, 2003, means a period commencing on July 1 in one year and ending on June 30 in the following year; and (ii) with respect to the period commencing on January 1, 2004, means a period commencing on January 1 in a year and ending on December 31 in the same year; (c) “family unit income” means the family unit income for a taxation year of a family unit calculated in accordance with section 12.5; (d) “return” means a return of income as defined in section 122.6 of the Income Tax Act (Canada); (e) “threshold co-payment” means, subject to sections 5.1, 6.1, 7.1 and 7.2, the threshold co-payment of a family unit calculated in accordance with section 12.4; (f) “threshold co-payment benefit” means the threshold co-payment benefit of a family unit determined in accordance with section 12.3; (g) “threshold co-payment factor” means the threshold co-payment factor of a family unit calculated in accordance with section 12.2; (h) “transition period” means the period commencing on July 1, 2003 and ending on December 31, 2003. (1.1) For the purposes of this section and sections 12.1 to 12.7: (a) the transition period is a benefit period; and (b) in calculating the amount of benefits to which a family unit is entitled for the transition period, the transition period is to be treated as if it were part of the benefit year commencing on July 1, 2002 and ending on June 30, 2003. (2) Subject to this section, a family unit to which sections 8 to 11 do not apply is eligible for benefits calculated in accordance with section 12.1 or recalculated in accordance with section 12.6 or 12.7. (3) Unless each adult member of the family unit has provided a written consent pursuant to clause (5)(b), a family unit must apply for benefits in accordance with subsections (4) to (6): (a) with respect to the transition period; and (b) with respect to each benefit year after the transition period. (4) An application for benefits: (a) must be in the form supplied by the minister; (b) must provide all information required by the form; 24 P-23 REG 3 PRESCRIPTION DRUGS, 1993 (c) must be signed by all adults who are members of the family unit; and (d) must provide information respecting the income of each adult member of the family unit in accordance with subsection (5) or (6). (5) With respect to each adult member of a family unit who has filed a return for the applicable taxation year, an application: (a) must state the total income of the individual for the applicable taxation year, as set out on line 150 of the return, minus the deduction, if any, for the elected split-pension amount, as set out on line 210 of the return; or (b) must contain the written consent of the individual to the disclosure to the department of information with respect to the individual’s income in the records of the Canada Customs and Revenue Agency for the purpose of determining the eligibility of the family unit to receive benefits. (6) With respect to each adult member of a family unit who has not filed a return for the applicable taxation year, an application: (a) must state the income of the individual for the applicable taxation year; and (b) must contain the written consent of the individual to the disclosure to the ministry of information with respect to the individual’s income in the records of the Canada Revenue Agency for the purpose of determining the eligibility of the family unit to receive benefits. (7) A family unit shall provide the minister with any information that the minister considers necessary for the purposes of calculating the benefits to which the family unit is entitled. (8) Subject to sections 12.6 and 12.7: (a) if the application of a family unit is approved and each adult member of the family unit has provided a written consent pursuant to clause (5)(b): (i) the family unit is entitled to receive benefits for each benefit period while the family unit remains eligible, commencing with the benefit period in which the application is made; (ii) the benefits to which the family unit is entitled are to be calculated from the day on which a complete application is received by the minister; and (iii) the entitlement to benefits expires on the last day of the transition period or the benefit year, as the case may be, in which: (A) the family unit ceases to be eligible for benefits; or (B) an adult member of the family unit withdraws a written consent provided pursuant to clause (5)(b) and the family unit fails to make a new application for the next benefit year; and 25 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (b) if the application of a family unit is approved and each adult member of the family unit has not provided a written consent pursuant to clause (5)(b): (i) the family unit is entitled to receive benefits: (A) for the transition period, if the application is made with respect to the transition period; or (B) with respect to benefit years commencing after the transition period, for each benefit period in the benefit year with respect to which the application is made; (ii) the benefits to which the family unit is entitled are to be calculated from the day on which a complete application is received by the minister; and (iii) the entitlement to benefits expires on the last day of the transition period or the benefit year, as the case may be, and a new application must be made for the next benefit year. (9) A family unit that fails to provide the minister with the information required by this section is not entitled to receive benefits. 12 Jly 2002 SR 53/2002 s9; 18 Jly 2003 SR 65/2003 s10; 27 Jne 2008 SR 53/2008 s8; 7 Apr 2017 SR 25/2017 s13. Calculation of benefits 12.1(1) In this section, “drug total” means the total of all recognized drug prices for: (a) drugs obtained by a family unit during a benefit period from participating pharmacies; and (b) drugs obtained by the family unit during a benefit period for which the family unit is entitled to reimbursement pursuant to section 13. (2) If the threshold co-payment factor of a family unit for a benefit period is equal to or less than 0.35, the amount of benefits to which the family unit is entitled during the benefit period with respect to a drug obtained is the amount B calculated in accordance with the following formula: B = TCB x RDP where: TCB is the threshold co-payment benefit of the family unit; and RDP is the recognized drug price for the drug obtained. 26 P-23 REG 3 PRESCRIPTION DRUGS, 1993 (3) If the threshold co-payment factor of a family unit for a benefit period is greater than 0.35, and the drug total of the family unit for the benefit period is less than its threshold co-payment for the benefit period, the amount of benefits to which the family unit is entitled is the amount B calculated in accordance with the following formula: B = TCB x RDP where: TCB is the threshold co-payment benefit of the family unit for the benefit period; and RDP is the recognized drug price for the drug obtained. (4) If the threshold co-payment factor of a family unit for a benefit period is greater than 0.35, and the drug total of the family unit for the benefit period is equal to or greater than its threshold co-payment for the benefit period, the amount of benefits to which the family unit is entitled is the amount B calculated in accordance with the following formula: B = 0.65 x RDP where RDP is the recognized drug price for the drug obtained. (5) Where the addition of a recognized drug price for a drug obtained by a family unit during a benefit period to the drug total of the family unit for the benefit period would cause the drug total to exceed the threshold co-payment, the amount of the recognized drug price is to be apportioned so that: (a) only an amount that, when added to the drug total, would keep the drug total below the threshold co-payment is taken into account for the purposes of subsection (3); and (b) the remainder is taken into account for the purposes of subsection (4). 12 Jly 2002 SR 53/2002 s9. Calculation of threshold co-payment factor 12.2 The threshold co-payment factor of a family unit for a benefit period is the amount TCF calculated in accordance with the following formula: TC TCF = (BPDP x 2) where: TC is the threshold co-payment for the benefit period; and BPDP is the sum of all recognized drug prices for: (a) drugs obtained by the family unit during the previous benefit period from participating pharmacies; and (b) drugs obtained by the family unit during the previous benefit period for which the family unit is entitled to reimbursement pursuant to section 13. 12 Jly 2002 SR 53/2002 s9. 27 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 Determination of threshold co-payment benefit 12.3 The threshold co-payment benefit of a family unit for a benefit period is the greater of zero and (1 – TCF), where TCF is the threshold co-payment factor for the benefit period. 12 Jly 2002 SR 53/2002 s9. Calculation of threshold co-payment 12.4 The threshold co-payment of a family unit for a benefit period is the amount TC calculated in accordance with the following formula: TC = 0.034 x FUI where FUI is the family unit income for the applicable taxation year. 12 Jly 2002 SR 53/2002 s9; 18 Jly 2003 SR 65/2003 s11. Calculation of family unit income 12.5 The family unit income of a family unit for a taxation year is the amount FUI calculated in accordance with the following formula: FUI = TIFU – ($3,500 x ND) where: TIFU is the total income for the taxation year of all adult members of the family unit as described in subsection 12(5) or (6); and ND is the number of members of the family unit who are described in subclause 2(1)(e)(iii). 12 Jly 2002 SR 53/2002 s9. Request for recalculation 12.6(1) A member of a family unit or another person on behalf of a family unit may, at any time, request a recalculation of the benefits to which the family unit is entitled pursuant to section 12, if: (a) the person making the request disagrees with the values calculated for the family unit’s benefits; (b) the composition of the family unit has changed; (c) there has been a significant change in the family unit income; or (d) the family unit has had a significant change in the cost of drugs since its threshold co-payment benefit was last calculated. (2) A request for recalculation: (a) must be in writing; (b) must set out the grounds for the request; and (c) must be accompanied by all information and documents necessary to support the request. (3) The minister may require the person making the request to provide any additional information or documents that the minister considers necessary in order to determine whether recalculation is justified. 28 P-23 REG 3 PRESCRIPTION DRUGS, 1993 (4) Where the minister is satisfied that sufficient information and documents have been provided to enable the minister to determine whether recalculation is justified: (a) the minister shall review the request; and (b) if the minister is satisfied that recalculation is justified, the minister shall recalculate the family unit’s benefits. (5) In a recalculation based on a change in family unit income, the family unit income may be recalculated on the basis of the income that the family unit is projected to receive during the current taxation year or on the basis of an adjustment to the family unit income for the preceding taxation year, as the case may require. (6) In a recalculation based on a change in the cost of drugs of the family unit, the recalculation may be made on the basis of the projected costs of the recognized drug prices for the family unit for the current benefit period and not the previous benefit period. (7) If, on a recalculation pursuant to this section, it is determined that the benefits to which the family unit is entitled should be greater than they were determined to be on the initial calculation, the family unit is entitled to benefits at the level determined by the recalculation from the day on which the minister receives information satisfactory to the minister that justifies the recalculation. 12 Jly 2002 SR 53/2002 s9; 18 Jly 2003 SR 65/2003 s12; 27 Jne 2008 SR 53/2008 s9. Recalculation initiated by minister 12.7(1) The minister may, at any time, recalculate the benefits of a family unit if: (a) the minister is satisfied that the benefits were incorrectly calculated: (i) as a result of administrative error; or (ii) on the basis of incorrect information provided to the minister, whether by mistake or otherwise; or (b) the minister becomes aware of changes in the circumstances of the family unit at any time after the submission of the family unit’s application. (2) If, on a recalculation pursuant to this section, it is determined that the benefits to which the family unit is entitled should be different than they were determined to be on the initial calculation, the family unit is entitled to benefits at the level determined by the recalculation: (a) in the case of a recalculation resulting from administrative error: (i) from the first day of the transition period or the benefit year, as the case may be, if the recalculation results in an increase in the amount of the benefits; or (ii) from the day on which the error was discovered, if the recalculation results in a decrease in the amount of the benefits; and 29 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 (b) in the case of a recalculation resulting from incorrect information or from a change in circumstances, from the day on which the minister receives information satisfactory to the minister that justifies the recalculation. (c) Repealed. 27 Jne 2008 SR 53/2008 s10. 12 Jly 2002 SR 53/2002 s9; 18 Jly 2003 SR 65/2003 s13; 27 Jne 2008 SR 53/2008 s810 12.8 Repealed. 7 Apr 2017 SR 25/2017 s14. 12.81 Repealed. 7 Apr 2017 SR 25/2017 s14. 12.9 Repealed. 7 Apr 2017 SR 25/2017 s14. Out of province and non-participating pharmacies 13(1) Where a family unit or a senior obtains a drug: (a) within Saskatchewan from a pharmacy that is not a participating pharmacy; or (b) within Canada but outside Saskatchewan from a pharmacy that is not a participating pharmacy; the family unit or the senior is entitled to receive from the minister a reimbursement of the amount that the minister would pay on behalf of the family unit or the senior if the drug had been obtained within Saskatchewan from a participating pharmacy. (2) To receive a reimbursement pursuant to subsection (1), the family unit or the senior shall submit any information that, in the opinion of the minister, is sufficient to establish the entitlement of the family unit or the senior for the reimbursement. 11 Jne 93 cP-23 Reg 3 s13; 6 Jly 2007 SR 54/2007 s9. Benefits where Hepatitis C Settlement Agreement applies 13.1(1) Notwithstanding any other provision of these regulations but subject to subsection (2), the family unit of a person who is a Class Member within the meaning of the 1986-1990 Hepatitis C Settlement Agreement made June 15, 1999 is entitled to continue receiving the benefits pursuant to the program established by the Act that the person was receiving on April 1, 1999 unless the family unit ceases to be eligible for those benefits for a reason other than the fact that a member of the family unit is a Class Member. (2) A family unit is not entitled to benefits with respect to drugs for which the person mentioned in subsection (1) is entitled to receive reimbursement pursuant to one of the Plans defined in the Hepatitis C Settlement Agreement. 7 Jly 2000 SR 47/2000 s2. 30 P-23 REG 3 PRESCRIPTION DRUGS, 1993 Database re drugs 13.2(1) For the purposes of subsection 3.3(3) of the Act, a proprietor, as defined in The Pharmacy and Pharmacy Disciplines Act, shall collect from the subject individual and provide to the minster the personal health information and other information set out in the Appendix with respect to: (a) each drug prescribed or dispensed to a subject individual in Saskatchewan; and (b) each designated drug that is sold to a subject individual in Saskatchewan. (2) For the purposes of subsection 3.3(3) of the Act, an operator of a publicly operated pharmacy, as defined in The Pharmacy and Pharmacy Disciplines Act, shall collect from the subject individual and provide to the minister the personal health information and other information set out in the Appendix with respect to: (a) each drug prescribed or dispensed to a subject individual who is not an in-patient at a facility served by that pharmacy; and (b) each designated drug that is sold to a subject individual who is not an in-patient at a facility served by that pharmacy. 7 Apr 2017 SR 25/2017 s15. R.R.S c.P-23 Reg 2 repealed 14 The Prescription Drugs Regulations, 1991 are repealed. 11 Jne 93 cP-23 Reg 3 s14. 31 FOREST FIRE CONTINGIENCY FUND P-23 REG 3 Appendix [Section 13.2] Information, including Personal Health Information, to be Collected and Submitted by Practitioners to Drug Database 1. The following information respecting the subject individual to whom the drug is dispensed: (a) the subject individual’s health services number; (b) the subject individual’s full name, date of birth and address. 2. The following information respecting the practitioner who prescribed the drug: (a) either: (i) the practitioner’s health provider identifier assigned by the minister; or (ii) the practitioner’s licence number assigned by the Saskatchewan College of Pharmacy Professionals; and (b) the practitioner’s health provider organization identifier assigned by the minister. 3. In the case of designated drugs, the identifier of the provider who sold a designated drug to a subject individual. 4. The drug identification number: (a) assigned by Health Canada to the drug; or (b) in the case of a product for which there is no drug identification number assigned by Health Canada, the drug identification number assigned to the product by the minister or by a payer other than the minister. 5. In the case of the practitioner who dispensed the drug: (a) the practitioner’s licence number assigned by the Saskatchewan College of Pharmacy Professionals; and (b) the practitioner’s organization identifier assigned by the minister to identify the province where the drug was dispensed. 6. In the case of methadone that has been compounded, the number of milligrams of methadone prescribed to the patient per day. 7. In the case of a drug other than methadone that has been compounded, the product name as it appears on the prescription label given to the subject individual to whom the drug is dispensed. 8. The amount, if any, charged for compounding a preparation dispensed pursuant to a prescription. 32 P-23 REG 3 PRESCRIPTION DRUGS, 1993 9. The number of days of treatment to be provided by the dispensed drug, as estimated by the practitioner who dispensed the drug. 10. The date on which the drug is dispensed. 11. The Drug Plan billing number assigned to the pharmacy by the minister. 12. The prescription number assigned to the prescription by the pharmacy through use of the Pharmacy Practice Management System. 13. Whether or not the prescription was dispensed without substitution. 14. The quantity of the dispensed drug. 15. Whether or not the prescription is to be submitted to a payer other than the minister. 16. Whether or not the practitioner dispensing the drug is submitting the prescription to the minister to determine the person’s eligibility for financial assistance under the program. 17. The acquisition cost per unit of the drug dispensed. 18. The dispensing fee charged by the practitioner. 19. If the prescription is not submitted to the minister to determine eligibility for financial assistance under the program, the total cost of the prescription. 20. If the prescription is to be submitted to the minister to determine eligibility for financial assistance under the program and, at the time the drug is dispensed to the subject individual, the electronic link with the ministry is not operating, the following information: (a) the total cost of the prescription; and (b) the amount paid by the person to the practitioner. 21. The mark-up percentages (Tiers 1, 2 and 3) to be used in calculating the drug material cost of the dispensed drug. 22. The percentage, if any, of the total prescription cost provided at a discount to the person to whom the drug was dispensed. 7 Apr 2017 SR 25/2017 s16. REGINA, SASKATCHEWAN Printed by the authority of THE QUEEN’S PRINTER Copyright©2017