Medication coverage can vary significantly based on your province of residence, insurance provider, and the specific terms of your benefits plan.
Our partner pharmacy will submit claims directly to your insurance or benefits provider; however, please note that pre-adjudication is not available. This means we are unable to confirm your exact coverage amount prior to processing your first fill.
Once your prescription has been processed, any remaining out-of-pocket costs will be charged to your credit card. You will also receive an email with a detailed cost breakdown.
If you are approved for coverage after your fill has already been processed, you can submit a manual claim directly with your provider by using the receipt from your package.
📌 If you have private insurance or a provincial health card, please ensure this information is uploaded under the Billing & Shipping tab of your account to facilitate accurate billing.
Below is an overview of the different types of coverage that may apply.
🏥 Private Insurance
If you have private or workplace insurance:
Contact your insurer with the medication name and DIN to check eligibility
Our partner pharmacy will bill the insurance we have on file for any potential coverage
🧠 Note: Practitioner visits are not typically covered by private insurance.
🍁 Provincial Drug Plans
Ontario Drug Benefit (ODB)
Eligibility depends on the program you’re enrolled in and whether your medication is listed on the ODB Formulary.
ODB includes:
OHIP+ (under 25 without private insurance)
ODSP (disability support)
Ontario Works (financial assistance)
British Columbia – PharmaCare
Register for Fair PharmaCare
Check PharmaCare Special Authority for more information
Upload both sides of your BC Services Card (PHN) under the Billing and Shipping tab
Coverage applies automatically if the medication qualifies
For more information on birth control coverage through PharmaCare, please see this article: Insurance & Birth Control Coverage
Other Provincial Health Plan Coverage:
For more details on provincial health plan coverage, see below:
Currently, our partner pharmacies are located in Ontario and British Columbia, so we can only direct bill these two provincial plans.
For direct billing to provincial plans other than Ontario and British Columbia, you will need to have your Felix prescription sent to a local pharmacy. You can do this at checkout by selecting “Pickup at external pharmacy” under your shipping address, then entering your local pharmacy’s name and fax number.
When opting for delivery, the receipt located within the parcel can be used to submit manual claims to provincial health plans.
How can I submit a manual claim to my provincial plan?
If you still wanted to receive direct deliveries from our pharmacy and were located in Alberta, Manitoba, Newfoundland and Labrador, Nova Scotia, Prince Edward Island, or Saskatchewan, you can submit a manual claim using the receipt found in your package.
For Alberta specifically, you can submit online by logging in here.
For the following provinces, manual forms will need to be filled out and submitted directly:
For the following provinces, we recommend reviewing their sites directly and contacting them for exact next steps:
Note: Blue Cross plans are separate from provincial plans, so our pharmacies will still attempt to direct bill these plans.
🧾 NIHB (First Nations & Inuit)
The Non-Insured Health Benefits (NIHB) program provides prescription drug coverage for eligible patients who are:
Registered under the Indian Act, or
An Inuk recognized by a land claim organization
See full eligibility
Felix Pharmacy can bill NIHB directly. Just upload:
Your status card or NIHB number to the front section of your Billing information
Your private insurance card, if applicable, to the back section of your Billing information— NIHB will act as secondary coverage
Review the NIHB Drug Benefit List for eligible medications.
⚠️ Why Was I Still Charged?
Even with insurance uploaded, you may be charged if:
Special authorization is required (common for weight loss medications)
You have requested an early refill
You’ve reached your plan's maximum limit
The medication is compounded (does not include a Drug Identification Number)
→ In that case, your shipment includes a receipt for submitting a manual claim.
✅ What To Do:
Review your plan details using the resources linked above to better understand your coverage
Upload all insurance and health plan info to your the Billing and Shipping tab of your account
If you did not receive the expected amount of insurance coverage, we always recommend reaching out to your provider directly first as they should have full details in regards to your specific plan.