Generic Drug Program Application

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Personal information on this form is collected under section 31(c) of Prince Edward Island’s Freedom of Information and Protection of Privacy (FOIPP) Act as it relates directly to and is necessary for providing services under the Drug Cost Assistance Act. If you have any questions about this collection of personal information, you may contact the program office at 902-368-4947 or 1-877-577-3737.

Identification
Please note: Individuals that have private drug insurance are not eligible for the Generic Drug Program.
For example: C1B 0X1 or 12345
For example 902-555-5555
Please enter the 8-digits from your PEI health card.
You must be under the age of 65 to apply.
If your spouse has private insurance, he/she is not eligible for coverage provided by the Generic Drug Program.