Pharmacare Forms and Worksheets

The Pharmacare form and worksheet below are available for download as PDF documents, for your convenience.

• The Pharmacare Application and Consent Authorization Form
• The 2024/2025 Pharmacare Benefit Year Projected Income Worksheet

Completed forms and worksheets, and any supporting documentation if required, can be submitted by fax or mail to the address below.

Manitoba Health
Non-Insured Benefits
300 Carlton Street
Winnipeg, Manitoba R3B 3M9
Phone: 204-786-7141
Toll free: 1-800-297-8099
FAX: 204-786-6634
TTY/TDD Relay Service: 204-774-8618, outside Winnipeg: 711 or 1-800-855-0511
E-mail: pharmacare@gov.mb.ca