Medical Supplies Coverage

In addition to a broad range of drugs, PharmaCare covers certain medical supplies for eligible British Columbians. Click on a link below for more information:

• Insulin pumps for children and adolescents
• Insulin Pump Supplies
• Other diabetes supplies (including blood glucose testing strips, insulin, needles and syringes)
• Prosthetic and Orthotic Program (including mastectomy supplies)
• Ostomy supplies

Insulin Pumps for Children and Adolescents

PharmaCare covers insulin pumps for children and adolescents age 18 or younger with Type 1 diabetes or other forms of diabetes requiring insulin. Supplies for insulin pumps are covered for both children and adults.

• are 18 years of age or younger, and
• have Type 1 diabetes or another form of diabetes requiring insulin, and
• are covered under Fair PharmaCare, PharmaCare Plan C (B.C. Income Assistance Recipients) or PharmaCare Plan F (Children in the At Home Program), and
• have confirmation from their diabetes physician that they meet the medical criteria, and
• have SA coverage (see “How do we obtain coverage?” below).

• if you are on Plan C (B.C. Income Assistance), PharmaCare covers 100%
• if you are on Plan F (Children in the At Home Program), PharmaCare covers 100%
• if you are covered under the Fair PharmaCare plan, PharmaCare covers 70% of costs above your deductible and 100% of costs above your family maximum.

Insulin Pump Supplies

Who is eligible for coverage?

PharmaCare covers certain insulin pump supplies if you are covered under:

• Fair PharmaCare
• Plan C (B.C. Income Assistance)
• Plan F (At Home Program)

This coverage is available whether or not your pump was covered by PharmaCare.

PharmaCare pre-approval is not needed for insulin pump supplies.

Which supplies are covered?

PharmaCare covers infusion sets/kits and insulin pump reservoirs/cartridges as shown on our Insulin Pump Supplies page. PharmaCare does not cover batteries, battery caps, adhesive pads, etc.

Where should I buy my insulin pump supplies?

PharmaCare reimburses claims for eligible insulin pump supplies purchased from pharmacies and approved insulin pump vendors who submit medical supply claims on PharmaNet. PharmaCare cannot accept paper ("manual") claims for insulin pump supplies.

Other Diabetes Supplies

Blood Glucose Test Strips

PharmaCare covers blood glucose test strips if you are covered under:

• Fair PharmaCare
• Plan C (B.C. Income Assistance)
• Plan F (At Home Program)

PharmaCare covers your blood glucose test strips if:

• blood glucose testing has been deemed medically necessary for you; and
• you have a Certificate of Training issued by a Diabetes Education Centre.

Your Diabetes Education Centre will provide you with a printed certificate (in a wallet card form) and fax your information to PharmaCare.

Usually, a Certificate of Training gives you permanent PharmaCare coverage of testing strips. However, if the Diabetes Education Center enters an end date on your certificate (for instance, if you have gestational diabetes), coverage of testing strips is only for the period shown on your certificate.

Needles and syringes

PharmaCare covers needles and syringes if you have insulin-dependent diabetes and you are covered under:

• Fair PharmaCare
• Plan C (B.C. Income Assistance)
• Plan F (At Home Program)

You do not need a Certificate of Training from a Diabetes Education Centre to qualify for this coverage.

For needles and syringes for insulin therapy, PharmaCare covers the regular retail price but does not cover a dispensing fee.

Insulin

PharmaCare covers insulin if you are covered under:

• Fair PharmaCare
• Plan B (Residential Care)
• Plan C (B.C. Income Assistance)
• Plan F (At Home Program)
• Plan P (B.C. Palliative Care Drug Plan)

You do not need a Certificate of Training from a Diabetes Education Centre to qualify for this coverage.

PharmaCare covers most insulin up to the regular retail price but does not cover a dispensing fee.

Prosthetic and Orthotic Program

The PharmaCare Prosthetic and Orthotic Program helps eligible British Columbia residents with the cost of pre-approved prostheses and orthoses needed to attain or maintain basic functionality.

Who is eligible for the Prosthetic and Orthotic Program?

To be eligible you must be covered by one of the following PharmaCare plans:

• Fair PharmaCare
• Plan B (Residential Care)
• Plan C (B.C. Income Assistance)
• Plan F (At Home Program)

What does this program cover?

This program covers:

• pre-approved prostheses for eligible patients of any age;
• pre-approved orthoses for eligible patients age 18 or younger;
• the lowest cost devices needed to attain or maintain basic functionality or, for orthoses, to prevent further deformity.

For a list of items that may be covered, see Prosthetic & Orthotic Product Identification Numbers (pre-approval required).

What is not covered?

• back-up devices or the replacement of lost or stolen items;
• products or devices covered by another insurer such as ICBC, WorkSafeBC, Veterans Affairs Canada, Health Canada’s Non-Insured Health Benefits Program, similar programs from other provinces or jurisdictions, or under an award for damages.

How much assistance will I receive?

Your coverage depends on the rules of your PharmaCare plan, including any deductible requirement.

How do I apply?

After your health care provider decides what you need:

• You can send a claim directly to PharmaCare for service or supplies under $400 if you are registered for Fair PharmaCare.


Note:  Your prosthetic or orthotic health care provider will send in claims under $400 if you are on another PharmaCare plan

• You need PharmaCare’s pre-approval for all services or supplies over $400.  Your prosthetic or orthotic health care provider will submit an Application for Financial Assistance to PharmaCare if your claim is $400 or more.

Orthoses

Eligible patients who are 18 or younger can get help with the cost of some orthotic devices that help attain or maintain basic functionality or prevent deformity.

The program covers:  

• lower extremity orthoses (permanent leg braces);
• spinal orthoses (body braces) – to correct medical conditions such as spina bifida and scoliosis; and,
• plagiocephaly helmets.

If you get benefits through the:

• Ministry of Housing and Social Development ; or,
• Ministry of Children and Family Development

Those ministries may be able to help you pay for devices not covered under this PharmaCare program.

Breast Prostheses and Supplies

If you have a mastectomy or lumpectomy, you may be eligible for coverage of prostheses and supplies, subject to the rules of your PharmaCare plan, including any deductible requirement.

The following products are included in the program:

Breast prostheses

• one every 2 years or at the end of the manufacturer’s warranty
• maximum $350 for mastectomy, $300 for lumpectomy




Post-mastectomy brassieres

• two per mastectomy or lumpectomy if purchased within six months after surgery




Lymphedema arm sleeves

• two per mastectomy, per year




Glove or gauntlets for lymphedema arm sleeves

• two per mastectomy, per year
• maximum $150 for off-the-shelf products, $300 for custom-fit products.

Repairs and Replacements

The program only covers repairs and replacements if they:

• are not covered by a warranty;
• help attain or maintain basic functionality;
• extend the useful life of the device; and,
• are for a device covered by PharmaCare when it was bought.

Note: All repairs and replacements of $400 or more require PharmaCare pre-approval.

There are time and quantity limits for repairs and replacements. Your health care provider can help you determine which repairs and replacements are covered.

Additional Information

For more information, please see:

• Prosthetic and Orthotic Program patient information sheet
• Prosthetic and Orthotic Program – General Statement of Policy

Ostomy Supplies

PharmaCare covers ostomy supplies for patients who have undergone surgery on the bowel and/or bladder that results in a colostomy, ileostomy or urostomy.  Actual coverage is subject to the rules of the patient's PharmaCare plan, including any deductible requirements.

To be eligible you must be covered by one of the following PharmaCare plans:

• Fair PharmaCare
• Plan B (Residential Care)
• Plan C (B.C. Income Assistance)
• Plan F (At Home Program)

What is covered? What is not covered?