Medical Supplies CoverageIn 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 AdolescentsEffective November 17, 2008, 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. Who is eligible for coverage?Insulin pump coverage is available to children who:
PharmaCare covers 100% of the cost of one of the approved insulin pumps every five years subject to the rules of your PharmaCare plan. For instance:
How do we obtain coverage? The first step is to speak to your diabetes physician specialist. If your child meets the medical criteria for coverage of a pump, the specialist will submit a Special Authority request to PharmaCare. When your physician specialist requests coverage, your child (or their parent or guardian) will need to sign a form confirming that they are committed to blood glucose monitoring, to the safe and appropriate use of the insulin pump and to ongoing age-appropriate diabetes education. If the request is approved, we will send an approval letter to your specialist's office. Your specialist will give you a copy of this letter to take to the insulin pump vendor of your choice. Important: Be sure to wait for the approval letter before purchasing the insulin pump. PharmaCare cannot provide retroactive coverage for purchases made before approval is confirmed. Where should I buy my insulin pump? You may buy your insulin pump from any approved vendor in B.C. What if I encounter problems using a pump instead of regular injections? Speak to your diabetes specialist. If, in consultation with your specialist, it is determined that you cannot continue using a pump, you may be able to return it. Some vendors may allow you to return the pump for a refund in the first 90 days after purchase. In this case, the vendor will reverse the PharmaCare claim and refund any portion of the cost you paid. How often will PharmaCare cover a new pump? PharmaCare covers only one insulin pump every five years and does not cover repairs. You may want to check that your home insurance covers any damage to the pump that is not covered under the manufacturer warranty. What if my pump stops working after the five year period is up? If your pump is beyond economical repair, contact the vendor of your pump and ask for a letter confirming your warranty expiry date. Take the letter to your diabetes physician. Your specialist will include the letter from the vendor with the Special Authority request to PharmaCare. What if we already own an insulin pump that was not covered by PharmaCare? PharmaCare coverage is available if you meet the medical criteria for a subsequent pump, your current pump is four or more years old and the manufacturer's warranty has expired. Your specialist can submit a Special Authority request to PharmaCare for coverage. Contact your pump vendor for a letter confirming your warranty expiry date. Your specialist will include this proof that your warranty is about to expire with the Special Authority request.
Insulin Pump SuppliesWho is eligible for coverage?Individuals of any age who are covered by the Fair PharmaCare Plan, Plan C (Income Assistance Recipients) or Plan F (At Home Program) are eligible for coverage of certain insulin pump supplies. 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? You can buy insulin pump supplies from any pharmacy and some approved vendors in British Columbia. All pharmacies and approved vendors can submit claims to PharmaCare.
Other Diabetes SuppliesBlood Glucose Test StripsPharmaCare covers blood glucose test strips for individuals covered under Fair PharmaCare, Plan C (Income Assistance) and Plan F (At Home Program). PharmaCare covers your blood glucose test strips if:
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 (Income Assistance) and 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 (Permanent Residents of Residential Care), Plan C (Income Assistance) and Plan F (At Home Program). 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 ProgramThe PharmaCare Prosthetic & Orthotic Program helps eligible British Columbia residents with the cost of prostheses and orthoses needed to achieve or maintain basic mobility.Who is eligible for the Prosthetic & Orthotic Program? To be eligible for the program:
PharmaCare covers prostheses for eligible residents of any age and orthoses for children or youth age 18 or younger when the prosthetic or orthotic device is needed to attain or maintain basic mobility. Note: The program does not cover back-up devices, replacement of lost or stolen items or devices or accessories for sports activities. For a full list of the items covered, see our Prosthetics and Orthotics List. How much assistance will I receive? Actual coverage is subject to the rules of your PharmaCare plan, including any deductible requirement. How do I apply? Your health care provider will determine your needs. If the costs is more than $400, your health care provider will submit an Application for Financial Assistance to PharmaCare. PharmaCare's pre-approval is needed for all services or supplies over $400. For service or supplies under $400, your health care provider will submit a claim directly to PharmaCare on your behalf. Orthotic Devices If you are age 18 or younger, you may be eligible for coverage of the following orthotic devices if the device is needed to achieve or maintain basic mobility:
Mastectomy Prostheses and Supplies If you have a mastectomy, you may be eligible for coverage of mastectomy prostheses and supplies. Actual coverage is subject to the rules of your PharmaCare plan, including any deductible requirement. The following products are included in the program:
PharmaCare may help you with the cost of repairs to, or replacement of, prostheses or orthoses that no longer meet your basic needs. 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 the Prosthetic & Orthotic Program – General Statement of Policy.
Ostomy SuppliesPharmaCare covers ostomy supplies for patients who have undergone ostomy surgery. Actual coverage is subject to the rules of your PharmaCare plan, including any deductible requirement.What is covered? What is not covered? For a list of the items PharmaCare does and does not cover, see our Ostomy Supplies page. |
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