Ostomy Supply Reimbursement In British Columbia

BC PharmaCare – Ministry of Health
PharmaCare is British Columbia’s publicly funded program that helps BC residents pay for prescription drugs, medical supplies, including ostomy products, and pharmacy services. As a resident of BC, you are eligible for Fair PharmaCare coverage. Exceptions to this are those covered by Non-Insured Health Benefits for First Nations and Inuit and Nisga’a Health Valley authority.

Am I Eligible?

The Pharmacare program may provide funding for ostomy supplies for clients:
Individuals who are not eligible may include:

Coverage

Patients are eligible for benefits if they are covered by one of the following PharmaCare plans:
  • Fair PharmaCare;
  • Plan B (Residential Care);
  • Plan C (BC Income Assistance); or
  • Plan F (At Home Program).

Deductibles and coverage rates vary based on income and pertain to the total of all items covered under the plan (including ostomy supplies). The Fair PharmaCare deductible is based on the net family income reported to Revenue Canada two years prior. For example, your 2020 deductible will be based on your 2018 income. Suppose your income has decreased by more than 10% in the past two years. In that case, you may be eligible for more coverage, so it is essential to contact Fair PharmaCare to organize a re-assessment.

Net Annual Family Income

Family Deductible

Pharmacare Portion

Family Max, then 100% covered

Below $15,000
Zero
70% of prescription
2% of net income
$15,000-$30,000
2% of income
70% of prescription
3% of net income
Over $30,000
3% of income
70% of prescription
4% of net income
SENIORS before 1939:

Net Annual Family Income

Family Deductible

Pharmacare Portion

Family Max

Below $33,000
None
75% of prescription
1.25% of net income
$33,000-$50,000
1% of income
75% of prescription
2% of net income
Over $50,000
2% of income
75% of prescription
3% of net income
You will pay 100% of the cost for your ostomy supplies until you reach the Family Deductible. Costs will then be split between you and Pharmacare (i.e. Pharmacare pays 70%, you pay 30%). Once you have reached your Family Maximum, Pharmacare will pay 100% for the rest of the year.100% coverage is provided for persons who are:
  • Permanent residents of a licensed long term care facility
  • Persons eligible for benefits through the Ministry of Human Resources,
  • Severely handicapped children eligible for the “At Home” Program
  • Registered with a provincial Cystic Fibrosis Clinic
  • Clients eligible for financial assistance through mental health centres, palliative care, and drug plans

Coverage

Patients are eligible for benefits if they are covered by one of the following PharmaCare plans:
  • Fair PharmaCare;
  • Plan B (Residential Care);
  • Plan C (BC Income Assistance); or
  • Plan F (At Home Program).

Deductibles and coverage rates vary based on income and pertain to the total of all items covered under the plan (including ostomy supplies). The Fair PharmaCare deductible is based on the net family income reported to Revenue Canada two years prior. For example, your 2020 deductible will be based on your 2018 income. Suppose your income has decreased by more than 10% in the past two years. In that case, you may be eligible for more coverage, so it is essential to contact Fair PharmaCare to organize a re-assessment.

Net Annual Family Income

Below $15,000

Family Deductible

Zero

Pharmacare Portion

70% of prescription

Family Max, then 100% covered

2% of net income

Net Annual Family Income

$15,000-$30,000

Family Deductible

1% of income

Pharmacare Portion

70% of prescription

Family Max, then 100% covered

3% of net income

Net Annual Family Income

Over $30,000

Family Deductible

2% of income

Pharmacare Portion

70% of prescription

Family Max, then 100% covered

4% of net income
SENIORS before 1939:

Net Annual Family Income

Below $33,000

Family Deductible

None

Pharmacare Portion

75% of prescription

Family Max

1.25% of net income

Net Annual Family Income

$33,000-$50,000

Family Deductible

1% of income

Pharmacare Portion

75% of prescription

Family Max

2% of net income

Net Annual Family Income

Over $50,000

Family Deductible

2% of income

Pharmacare Portion

75% of prescription

Family Max

3% of net income
You will pay 100% of the cost for your ostomy supplies until you reach the Family Deductible. Costs will then be split between you and Pharmacare (i.e. Pharmacare pays 70%, you pay 30%). Once you have reached your Family Maximum, Pharmacare will pay 100% for the rest of the year.100% coverage is provided for persons who are:
  • Permanent residents of a licensed long term care facility
  • Persons eligible for benefits through the Ministry of Human Resources,
  • Severely handicapped children eligible for the “At Home” Program
  • Registered with a provincial Cystic Fibrosis Clinic
  • Clients eligible for financial assistance through mental health centres, palliative care, and drug plans

What Products Are Covered?

BC PharmaCare covers a comprehensive list of drugs and certain medical supplies and pharmacy services.

Some items not covered by Fair PharmaCare include:

  • Ostomy deodorants/lubricants
  • Tape other than paper tape
  • Wound dressings
  • Continence supplies (catheters, leg bags, etc.)


*Please note that not all medications or ostomy products are covered. For a complete list of the items covered, please visit: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/what-we-cover/medical-supplies-coverage/ostomy-supplies

Reimbursement Procedure

Clients must purchase supplies through the province’s Ministry of Health approved vendor and supply list (currently under revision with NSWOC input).

Your ostomy order will then be processed through Pharmacare like a prescription (you do not need a prescription for ostomy supplies). The pharmacy’s receipt will indicate how much you pay and what Pharmacare covers. You can claim this portion to a third-party program or a Medical Expense on your income tax.

Contact Information:

Fair PharmaCare Administration

P.O. Box 9655
Stn Provincial Government
Victoria BC V8W 9P2

Toll-Free: 1-800-663-7100

Disclaimer: The information contained in this page have been researched and sourced from a variety of provincial and federal sites. However information may change and we encourage individuals to check for updates of policies, plans and forms.
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