Prostheses covered by BC PharmaCare
Last updated on July 30, 2024PharmaCare helps eligible B.C. residents with the cost of pre-approved prostheses needed to attain or maintain basic functionality.
On this page:
About coverage
A prosthetic device provider determines your needs. If required, the prosthetist, or orthotist in the case of a transmetatarsal prosthesis, submits an Application for Financial Assistance to PharmaCare ("the application") for pre-approval of coverage for the device, supplies, or service, on your behalf.
PharmaCare reviews the application and determines the maximum amount it will cover. The amount PharmaCare actually reimburses depends on your plan rules, including any annual deductible. You are responsible for paying any remaining cost.
Time and quantity limits may apply to all prosthetic benefits. These limits are different for each item; please talk to your device provider for details.
Eligibility
To be eligible you must be covered by one of the following PharmaCare plans:
- Fair PharmaCare
- Plan B (Residential Care)
Note: you must have PharmaCare coverage in place before your device provider dispenses your device.
Limb prostheses
PharmaCare covers basic functionality prostheses, supplies, and services for
- Partial foot (must be at least trans-metatarsal amputation—through midfoot)
- Leg (includes amputation through ankle, above and below knee, and hip)
- Arm (includes amputations through the wrist, above and below elbow, and shoulder)
PharmaCare does not cover prostheses for individual toes or fingers. Some limits apply.
What is not covered?
PharmaCare does not cover:
- Prostheses, and associated supplies and services, that exceed basic functionality
- Back-up prostheses
- Replacement of lost or stolen prostheses or supplies
- Prostheses for individual fingers or toes
- Scleral lenses for those with sight in the eye
- 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 associated with an award for damages (see the PharmaCare Policy Manual, Section 3.4, for more details.)
Repairs and replacements
The program covers repairs and replacements only if they:
- Are not covered by a warranty
- Help attain or maintain basic functionality
- Extend the useful life of the prosthetic device; and
- Are for a device or a component of a device that was 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 provider can help you determine which repairs and replacements are covered.
