4.2 Manual Patient Claims

Last updated: November 9, 2023

General Policy Description

B.C. residents may request reimbursement for items they paid for that are eligible for PharmaCare coverage. This includes devices that the provider did not submit a claim directly to PharmaCare for, benefits from PharmaCare-approved border pharmacies in Alberta, offline medical device suppliers (e.g., ostomy supplies), and benefits purchased out of province by clients of the First Nations Health Authority.

Policy details

Claims made by patients must include a letter with the patient's Personal Health Number (PHN), full name, birth date, and address, that explains why the claim is being submitted manually.

Some medical device claims require a completed PharmaCare Invoice (i.e., mastectomy, prosthetic and orthotic, ostomy) instead of a letter.

A receipt showing the amount was paid in full must be included with all claims. Claims must be submitted before March 31 of the year following the purchase.

How providers can help a patient submit a manual claim

1. Collect payment for the full cost of the item from the patient.
2. Provide the patient with a PharmaCare invoice and a receipt that clearly shows the itemized costs and total paid, as well as the site ID, provider name, and address.
3. The provider or patient mails or faxes the claim to Health Insurance BC. If faxed, all receipts must be clearly visible. If mailed, receipts should be loose in the envelope and not taped or stapled to the cover letter.

Fair PharmaCare claims

HIBC processes Fair PharmaCare claims through PharmaNet. If a Fair PharmaCare patient’s annual deductible has not been met, the eligible amount that was paid by the patient will go towards their deductible and family maximum. Any reimbursement PharmaCare owes the patient is paid by cheque and mailed to the patient. Patients must pay out-of-pocket for the amounts that are not covered.

PharmaCare will also mail back the patient’s receipts and a remittance statement that shows what the patient paid and what PharmaCare covered for each receipt submitted. A patient may use the returned receipts and Remittance Statement to submit a claim for the same item(s) to their third-party insurer.

If a claim is faxed from a private and secure fax, any follow-up communication, including the remittance statement, may be faxed back to that number.