“I have to pay for my Ostomy supplies?” This is one of the most frequent questions I get asked as an ET nurse.

How does Ostomy coverage work in the province of British Columbia?

As a resident of BC you are eligible for Fair PharmaCare. Exceptions to this are those covered by Non-Insured Health Benefits for first Nations and Inuit and Nisga’a Health Valley authority.

How does Fair PharmaCare work?

A resident of BC needs to be register for Fair PharmaCare. To do this you will need your BC Care Card and have filed income tax for the past two years.

What is a deductible?

A deductible is a specified amount of money that the insured must pay before an insurance company will pay a claim. Each family has a deductible that will need to be reached prior to Fair Pharmacare covering any portion of your eligible medical expenses.

How is that deductible determined?

The Fair PharmaCare deductible is based on the family net income reported to Revenue Canada, two years prior. For example, your 2018 deductible will be based on your 2016 income. If your income has decreased by more than 10% in the past two years you may be eligible for more coverage. Thus, it is important to contact Fair PharmaCare to organize a reassessment.

 Determining your deductible:

Net Family Income

Family deductible

Portion PharmaCare Pays

Family Max then 100% covered

< $15 000.

zero

70%

2% of net income

$15 000 -

$30 000.

2% of net income

70%

3% of net income

>$30 000.

3% of net income

70%

4% of net income

 

 

Until Deductible Reached After Deductible Reached After Family Max Reached
You pay 100% You pay 30%/PharmaCare pays 70% PharmaCare pays 100%

 

What is covered by Fair PharmaCare?

BC PharmaCare covers a comprehensive list of drugs as well as 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, such as 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:

http://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/ostomy.pdf

 If you are unsure if you are registered for Fair PharmaCare you can call:

Vancouver:        (604) 683-7151

Toll-free:            (800) 663-7100

If you are currently purchasing prescription medication, ask your pharmacist if you have any PharmaCare coverage. It is likely that you have already registered with PharmaCare but it is good to double check. Your ostomy product purchases will go towards the same deductible as your prescription medications. Thus, you should reach your deductible sooner than previous years.

Example:

Your deductible is $1,000

Medication A costs $300 for 3 months

Medication B costs $200 for 3 months

You will have paid your deductible by June 30th if you ordered these January 1st. You will then be covered 70%

Now that you have an Ostomy you are spending $250 per 3 months on product. You should reach your deductible by (approximately) the end of April.

Private Medical Insurance:

If you have private medical insurance you will still need to register for Fair PharmaCare. Your purchase will automatically be submitted to PharmaCare by Nightingale Medical Supplies. This allows for your eligible ostomy supplies to go towards your deductible. You will then need to submit your Nightingale invoice to your private insurance provider.  The amount covered will depend on your policy.

Students between the ages of 19-24 years old who are enrolled in post-secondary education full time can remain under parental coverage.  Dependents under 19 must register as an individual before the end of the year that they turn 19.  They must pay their own MSP premiums and file and income tax return from the past two years (even if it is for $0) in order to become eligible for Fair PharmaCare.  

What to do with the balance not covered by private insurance or prior to reaching your deductible?

You can save your receipts and submit them on your tax return. Please visit the address below for more information:

http://www.cra-arc.gc.ca/medical/

 

 

Written by Lauren Wolfe RN, BSN, CWOCN

Lauren’s nursing career has been a combination of acute spinal cord nursing, intensive care nursing and clinical teaching for Douglas College. She completed her Bachelor of Science at the University of Victoria in 1997. In 2004 she moved to Richmond Hospital ICU. She then completed the WOCN program at Emory University in Atlanta, Georgia in 2006. Lauren started her WOCN career at Richmond Hospital where she worked to establish the WOCN program over six years.