Understanding Ostomy Coverage in 2021

As we approach winter, remember that come January 1st, the 2021 family deductible limit for those on the Fair PharmaCare program will reset back to zero. This program helps pay for eligible prescription drugs and some medical supplies. It is income based – the lower your income, the more help you receive. Most B.C. residents are eligible for coverage by this plan, however you must register. To register online, by phone or with a paper form, refer to https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/about-pharmacare. To do this you will need your BC Care Card and to have filed income tax for the past two years.

How is the deductible set?

Based on income, a deductible is set for your family. Your 2021 deductible will be based on your family’s net income for 2019.  The deductible is the amount you need to spend before Fair PharmaCare starts to help with the costs of eligible expenses. Your prescription and medical supply (including ostomy supplies) purchases go towards the same deductible. Once your deductible is reached, PharmaCare will pay 70% of the costs for the remainder of the year. In January of each year, the deductible is reset.

In addition to the deductible, each family has a maximum that they will spend out of pocket, per year. If the family maximum is reached PharmaCare will pay 100% of the eligible expenses for the remainder of the year.

If your income has decreased by more than 10% over the last two years, you may be eligible for more coverage. Contact Fair PharmaCare for reassessment.

Fair PharmaCare covers most prescription drugs and some medical supplies. Basic ostomy supplies are covered. Items not covered include: catheters, incontinence products, pouch covers, pouch liners, stoma hole cutters, hernia support belts, cleansers, lubricants, tapes other than paper tape, deodorants, alcohol swabs and gauze. Elastic barrier strips (also called barrier extenders) were recently approved for coverage. Any items purchase through online suppliers are not covered. For more detail refer to https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/ostomy.pdf.

Click here to learn more about the PharmaCare program. To confirm that you are registered for the program, call: (604) 683-7151 in Vancouver, or toll-free from elsewhere (800) 663-7100.