Prostheses

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About Coverage of Prostheses

PharmaCare helps eligible B.C. residents with the cost of pre-approved prostheses needed to attain or maintain basic functionality.

A prosthetic device provider determines your needs. If required, the prosthetist 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 maxiumum amount that it will cover. The amount PharmaCare actually reimburses depends on your plan rules, including any annual deductible requirement. 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.

Who is eligible?

To be eligible you must be covered by one of the following PharmaCare plans:

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. Please talk to your provider for details.

Breast Prostheses

Following mastectomy or lumpectomy surgery, PharmaCare covers:

  • Breast prostheses
  • Lymphedema arm sleeves
  • Glove or gauntlets for lymphedema arm sleeves

Note that pre-approval is not required for most breast prostheses. Some limits apply. Please talk to your provider for details.

Ocular Prostheses

PharmaCare covers custom ocular prostheses and polishing, provided by certified ocularists.

Some limits apply. Please talk to your provider for details.

Nasal/Ear Prostheses

PharmaCare covers custom-made nose and ear prostheses. 

Some limits apply. Please talk to your provider for details.

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.

Additional Information

For more information, please see the Prosthetic and Orthotic Program information sheet.