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The PharmaCare Prosthetic and Orthotic program helps eligible patients, aged 18 or younger, with the cost of custom orthoses that help attain or maintain basic functionality or prevent further deformity.
If your child requires an orthotic device, a certified orthotist can help determine which device will fit your child's needs. If appropriate, the orthotist submits an Application for Financial Assistance ("the application") to PharmaCare for pre-approval for the orthosis, on your child's behalf. PharmaCare reviews the application and determines the maximum amount it will cover. The amount PharmaCare actually reimburses depends on your PharmaCare plan rules, and any annual deductible requirement. If you get benefits through the Ministry of Housing and Social Development or the Ministry of Children and Family Development, they may be able to help pay for orthotic devices PharmaCare does not cover.
To be eligible, a person must be 18 years of age or younger, and covered by one of the following PharmaCare plans:
The program covers:
- lower extremity orthoses (permanent leg braces)
Note: PharmaCare covers only one orthosis per limb.
- spinal orthoses (body braces) to correct medical conditions such as spina bifida and scoliosis
- plagiocephaly helmets (PDF) for infants
Examples of items PharmaCare does not cover include:
- back-up orthoses
- replacement of lost or stolen orthoses
- orthoses requried for part-time use or for less than a year (including post-surgical orthoses or those for injuries)
- orthotic footwear
- off-the-shelf orthotic products
- foot orthoses
- upper extremity orthoses
- orthotic supplies, such as socks
Note: this list is not comprehensive.
Additionally, PharmaCare does not cover 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 3.3 (PDF), for details.)
The program covers repairs and replacements only if they:
- are not covered by a warranty;
- help attain or maintain basic functionality or prevent further deformity;
- extend the useful life of the orthoses; and
- are for an orthosis covered by PharmaCare when it was initially purchased.
Note: All repairs and replacements of $400 or more require PharmaCare pre-approval. There are time and quantity limits for repairs and replacements. Your device provider can help you determine which repairs and replacements are covered.
For more information, please see the Prosthetic and Orthotic Program patient information sheet (PDF).