Device and supply providers
Last updated on June 10, 2026
This page likes to the information most needed by device and supply providers enrolled in PharmaCare.
On this page
- Policy manuals
- For your clients
- Preapproval requirements and forms
- Invoices
- PINs, reimbursement, repairs
- Girling formula
The Prosthetic and Orthotic Program helps patients achieve or maintain basic functionality. Coverage is subject to PharmaCare plan rules, including deductible and family maximum requirements under Fair PharmaCare.
Health Canada’s Non-Insured Health Benefits (NIHB) covers prosthetic, orthotic, mastectomy, and ostomy benefits for First Nations Health Authority (FNHA) clients. These are not currently covered for FNHA clients under PharmaCare Plan W.
Policy manuals
For your clients
Please always encourage your clients to register for the income-based Fair PharmaCare Plan. Post the Fair PharmaCare Registration poster and distribute the Get Covered! (PDF, 74KB) handout. Full page - colour and grayscale. Quarter-page - colour and greyscale.
Information sheets in 15 languages:
Medical devices and supplies are exempt from PharmaCare’s Full Payment Policy. This means that even if a client is receiving 100 percent coverage of the maximum eligible PharmaCare amount, providers are able to directly charge clients any amount in excess of that amount.
Preapproval requirements and forms
PharmaCare requires pre-approval for all eligible prostheses and orthoses except:
- Prosthetic supplies under $400.00
- Prosthetic and orthotic repairs or adjustments under $400.00
- Lymphedema arm sleeves and gloves/gauntlets
- Plagiocephaly helmets for clients who meet the criteria on page 2 of the HLTH 5450 - PharmaCare Orthotic Benefits: Plagiocephaly Helmet (PDF, 529KB) form
- Regular benefit breast prostheses (unless requesting an exception to policy, such as replacing a breast prosthesis before the two-year limit; in that case, pre-approval is required)
- Facial prostheses replacements when it has been longer than 36 months since the last prosthesis was dispensed, the client does not require extra fitting time, and all other criteria under P&O Manual sections 5.3.1, 5.3.2, 5.4.1 and 5.4.2 are met as appropriate for the type of prosthesis
PharmaCare does not cover any non-exempt item unless pre-approval has been granted.
- HLTH 5400 - Orthotic Benefits: Application for Financial Assistance (PDF, 671KB)
- HLTH 5450 - Orthotic Benefits: Plagiocephaly Helmet (PDF, 529KB)
- HLTH 5402 - Prosthetic Benefits: Application for Financial Assistance (PDF, 690KB)
- HLTH 5404 - Prosthetic Benefits (Non-Limb): Application for Financial Assistance (PDF, 683KB)
- HLTH 5418 - Offloading Orthotic Benefits Application for Financial Assistance (PDF, 2.2MB)
PharmaCare does not cover prostheses if the injury was the fault of a third party and the client received an award or settlement. Read Section 4, P&O Manual - Client Eligibility for details. If such a client is applying for PharmaCare coverage, they must submit HLTH 5467 - PharmaCare Eligibility: Awards and Settlements (PDF, 521KB)
Invoices
- HLTH 5415 - Mastectomy Benefits Invoice (PDF, 500KB)
- HLTH 5417 - Prosthetic and Orthotic Benefits Invoice (PDF, 500KB)
- HLTH 5413 - Ostomy Benefits Invoice (PDF, 609KB)
PINs, reimbursement, repairs
- Facial prostheses PINs
- Breast prostheses and compression PINs
- Limb P&O supplies and services PINs
- Definitive socket PINs
- Osseointegration components and PINs
- Orthoses PINs
- Offloading devices PINs
- Ostomy supplies PINs
- Ocular
- Flash and continuous glucose monitors
- Insulin pumps
- Insulin pump supplies
Girling formula
Subscribe to the PharmaCare Newsletter for important policy updates. Providers are required to keep up with policy and procedures changes.