Benefit Groups

Eligibility process

The benefit eligibility process uses a relationship, established by PharmaCare, between a product, its associated benefit group and the plan rules.

Benefit Group Description
A No longer a benefit group. Plan discontinued in 2003.
AD Alzheimer’s ADTI Medications—Special Authority required
AM Seniors over 65 Methadone Maintenance
B Residential Care Clients—eligible under Plan B
C Recipients of B.C. Income Assistance—eligible under Plan C
CH Recipients of B.C. Income Assistance under age 19—eligible under Plans CN, F, K0-K9, KA-KZ, 1K-4K, QN and UK
CF

Registered Cystic Fibrosis Clients—eligible under Plan D

Supplements & Enzymes Identification Numbers

DS

Syringes and Infusion Sets for Patients with Diabetes—eligible under Plans C, F, I0-9, IA-IZ, 1I-4I, J0-J9, JA-JZ, 1J-2J, Q, UI, and W

Diabetic Supplies Identification Numbers

F At Home Clients—eligible under Plan F
I2 Insulin (No Fee Allowed)—eligible under Plans B, C, F, I0-9, IA-IZ, 1I-4I, J0-J9, JA-JZ, 1J-2J, Q, & UI
LC

Limited Coverage Items—Special Authority Required

Special Authority Categories

MH

Psychiatric Medications—eligible under Plan G
Psychiatric Medications Formulary

A limited number of medications in the formulary are available under the Trial Prescription Program.

N Nebulizers for Children Under 19—eligible under Plans CN, F, K0-K9, KA-KZ, 1K-4K, QN, UK and W
NS Non-Steroidal Anti Inflammatory—eligible under Plan B
OS

Prosthetic / Mastectomy / Ostomy Supplies—eligible under Plans B, C, F, I0-9, IA-IZ, 1I-4I, J0-J9, JA-JZ, 1J-2J, Q, UI, and W*

Prosthetic & Mastectomy Product Identification Numbers
Ostomy Product Identification Numbers

*Coverage should be obtained through Non-Insured Health Benefits (NIHB).

PC Clients Registered for BC Palliative Care Benefits Program
TA

Trial Prescriptions—eligible for Plans C, F, I0-9, IA-IZ, 1I-4I, J0-J9, JA-JZ, 1J-2J, Q, UI, and W

Trial Prescription Program

U Fair PharmaCare clients—eligible under Plans I0-9, IA-IZ, 1I-4I, J0-J9, JA-JZ, 1J-2J, Q, & UI
W First Nations Health Benefitseligible under Plan W, WC, WD, WX