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