7.5 Cystic Fibrosis (Plan D)
General Policy Description
Individuals registered with a provincial cystic fibrosis clinic receive coverage of eligible digestive enzymes. These individuals are also eligible for coverage of certain vitamins, nutritional supplements and hypertonic saline solutions through their primary PharmaCare plan.
Policy Details
To be eligible for Plan D, individuals must have active Medical Services Plan (MSP) coverage.
Coverage under Plan D is for individuals, rather than families.
PharmaCare does not confirm eligibility for Plan D.
An individual must be registered with one of the province’s four cystic fibrosis (CF) clinics (listed in the Tools and Resources section below) which will confirm the individual’s eligibility for Plan D and enroll them in the plan.
Only a CF clinic can request additions, changes and deletions to PharmaCare coverage under Plan D.
Plan D coverage is not available to patients in acute or extended care hospitals.
CF clinics provide eligibility information to PharmaCare. Coverage is in effect from the time it is entered into PharmaNet.
Plan D coverage cannot be provided retroactively.
| Eligible costs of digestive enzymes |
100% coverage when the product is purchased at a community pharmacy and a claim is submitted on PharmaNet. |
|---|---|
| Coverage of the eligible costs of vitamins and nutritional supplements |
Coverage under the rules of the individual’s primary PharmaCare plan (i.e., Fair PharmaCare, Plan C or Plan F) when the product is purchased at a community pharmacy and a claim is submitted on PharmaNet. |
| Coverage of the eligible costs of hypertonic saline solutions |
>> See the Cystic Fibrosis Formulary for a list of products covered
Items in the Cystic Fibrosis Formulary are eligible for coverage only if they are purchased at a pharmacy in the same manner as prescription drugs. This is important because the pharmacy must submit a claim on PharmaNet at the time of purchase to initiate PharmaCare reimbursement.
Digestive enzymes and hypertonic saline solutions are reimbursed up to the PharmaCare maximum price plus a dispensing fee (up to the PharmaCare maximum dispensing fee).
>> For information on the PharmaCare Maximum Pricing Policy, see Section 5.6.
Vitamins and nutritional supplements are reimbursed at actual acquisition cost plus a dispensing fee (up to the PharmaCare maximum dispensing fee).
>> For more information on the Actual Acquisition Cost Policy, see Section 5.7.
Procedures for Pharmacies
Dispensing cystic fibrosis items
- Consult the Cystic Fibrosis Formulary to determine if the item is covered.
- Submit the claim with the correct DIN/PIN.
For liquid nutritional supplements, the dispensed quantity claimed should be the total metric quantity dispensed. For example, when submitting a claim for case of Ensure® (12 cans @ 235 ml per can) enter the total metric volume of the case (i.e., 2820 mL).
The claim will adjudicate under Plan D or the patient’s primary PharmaCare plan, as appropriate.
Tools and Resources
For information on products not listed in the Cystic Fibrosis Formulary, contact the PharmaCare Help Desk at Health Insurance BC.
For more information on eligibility for Plan D, contact the nearest cystic fibrosis clinic.
- B.C. Children's Hospital
4480 Oak Street, Vancouver BC V6H 3V4
Clinic: 604-875-2345
Email: cfclinic@cw.bc.ca
- St. Paul's Hospital (Adult)
1081 Burrard Street, Vancouver BC V6Z 1Y6
Clinic: 604-806-8522
Email: cfclinic@providencehealth.bc.ca
- Victoria General Hospital (Paediatric)
1 Hospital Way, Victoria BC V8Z 6R5
Clinic: 250-727-4247
- Royal Jubilee Hospital (Adult)
Victoria Adult CF Clinic
1952 Bay Street, Royal Block 4 - RB 422, Victoria BC V8R 1J8
Clinic: 250-519-5300 local 13395
