4.2 Manual Patient Claims
Last updated: October 24, 2022
B.C. residents can request reimbursement for PharmaCare benefit items they purchased themselves. Claims can be submitted any time during the year they're purchased and as late as March 31 of the following year. One claim submission can include up to 100 eligible purchases.
Process for claims other than prostheses and orthoses
The patient writes a letter that explains why they paid for items that were eligible for PharmaCare coverage. This could be, for example, because they bought them at a PharmaCare-approved pharmacy across the border in Alberta.
The patient sends the letter and store receipts for the items purchased to PharmaCare by fax or mail (see below). The letter must include the patient’s full name, birth date, personal health number (PHN) and address. Submitted receipts/invoices must show itemized costs and include the provider’s name and address.
If requested by the patient, the provider can mail or fax the letter and receipts/paid invoice to PharmaCare.
Process for prostheses and orthoses
In most cases, the device supplier will submit the patient’s paid invoice and the approved PharmaCare application form (e.g., HLTH 5400, HLTH 5404).
If a patient wishes to submit the claim, they will request that the supplier submit the PharmaCare invoice on their behalf, and the patient will mail or fax the receipt(s) and any other supporting documents to PharmaCare.
A Fair PharmaCare client may submit a claim for a prosthetic or orthotic device or service directly to PharmaCare only if they paid the provider the entire cost of the device or service. Reimbursement will depend on the patient’s Fair PharmaCare rules (i.e., deductible, family maximum).
Send claims to:
PO Box 9655 Stn Prov Govt
Victoria BC V8W 9P2
Fax: 250-405-3587 — All receipts must be clearly visible and “PRIVATE FAX” must be written on the first page if the patient wishes to receive return correspondence by fax.
After the claim is processed
PharmaCare will return all receipts that are sent by mail, along with a PharmaCare Remittance Statement showing the items and amounts reimbursed and a cheque, if applicable. A patient covered by a third-party insurer may use the returned receipts and statement to submit a claim to that insurer.
Note that if Fair PharmaCare is the patient’s benefits plan and they have not met their deductible and family maximum, PharmaCare may reimburse only some (or none) of the amount claimed.