Prosthetic & Orthotic product identification numbers (PINs)

PharmaCare provides coverage for mastectomy prostheses and supplies for eligible individuals who have undergone a mastectomy.

*Maximum coverage updated June 24, 2015

Note: Adjudication through PharmaNet does not mean that two years have elapsed. Contacting the Help Desk will ensure that the patient is entitled to the benefit and that the claim adjudicates accurately.

Claims to PharmaCare should include labour and material costs associated with the device, as included on the pre-approval. These costs should be claimed under the appropriate PIN based on the side that is being fitted.

Prosthetic devices may be replaced:

• No sooner than three years from the date on the PharmaCare approval letter/form; and
• Only if it is demonstrated that the existing device no longer meets the patient’s basic functionality needs.

Claims to PharmaCare should include clinical labour and material costs associated with the device, as included on the pre-approval. These costs should be claimed under the appropriate PIN based on the type of offloading device being fitted.

Claims to PharmaCare should include clinical labour, material and component costs associated with the device, as included on the pre-approval. These costs should be claimed under the appropriate PIN based on the type of orthosis being fitted.

Orthoses for children and youth may be replaced:

• No sooner than one year from the date on the approval letter; and
• Only if it is demonstrated that the existing device no longer meets the basic functionality needs for the patient.

The ostomy supplies listed below are covered for eligible patients who have undergone bowel and/or bladder surgery that results in a colostomy, ileostomy, or urostomy, requiring an external pouch. Actual reimbursement is subject to the rules of the patient’s PharmaCare plan, including any deductible requirements.

Note: PharmaCare covers certain ostomy supplies for First Nations Health Authority clients under Plan W (see list below). The Non-Insured Health Benefits (NIHB) program may still cover some supplies not eligible under Plan W which may require NIHB prior authorization. 

*Products in the right-hand column are examples only. Their inclusion is not an endorsement of these products. Coverage is not limited to these products or manufacturers.

**These items are covered only for patients using ostomy pouch – urostomy (PIN 88123431).

Non-benefit items

The following items are not benefits.

• Catheters—for any use, including
  • for management of any medical or post-surgical condition
  • all products for management of continent urostomies—catheters, absorbent pads
  • Note: PINs 88123480, 88123492 and 88123510 are benefits for patients using a urostomy pouch (PIN 88123431)
• All products for the management of nephrostomy tubes, feeding tubes, other drainage tubes, wound  drainage—such as Hollister drain tube attachment device, or urinary drainage collection equipment  (including PINs 88123480, 88123492 and 88123510, except as noted above)
• All products for management of urinary incontinence—catheters, condoms, drainage containment  equipment, diapering systems, incontinence pads, tubing and adapters (including PINs 88123480, 88123492 and 88123510, except as noted above)
• Cotton covers for pouches or night drainage bottles
• Pouch liners—such as Colo-Majic
• Stoma hole cutters
• Ostomy support belts—such as Nu-Hope
• Skin protectants—such as Marathon skin protectant
• Creams—such as Sween Cream, Chiron Cream, BAZA cream
• Cleansers—such as Uni-Wash, ConvaTec AloeVesta products
• Lubricants—such as KY Jelly, Hollister stoma lubricant
• Tapes (other than paper-type or elastic barrier tape)—such as waterproof tape, Elastoplast, straight  transparent dressings—such as OpSite, Tegaderm
• Room deodorants—such as M9
• In-pouch deodorants—such as Uri-Kleen, M9, Banish
• Hydrocolloid dressings—such as DuoDerm, Restore, Tegasorb
• Instruments—such as scissors, dressings sets
• Alcohol swabs, sterile and unsterile gauze
• Any items purchased through online suppliers – items must be purchased from authorized PharmaCare providers.

Note: Exclusion of a product from this list does not imply it is a benefit product.

PharmaCare does not cover any items, even if they are listed in this document, not used for the purposes stated. Non-benefit uses include management of a catheter, diabetes, an insulin pump, wounds, ineligible types of ostomy (e.g., a cecostomy or nephrostomy), feeding tubes, or urinary incontinence.

Claims to PharmaCare should include clinical labour, material and component costs associated with the device, as included on the pre-approval. These costs should be claimed under the appropriate PIN based on the level of amputation, and the side that is being fitted.

Prosthetic devices may be replaced:

• No sooner than three years from the date on the PharmaCare approval letter/form; and
• Only if it is demonstrated that the existing device no longer meets the patient’s basic functionality needs.

• ​Girling Formula for Prosthetic and Orthotic Devices (PDF, 151KB)
• PINs and Reimbursement Schedule for Mastectomy Supplies
• PINs and Reimbursement Schedule for Non-Limb Prostheses
• PINs and Reimbursement Schedule for Offloading Devices
• PINs and Reimbursement Schedule for Orthoses
• Reimbursement Schedule for Definitive Sockets
• Reimbursement Schedule for Osseointegration Components
• Reimbursement Schedule for Prosthetic and Orthotic Services and Supplies