PART C – Decision under Appeal
The decision under appeal is the reconsideration decision dated June 1, 2017, made by the Ministry
of Social Development and Social Innovation (the ministry), which determined that the appellant was
not eligible to receive reimbursement for a shingles vaccine prescription as the ministry is not
authorized to pay for prescription medications and the appellant has not provided evidence that she
does not have other resources to pay for the prescription.
PART D – Relevant Legislation
The relevant legislation is section 69 of the Employment and Assistance for Persons with Disabilities
Act (EAPDWA) and section 2(1) of Schedule C the Employment and Assistance for Persons with
Disabilities Regulation (EAPDWR).
PART E – Summary of Facts
The appellant is in receipt of disability assistance. She has approximately 25% lung function and
requires a double lung transplant.
The evidence before the ministry at the time of the reconsideration decision consisted of:
(1) A letter from the appellant to the ministry dated April 12, 2017, stating the following:
On April 11, 2017, I had to have the shingles vaccine done by the Cystic Fibrosis Clinic
Nurse.
I cannot be on the transplant list unless I had this vaccine done.
If this vaccine was not done I would get rejection if I developed shingles due to being
immune compromised.
I am on disability and I cannot afford to spend this kind of money.
Would you please cover the cost of this vaccine in the amount of $225.61.
I am attaching the receipt of the vaccine.
(2) A receipt dated April 7, 2017, for a prescription of the shingles vaccine in the amount of $225.61.
(3) A request for reconsideration dated May 16, 2017, in which the appellant writes:
Once again I am asking to be reimbursed $225.61 for the needed shingles vaccine.
I am on the list for a double lung transplant, without this vaccine I could get rejection if I
did develop shingles post transplant.
PART F – Reasons for Panel Decision
The issue under appeal is whether the ministry’s determination that the appellant is not eligible to
receive reimbursement for a shingles vaccine prescription was reasonably supported by the evidence
or a reasonable application of the legislation in the circumstances of the appellant.
The relevant legislation is section 69 of the EAPWDA and 2(1) of the EAPWDR:
Health supplement for persons facing direct and imminent life threatening health need
69 The minister may provide to a family unit any health supplement set out in sections 2 (1) (a) and
(f) [general health supplements] and 3 [medical equipment and devices] of Schedule C, if the health
supplement is provided to or for a person in the family unit who is otherwise not eligible for the health
supplement under this regulation, and if the minister is satisfied that
(a) the person faces a direct and imminent life threatening need and there are no resources available to
the person's family unit with which to meet that need,
(b) the health supplement is necessary to meet that need,
(c) a person in the family unit is eligible to receive premium assistance under the Medicare Protection
Act, and
(d) the requirements specified in the following provisions of Schedule C, as applicable, are met:
(i) paragraph (a) or (f) of section (2) (1);
(ii) sections 3 to 3.12, other than paragraph (a) of section 3 (1).
General health supplements
2 (1) The following are the health supplements that may be paid for by the minister if provided to a family unit
that is eligible under section 62 [general health supplements] of this regulation:
(a) medical or surgical supplies that are, at the minister's discretion, either disposable or reusable, if the
minister is satisfied that all of the following requirements are met:
(i) the supplies are required for one of the following purposes:
(A) wound care;
(B) ongoing bowel care required due to loss of muscle function;
(C) catheterization;
(D) incontinence;
(E) skin parasite care;
(F) limb circulation care;
(ii) the supplies are
(A) prescribed by a medical practitioner or nurse practitioner,
(B) the least expensive supplies appropriate for the purpose, and
(C) necessary to avoid an imminent and substantial danger to health;
(iii) there are no resources available to the family unit to pay the cost of or obtain the supplies;
(a.1) the following medical or surgical supplies that are, at the minister's discretion, either disposable or
reusable, if the minister is satisfied that all the requirements described in paragraph (a) (ii) and (iii) are
met in relation to the supplies:
(i) lancets;
(ii) needles and syringes;
(iii) ventilator supplies required for the essential operation or sterilization of a ventilator;
(iv) tracheostomy supplies;
(a.2) consumable medical supplies, if the minister is satisfied that all of the following requirements are
met:
(i) the supplies are required to thicken food;
(ii) all the requirements described in paragraph (a) (ii) and (iii) are met in relation to the supplies;
…
(1.1) For the purposes of subsection (1) (a), medical and surgical supplies do not include nutritional
supplements, food, vitamins, minerals or prescription medications.
THE APPELLANT’S POSITION
The appellant was represented by her parents at the appeal hearing. The appellant’s representatives
did not argue against the ministry’s position that it is not authorized to pay for prescriptions or that the
appellant does not meet the criteria set out in section 69 of the EAPWDA. Rather, they argued that
the ministry should cover this expense because the appellant cannot afford to and it is the only way
that the appellant can move forward with her surgery and regain her health.
The appellant’s representatives also stated that subsequent to the reconsideration decision the
appellant’s physician sought special authority from BC PharmaCare to have the prescription covered
and this request has been denied.
THE MINISTRY’S POSITION
The ministry relied on its reconsideration decision at the appeal hearing. That decision looked to
section 2(1.1) of the EAPWDR, which states that the ministry cannot pay for “prescription
medications” under the items listed in section 2(1). As what is being asked for is reimbursement of a
prescription, the ministry is expressly barred from paying this medical expense.
The ministry’s reconsideration decision also found that the appellant did not qualify under section 69
because the appellant has not demonstrated that she did not have other resources to pay for the
prescription as she had not provided evidence that she had attempted to claim the amount through
BC PharmaCare.
THE PANEL’S DECISION
There is no question that section 2(1.1) bars the ministry from paying for prescription medications and
that what is being asked for is reimbursement for a prescription medication. The panel finds that the
ministry was reasonable in determining that it could not reimburse the appellant under section 2(1).
At the time of the reconsideration decision there was no evidence before the ministry that the
appellant had attempted to have her prescription costs reimbursed by BC PharmaCare. At the appeal
hearing, the appellant’s representatives stated that subsequent to the reconsideration decision they
have been informed by BC PharmaCare that it will not cover this cost. They did not, however, provide
any evidence to substantiate this claim. Therefore, the situation has not changed. Section 69(d)(i) of
the EAPWDA (referencing section 2(1)(iii) of the EAPWDR) requires that the appellant have no other
resources available to cover the cost of the medical supply. In this case, the ministry was reasonable
in determining that the appellant had not pursued all other sources of funding for the prescription at
the time of the reconsideration decision and so did not meet the requirements of section 69.
Based on the above analysis, the panel finds that the ministry’s determination that it could not
reimburse the appellant for her vaccine prescription was a reasonable interpretation of the legislation
and confirms the ministry’s decision.
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.