Drugs Requiring Pre-approval (Special Authority)

On this page...

 

What is "Special Authority" coverage?

PharmaCare covers some drugs only under specific medical circumstances. This is because some drugs work for only certain patients or are more costly than other, equally safe and effective, drug treatments.

Which drugs require Special Authority approval?

See the full list of drugs that require Special Authority approval.

Drugs in the following categories require Special Authority approval to be eligible for full PharmaCare coverage. To be eligible for coverage, Special Authority approval must be in place before you fill your prescription.

Limited Coverage Drugs All limited coverage drugs require Special Authority approval.
Reference Drug Program (RDP) drugs PharmaCare fully covers only the less costly drugs in an Reference Drug Program category. If you cannot take the less costly, fully covered drug for medical reasons, talk to your prescriber. You may qualify for full coverage of another drug.
Low Cost Alternatives If you cannot take a lower cost version of the a drug, your medical practitioner can request coverage of another version of the drug.
Psychiatric Medications Plan Some drugs are covered under this plan only if you have Special Authority approval.
Drugs for the treatment of Alzheimer's Disease PharmaCare covers donezepil to treat mild to moderate dementia if your prescriber applies for Special Authority coverage for you. Coverage of galantamine and oral rivastigmine (capsules ony) is available only if you cannot tolerate donezepil.
Medications for Medical Assistance in Dying (MAiD) PharmaCare covers 100% of the cost of MAiD medications if the prescribing physician submits an application for coverage to PharmaCare. 

 

How do I get Special Authority coverage?

If your prescriber believes your medical circumstances warrant the use of a specific drug, they can submit a request to PharmaCare explaining your medical situation. If PharmaCare agrees you meet the criteria for coverage, the drug will be eligible for full coverage, subject to the rules of your PharmaCare plan.

How does Special Authority affect my coverage?

If your prescriber's request is approved, PharmaCare fully covers the drug according to the rules of your PharmaCare plan and subject to PharmaCare general coverage policies.

For instance:

  • Actual reimbursement is always based on your PharmaCare plan rules, including any annual deductible requirement. If you have not met your deductible or family maximum, you may need to pay all of part of the cost.
  • A drug that is eligible for full PharmaCare coverage may be subject to general coverage policies that may limit the amount PharmaCare covers. For example, drug costs and dispensing fees vary from pharmacy to pharmacy, so PharmaCare sets a maximum drug cost and dispensing fee it will pay.

>> Learn more about PharmaCare General Coverage Policies such the Low Cost Alternative Program, Reference Drug Program, Pharmacy Maximum Days' Supply Policy and Maximum Pricing Policy.

When does Special Authority coverage begin?

Special Authority coverage begins the day the information is entered into PharmaNet, the computer network that links all BC pharmacies to  central databases. When your Special Authority coverage information has been entered, you can fill your prescription at pharmacy in B.C.

Ask your pharmacist to make sure Special Authority is in place before you purchase the drug. Coverage cannot be provided retroactively.

How long does Special Authority coverage last?

Special Authority coverage may be for a limited time (for example, 6 months) or indefinitely. If approval is for a specific period, your prescriber will need to submit another Special Authority request before the current one expires.

Are there products that are not eligible for Special Authority coverage?

Yes. Please see the list of items that are not eligible for PharmaCare coverage.