Submitting a Special Authority Request

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What you need to know before you submit a request

PharmaCare approves Special Authority Requests for patients who meet established criteria. Under exceptional circumstances, PharmaCare may cover patients who do not meet the pre-defined criteria.

Duration of coverage

Special Authority coverage is valid from the date that approval is entered into a patient's record on PharmaNet, B.C.'s electronic network that links all of the province's community pharmacies and other authorized health care providers.

The duration of coverage depends upon the specific drug and condition being treated.

Level of coverage provided to your patient

An approved Special Authority normally grants full coverage to a drug that would otherwise not be covered or be only partially covered.

Note that full coverage differs from actual reimbursement. Actual reimbursement depends on a patient's PharmaCare plan rules, including any annual deductible and co-payment requirements, and is subject to pricing policies such as the Maximum Pricing Policy, the Low Cost Alternative (LCA) Program or the Reference Drug Program (RDP).

Estimated turnaround times

  • Urgent = 1 business day
  • Priority medications = 3 business days
  • Regular medications = 10 business days

Collaborative Prescribing Agreements

PharmaCare introduced Collaborative Prescribing Agreements (CPAs) for a number of drugs to allow prescribers who agree to prescribe according to PharmaCare coverage criteria to do so without submitting a Special Authority Request for each patient.

>> Learn more about CPAs (PDF).

Obtaining coverage for a Limited Coverage or RDP drug

  1. Access the Special Authority Drug List.

The list includes only those medications for which Special Authority approval is required. It does not include regular PharmaCare benefits.

Note: Special Authority approval must be in place before the patient purchases the prescription. Coverage cannot be provided retroactively.

  1. Click on the drug name to view the drug criteria page through which you can access the appropriate Special Authority Request form.

You can also click on the Special Authority Category to see a description of the reimbursement program under which the drug is included.

  1. On the drug criteria page:
  • Review coverage criteria.
  • Check to see if a Prescriber Exemption is available.

If yes and you are in the exempted group, you do not need to submit a Special Authority form for your patient.Their prescription will be covered automatically.

  • Check to see if a Collaborative Prescribing Agreement (CPA) is available.

If you are eligible to enter into a CPA, after the CPA is granted, you do not need to submit a Special Authority Request when prescribing according to the terms of the CPA.

  • If you are not eligible for an exemption or a CPA, select the Special Authority Request form link at the bottom of the criteria page to  complete the form, documenting how your patient meets the coverage criteria.

For detailed instructions on completing the form, see the Prescriber Checklist (PDF).

  1. Sign the Special Authority Request form.
  1. Fax the form, toll-free in B.C., to 1 800 609-4884.

Obtaining full coverage for a Low Cost Alternative Program drug

The Low Cost Alternative (LCA) Program ensures British Columbians get the best value on multiple-source drugs. Each LCA category consists of drugs with the same active ingredient(s) and the same strength. PharmaCare covers only those drugs that meet a set price.

If your patient is allergic, or has an intolerance, to the non-therapeutic ingredients used in the fully covered drugs within an LCA category, you can submit a PharmaCare Special Authority request for full coverage of another drug (including an alternate generic brand of the same drug) in that category.

Please see the list of the multiple-source drugs that PharmaCare covers (XLS). In column F, a "P" indicates a partial benefit and "F" indicates a full benefit. Drugs not listed in the data file are not covered. Only drugs marked "P" require Special Authority to be covered.

To submit a request:

  1. Complete a General Special Authority Request (PDF) form, documenting your patient's clinical need for the drug. Be sure to list all the fully covered products they have trialed.

For detailed instructions on completing the form, see the Prescriber Checklist (PDF).

  1. Sign the Special Authority Request.
  2. Fax the form, toll-free in B.C., to 1 800 609-4884. 

After you submit the request

Special Authority requests are prioritized by date received and by urgency. Once the request is processed, PharmaCare will notify you (the prescriber) of the decision unless:

  • you have indicated you did not require confirmation, or
  • the office fax number you provided is illegible or incorrect.

To ensure continuity of coverage, you may wish to schedule an appointment with the patient for re-evaluation so that, if a request for renewal is required, you can submit the request for renewal at least 2 weeks before the expiry date.