PharmaCare Newsletter

PharmaNet entry when client is prescribed both witnessed and non-witnessed PA

Following the June 18 update, PharmaCare is providing further instruction on recording prescribed alternatives (PA) consumption in PharmaNet.

When dispensing a prescription for PA to a client which includes both witnessed and non-witnessed doses, pharmacies should enter both intervention codes "VS - Other outcome or intervention" in PharmaNet for the witnessed dose, and code "SA - Prescribed safer alternative" for the subsequent non-witnessed doses.

Pharmacists are asked to note the details of the witnessed and non-witnessed doses in brackets at the end of the SIG field, e.g., (Witness # times daily). Use numerals ("1, 2," instead of "once, twice") to minimize the truncation of directions recorded in PharmaNet (limit = 80 characters). 

Prescribed alternative scenario		Intervention code to use
Witnessed		First interaction of the day: VS Subsequent interactions same day: VS and UF
Witnessed with carries		First interaction of the day: VS and SA Subsequent interactions same day: VS and UF
Not witnessed		First dispense of the day: SA Subsequent dispenses same day: SA and UF

Examples of order entry

Example 1
RX: Hydromorphone 8 mg tablets – 1-3 tablets q1h as needed up to 14 tablets provided daily. (SA witness)
Dispense # in day		SIG/Directions	Quantity to PNet	Intervention codes
First		Take 1-3 tablets every hour as directed to max of 14 tablets daily (Witness)	3	VS
Second		Take 1-3 tablets every hour as directed to max of 14 tablets daily (Witness)	3	VS and UF
Third		Take 1-3 tablets every hour as directed to max of 14 tablets daily (Witness)	3	VS and UF

 

Example 2
RX: Hydromorphone 8 mg tablets – 1-3 tablets q1h as needed up to 14 tablets provided daily. (SA witness first dose with remainder as carry)
Dispense # in day		SIG/Directions	Quantity to PNet	Intervention codes
First		Take 1-3 tablets every hour as directed to max of 14 tablets daily (Witness 1 time daily)	14	VS and SA

 

Example 3
RX: Hydromorphone 8 mg tablets – 1-3 tablets q1h as needed up to 14 tablets provided daily. (SA witness twice daily with remainder as carry)
Dispense # in day		SIG/Directions	Quantity to PNet	Intervention codes
First		Take 1-3 tablets every hour as directed to max of 14 tablets daily (Witness 2 times daily)	7	VS and SA
Second		Take 1-3 tablets every hour as directed to max of 14 tablets daily (Witness 2 times daily)	7	VS and UF

Entry requirements for recording PA in PharmaNet were outlined in the June 2025 PharmaCare Newsletter (PDF, 699KB).

Resources

• June 2025 PharmaCare Newsletter (PDF, 699KB)

Pharmacies to provide permanent, monitored email address by August 31, 2025

PharmaCare providers are now required to register an email with HIBC that is permanent and checked daily. Between July 1 and August 31, pharmacies are asked to submit a PharmaCare Provider Change form (PDF, 1.3MB), completing the cover page, updating the email fields in Part A, and checking if Parts C and D are implicated, if:

• You registered as a provider with an email that is no longer in use
• You don't know which email we have on file
• The email we have on file isn't checked daily
• You need to update other contact information, or information related to your business name, owner, manager, location, power of attorney, sub-class, or give notice of a disposition or closure

The email may be subsequently updated, following business changes.

We spend a lot of time trying to reach providers, since many emails on file are defunct or rarely checked. Your support for this initiative is greatly appreciated.

Resources

• HLTH 5433 – PharmaCare Provider Change form (PDF, 1.3MB)

PharmaCare Trends 2023/24

Controlled prescription forms, physician prescribing authority

The College of Physicians and Surgeons of British Columbia (CPSBC) is providing guidance on faxed controlled prescriptions with visible security watermarks, and how physician licence terminology relates to prescribing authority.

Faxed controlled prescription forms

Due to the design of duplicate prescription pads, the "VOID" security watermark may occasionally be visible when a controlled prescription form is faxed to a pharmacy. This does not necessarily mean the prescription is invalid. The watermark is a security feature to prevent patients from forging prescriptions or copying prescriptions on colour copiers.

Pharmacists are advised to look out for forgeries and are encouraged to contact the prescriber's office directly to verify the prescription if they have concerns.

Licence terminology and prescribing authority

The physician licence status "Not Licensed for Independent Practice" indicated in the CPSBC registrant directory does not impact a physician's ability to issue valid prescriptions.

Residents in the UBC medical programs who hold the licence status "Not Licensed for Independent Practice" have prescribing privileges and are supervised by program preceptors. Their licences are reviewed, automatically recognized and loaded into the PharmaNet system. While active registration and the presence of a practitioner's licence in PharmaNet does not necessarily prove prescribing authority, generally, practitioners within this licence class do have prescribing authority. 

Pharmacists are asked to contact CPSBC's Drug Programs department by emailing drugprograms@cpsbc.ca or by phone at 604-733-7758 (ext. 2629) if they have any questions. 

Timely access to prescribed medications is essential, and CPSBC values the collaboration between physicians and pharmacists in supporting patient care.

Resources

• Registrant directory – College of Physicians and Surgeons of BC

TI Letter: Oral vs IV antibiotics

The Therapeutics Initiative recently published a Therapeutics Letter that reviewed the evidence that compared oral versus intravenous antibiotics. 

Visit Oral vs IV antibiotics to read the Letter.

Resources

• Therapeutics Initiative – [155] Oral vs IV antibiotics

Confidentiality and third-party insurers

Pharmacists are encouraged to get a client's consent before sharing dispense information with third-party insurers. Confidentiality can be a concern to clients for some medications. 

All healthcare professionals in B.C. are required to treat information as confidential to the individual client, unless there is a safety concern. In the case of third-party billing, privacy requirements are different.

Medications billed to a private insurance plan are accessible to the account holder, who could be a parent or spouse, and who may see the medication name, date, and cost in an insurance statement or online portal. 

Pharmacists are encourage to ask clients if they have concerns about the confidentiality of any of their prescriptions. Such prescriptions could include contraceptives, sexual and mental health medications, gender-affirming therapies, substance use disorder treatment, and palliative care.

For any prescription, taking care not to stigmatize certain medications, pharmacists can explain to a client: It looks as if you have both PharmaCare and extended health coverage with another insurer. Would you like me to submit to both? A record of the transaction will be provided to the account holder of the extended health plan, if I do. Do you have any questions or concerns?

If a client has concerns, pharmacists can offer to remove the third-party insurance from a prescription, before billing only PharmaCare. Pharmacies are not obligated to share medication records with third-party insurers.

If the full cost of the medication is covered by PharmaCare or subject to the full payment policy, the client pays nothing. If the prescription is only partially covered by PharmaCare, the pharmacist needs to explain to the client that they will have to pay some of the cost and a dispensing fee, which may have been covered by the third-party insurer. 

The PharmaCare communications team is also making efforts to inform the public that they can ask to withhold third-party billing when they have confidentiality concerns. 

RAT kit payment update

Since the last newsletter, PharmaCare has paid pharmacies for COVID-19 rapid antigen test (RAT) kit distribution as follows:

Payment month		Payment date
April 2025		July 8, 2025

RAT kit distribution fee program ends

As announced in the May 2025 and June 2025 PharmaCare Newsletters, PharmaCare has ended the RAT kit distribution fee program. The last day to submit claims for the PharmaCare RAT kit distribution fee was June 30, 2025.

Pharmacies are encouraged to order RAT kits from distributors, available free of charge until supplies run out. Pharmacy distributors have stockpiled kits to be available to pharmacies and stores until the supply is exhausted or expired (i.e., late 2026).

Resources

• May 2025 PharmaCare Newsletter (PDF, 450KB)
• June 2025 PharmaCare Newsletter (PDF, 685KB)
• PharmaCare Policy Manual, Section 8.15: Rapid antigen test kit distribution
• 2025 PharmaCare Provider Payment Schedule (PDF, 120KB)

Exchange rate for prosthetic and orthotic components

 As of June 5, 2025, PharmaCare's exchange rate has decreased from $1.4305 to $1.3659. PharmaCare's price list for P&O components is adjusted periodically, based on changes to the U.S. exchange rate posted by the Bank of Canada. When the rate changes by at least 5 cents over at least 5 consecutive business days, PharmaCare's exchange rate is adjusted to reflect the new rate.

Measles cases on the rise

Strategies to reduce pill burden

Reducing a patient's pill burden means working to reduce the number of pills a client takes daily. This can help support adherence and may lead to cost savings at the pharmacy for clients.

Pharmacists can consider the following strategies to reduce a client's pill burden:

• Consolidate medications by using combination products where possible (for example, a combination ramipril/hydrochlorothiazide tablet instead of two separate tablets of both drugs)
• Use fewer higher strength pills instead of more smaller dose pills (for example, citalopram 20 mg instead of two 10 mg tablets)
• Use longer-acting or once-daily formulations when appropriate (for example, bupropion XL formulation for once-daily dosing instead of bupropion SR for twice-daily doing)
• Synchronize dispenses by aligning medication refill dates. This can reduce the number of trips to the pharmacy and simplify a client's medication schedules
• Deprescribe medications that are no longer necessary. This may require discussion with a client's primary care team

Keep in mind that PharmaCare coverage may differ between strengths and formulations; be sure to discuss this with your clients who are interested in changing their dosing and/or regimen to reduce pill burden. You can use the PharmaCare Formulary Search to check a drug's PharmaCare coverage.

Resources

• Adapting prescriptions
• PharmaCare Formulary Search

Community pharmacy services return to Lytton

The Lytton Pharmacy celebrated its grand re-opening on June 1, 2025, following the July 2021 wildfire that destroyed much of Lytton. The pharmacy rebuild was enabled by funding from the Lytton Business Restart Program, and was supported by partners such as the First Nations Health Authority, Ministry of Health, and the College of Pharmacists of British Columbia. A temporary site for the pharmacy was provided by the First Nations Health Authority, near the Lytton First Nation Health Centre.

Policy spotlight: Veterinary prescriptions

June 18 update: Recording witnessed PA consumption

Important: Enter "VS – Other Outcome or Intervention" in PharmaNet to record witnessed PA consumption

Effective immediately, all prescribed alternative (PA) doses dispensed must be accompanied by either the intervention code “VS – Other outcome or intervention” for witnessed PA or the intervention code “SA – Prescribed safer alternative” for non-witnessed PA.

Entering the code for each witnessed consumption of PA is required for Ministry recordkeeping and to support PharmaCare tracking of pharmacy services provided. Pharmacies are also encouraged to indicate the frequency of witnessed ingestion in the SIG field.

The VS code must be entered for each instance of witnessed consumption of a PA (e.g., hydromorphone, fentanyl patch or tablets, oxycodone, sufentanil).

• If more than one dispense is required per day, enter both the witnessed intervention code VS and “UF – Patient gave adequate explanation, Rx filled as written.” This will ensure the drug cost is accepted 
• This may mean entering the VS code multiple times a day, depending on the prescriber’s direction

If a patient is still receiving PA without witnessed consumption, continue to enter the “SA – Prescribed safer alternative” intervention code.

Prescribers will continue to write the “SA” code on all PA prescriptions (for “safer alternative”) and will not write “VS”; the pharmacist is required to enter “VS” when the PA must be witnessed and “SA” if not witnessed.

If the prescriber neglected to add “SA” to the original prescription, but you confirmed – with the prescriber or the patient – that it was for safer supply, remember to add “SA” during processing.

Prescribed alternative scenario		Intervention code to use
Witnessed		VS – Other outcome or intervention
Witnessed – more than one dispense per day		VS and UF
Not witnessed		SA – Prescribed safer alternative
Not witnessed – more than one dispense per day		SA and UF

Do not enter SA for opioid, stimulant or benzodiazepine drugs when they are prescribed for non-PA indications.

Whether you enter SA or VS, the dispense will be recorded as a PA dispense for provincial health system tracking.

[End of June 18 update]