How PharmaCare decides which drugs to cover

Related links: Drug review results | Drug review decisions | Drug review for health industry professionals

Watch the short Got a Minute video about drug review.

Drug reviews determine the type of coverage a drug will have (if any) and the PharmaCare plan(s) it will be covered under.

PharmaCare considers a drug for coverage upon receiving a request by the drug's manufacturer. After completing its review, PharmaCare will decide whether a drug will be a full benefit, a partial benefit, a limited coverage benefit (covered only if a patient meets specific criteria) or a non-benefit.

Drug review process

1. Receive request

Before PharmaCare can consider covering a drug, it must receive a request for coverage from the manufacturer. The drug will have already been approved by Health Canada and may have been reviewed by CDA (formerly CADTH).

2. Clinical input

Clinicians contribute their expertise in the form of clinical practice reviewer reports.

3. Public input

Patients, caregivers and patient groups provide input through Your Voice.

4. Drug Benefit Council

Submitted drugs may be reviewed by the Drug Benefit Council (DBC). This independent advisory board has 12 members: 9 professionals with expertise in medicine, ethics, pharmacoeconomics and health economics; and 3 members from the public. The DBC weighs medical and economic benefits and makes an evidence-based recommendation on whether PharmaCare should cover the drug.

5. Decision and report

PharmaCare makes a decision after considering:

• The DBC recommendation
• Available evidence, public input and estimated cost
• Current PharmaCare policy and coverage for the same type of drug
• If coverage for the drug can be accommodated under the current PharmaCare budget

Drug review decisions are published online.

BC PharmaCare and health authorities joint drug reviews

As of July 31, 2023, PharmaCare and the province’s health authorities are piloting a joint drug review process. Aligned formularies will help ensure that patients have timely access to high quality, appropriate, and cost-effective pharmaceutical therapies and services.

Only drugs of interest to HAs will undergo a joint drug review with PharmaCare.

Benefits of the aligned review process include:

• Pooled resources, including patient input through YourVoice and clinical input from throughout the province
• Reduced duplication of work
• Joint price negotiations
• Improved patient care at transition points

The pilot was launched on July 31, 2023, and is continually being evaluated, with improvements and adjustments made to ensure its success.

 

 

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