BC PharmaCare drug review

This page has information about how BC PharmaCare decides which medications to cover.

On this page

• What to know
• Drug review process
• Joint drug reviews with health authorities

What to know

PharmaCare 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 decides 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 (not covered).

Drug review process

An independent national organization called Canada’s Drug Agency (CDA‑AMC) provides evidence‑based recommendations to publicly funded drug plans across Canada through its reimbursement review process.

As part of the CDA-AMC’s Reimbursement Review, the Canadian Drug Expert Committee (CDEC) makes reimbursement recommendations for non-oncology pharmaceuticals. In developing its recommendations, the CDEC considers:

• Whether the drug is safe and effective
• What the drug costs and whether funding it provides good value
• Ethical considerations of covering or not covering the drug
• Input from physicians, patients, caregivers, patient groups and drug submission sponsors

The Ministry makes a BC PharmaCare coverage decision by considering:

• Existing BC PharmaCare policies, programs and resources
• The evidence‑informed advice of the CDA-AMC
• The recommendations and reimbursement conditions of the CDEC
• The advice of an independent expert group called the Drug Benefit Council (DBC) (if a Ministry initiated review)
• BC-specific patient input collected through Your Voice
• Drugs already covered by BC PharmaCare that treat similar medical conditions
• The overall cost of covering the drug
• The outcomes of pan-Canadian Pharmaceutical Alliance (pCPA) negotiations with manufacturers

Drug review decisions are published online.

Joint drug reviews with health authorities

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 Your Voice 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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