Drugs Requiring Pre-Approval (Special Authority)

PharmaCare covers some drugs only under specific medical circumstances. These drugs are “limited coverage.” They aren’t automatically covered because they may work for certain patients only, or they’re more expensive—but equally safe and effective—than other drug treatments.

If your prescriber believes your medical circumstances warrant the use of a specific limited coverage drug, they can submit a Special Authority request to PharmaCare explaining your medical situation. If PharmaCare agrees you meet the criteria for coverage, the Special Authority (SA) team will approve the SA request, and the drug will be eligible for full coverage, subject to the rules of your PharmaCare plan. Read more on how this process is going digital.

Note: In order to receive coverage, SA approval must be in place before you fill your prescription. To find out if approval is in place, you can check the status in your Health Gateway account (see steps below), talk to your prescriber or pharmacist, or contact us.

An information sheet (PDF, 175KB) is also available for print.

The limited coverage drugs in the categories below need to be approved by Special Authority to be eligible for full PharmaCare coverage. You can also consult these lists:

Reference Drug Program (RDP)

PharmaCare fully covers the less costly drugs in a Reference Drug Program category. If you cannot take them (there can be more than one option in a given category), your prescriber can submit an SA request for full coverage of another drug in the category. See Reference Drug Program.

Low Cost Alternative (LCA) program 

If you cannot take a lower cost version of a drug, your prescriber can submit an SA request for full coverage of another version of the drug. See Low Cost Alternative Program.

Psychiatric Medications Plan (Plan G)

Some drugs are fully covered under this plan only if your prescriber submits an SA request that is approved. See Psychiatric Medications Plan (Plan G).

Alzheimer's disease

PharmaCare fully covers donezepil to treat mild to moderate dementia if your prescriber submits an SA request that is approved. If you cannot tolerate donezepil, your prescriber can submit an SA request for full coverage of galantamine and oral rivastigmine (capsules only).

Special Access Program

Physicians occasionally treat patients with medications not approved for sale in Canada in cases of serious or life-threatening illness when conventional therapies have failed, are unsuitable, are unavailable, or offer limited options.

PharmaCare coverage for these drugs is available only under exceptional circumstances through the Special Authority process. See section 6.2 of the PharmaCare Policy Manual.

Non-benefit drugs (exceptional requests)

Non-benefit drugs are considered for coverage on an exceptional, last-resort basis, generally when all available PharmaCare benefit options have been tried without success or are unsuitable for the patient and no other coverage options (e.g., Extended Health–Blue Cross) are available.

Such requests must be submitted by the prescriber with a signed letter including:

  • Patient diagnosis or indication
  • List of all medications tried to date, including dose; duration of trial; and either patient response to medication OR, if medications not tried, reasons for not doing so
  • Anticipated outcome(s) of treatment with requested drug (e.g., physical symptoms, quality of life/function)
  • Confirmation that patient has no other insurance that would cover any part of the drug’s cost
  • Any additional pertinent information

Exceptional approvals are usually of limited duration.

Exceptional funding of EDRDs

Expensive drugs for rare diseases (EDRDs) are considered PharmaCare non-benefits, but in exceptional cases, coverage may be approved. Requests are assessed on a case-by-case basis.

EDRDs are drugs with a very high per-patient cost—more than $100,000 each year—that treat rare diseases. All EDRDs are considered non-benefits, but some drugs and patients may be eligible for coverage on a case-by-case, last-resort basis.

EDRDs are generally associated with limited clinical information about both the disease and treatment. Because of this, therapies must be carefully reviewed by specialized clinicians. Clinician experts assess which patients are most suitable for a therapy, and ensure that the drugs are working for each patient.

If a patient meets the EDRD process patient eligibility requirements and their prescriber believes their medical circumstance warrants the use of a specific EDRD, the physician submits a request on behalf of their patient.

If you think you may be eligible, talk to your prescriber.

Actual reimbursement is always based on your PharmaCare plan rules. If you haven't met your deductible or family maximum, you may need to pay all of part of the cost.

General coverage policies may limit the amount PharmaCare covers. For example, drug costs and dispensing fees vary from pharmacy to pharmacy. PharmaCare sets a maximum drug cost and dispensing fee it will pay.

>> Learn more about PharmaCare General Coverage Policies.

SA coverage begins the day the information is entered into PharmaNet, the computer network that links all B.C. pharmacies to a central database.

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

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

Special Authority is going digital!  

Prescribers will soon be able to submit SA requests online.

This means:

  • Quicker approvals
  • Automatic approvals (for some drugs)
  • Improved tracking tools to help prescribers renew SA coverage without interruption
  • Increased security of personal health information
  • Better information for better treatment decisions

At the same time, the Ministry is continuing to increase patient access to personal health information, including details about their medication coverage. You can view your record of dispensed prescription medication online in the Health Gateway and track your SA status. See how to check your SA status in Health Gateway, below.

1. Register for an account and log in at www.healthgateway.gov.bc.ca
2. Click on "Health Records" in the Dashboard.

3. Use the "Options" drop-down menu to filter your results.

4. Select "Special Authority," then click "Apply."

5. Your Special Authority records will appear and show whether your request has been received for processing: 

If you were approved for coverage, it will display as "Status: Approved."
1. Register for an account and log in at www.healthgateway.gov.bc.ca
2. Click on "Health Records" in the Dashboard.

3. Use the "Options" drop-down menu to filter your results.

4. Select "Special Authority," then click "Apply."

5. Your Special Authority records will appear and show whether your request has been received for processing: 

If you were approved for coverage, it will display as "Status: Approved."