PharmaCare Newsletter

Last updated on December 4, 2024

December 2024 PharmaCare Newsletter

Click here, print off the PDF of this PharmaCare Newsletter, and post it in your Pharmacy for staff to read!

On this page:

Find past issues on the newsletter search page.

Denosumab for osteoporosis: Two important updates

The current edition of PAD Refills contains important updates to clinical evidence and PharmaCare coverage of denosumab. Make sure to subscribe so you don't miss out on news and updates!

Vaccination remittance payments

In October and November, transfer issues of vaccination records from ImmsBC to PharmaNet resulted in claims not being processed. As a result, a number of vaccination claims documented in ImmsBC were not reimbursed.

We apologize for the interruption in payments. The Ministry is working to issue payments for these vaccinations in early 2025.

Resources

Reminder: Pharmacists must register with labs before making test referrals

Pharmacists intending to refer patients for laboratory tests are reminded to register with laboratory operators after receiving their MSP practitioner number from Health Insurance BC (HIBC). The simple one-page pharmacist registration form gathers your contact information, pharmacy hours, and new MSP practitioner number. 

Pharmacists must register before ordering laboratory tests. Registration allows laboratories to distribute test results and bill for testing. If a pharmacist makes a referral without being registered, there is a high risk they will not receive the test results, or the patient may be turned away at the collection site. 

The pharmacist registration form is posted by Provincial Laboratory Medical Services. For detailed instructions on how pharmacists can get set up to refer for laboratory tests, visit Pharmacists ordering lab tests and Requirements for laboratory test referrals. You may also want to register for the new UBC Continuing Pharmacy Professional Development (CPPD) course, Introduction to Ordering and Interpretation of Laboratory Tests (refer to next article).

Resources

MSP number mail-out delay

Due to the Canada Post strike, the mail-out of MSP numbers may be delayed. Pharmacists can contact HIBC at 604-456-6950 (Lower Mainland) or 1-866-456-6950 (rest of B.C.) for status updates on MSP numbers. 

New UBC CPPD course on ordering and interpreting lab tests

UBC Continuing Pharmacy Professional Development (CPPD) is launching a new course called Introduction to Ordering and Interpretation of Laboratory Tests on January 15, 2025.

This free, accredited, online course will include:

  • In-depth study of the fundamentals of ordering and interpreting lab tests
  • Practical exercises with real-life scenarios
  • Expert guidance from experienced pharmacy professionals

More information on content, instructors and enrolment will be available in early January at Programs – UBC CPPD.

Resources

Expected Paxlovid shortage ends

On November 19, 2024, Pfizer announced that the anticipated shortage of Paxlovid® has been resolved, and the affected formulations are now available through wholesalers. 

Concerns arose in early October regarding a potential temporary shortage of 150/100 mg tablets in blisters of 30 (DIN 2524031) and renal packs of 150/100 mg in blisters of 20 (DIN 2527804) due to increased demand. However, with resupply efforts completed, the shortage has been resolved. 

Subscribe to Drug shortages to stay up to date on drug shortage advisories and mitigations.

Resources

PharmaCare contact information poster

The PharmaCare Help Desk provides support for pharmacists. 

The Medical Practitioner Line provides support for prescribers.

Both services record, monitor, and resolve problems in a timely manner. (Desk representatives do not answer questions about specific medical conditions or treatment).

Print and display the PharmaCare Help Desk poster (PDF, 54KB) for easy reference. Numbers are for providers only. They should not be given to or in view of the public.

Resources

RAT kit payment update

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

RAT kit payment update
Payment month Payment date
September 2024 December 2, 2024

Pharmacies are paid $75 for each case of RAT kits distributed, and pharmacists are reminded to enter the correct PIN for each case of RAT kits distributed.

  • BTNX: 66128325
  • Artron: 66128338

Resources

2024 year-end reminders

PharmaNet Help Desk holiday closure

The PharmaNet Help Desk will be closed from 10:15 pm on Tuesday, December 24 until 10:15 pm on Wednesday, December 25, 2024.

If you experience problems connecting to PharmaNet during this time, please call 778-875-4287. The interactive voice response system will be available. 

Fair PharmaCare registration holiday closure

To allow for annual maintenance, the Application for Health and Drug Coverage (AHDC) for MSP and Fair PharmaCare will be unavailable as follows:

  • Online applications unavailable:
    • 8 am, Tuesday, December 31 to 8 am, Wednesday, January 1, 2025 (24 hours)
  • Phone applications unavailable:
    • 8 am, Tuesday, December 24 to 8 am Thursday, December 26, 2024 (48 hours)
    • 8 am, Tuesday, December 31 to 8 am, Thursday, January 2, 2025 (48 hours)

2025 provider payment schedule

The weekly and monthly provider payment schedule for 2025 is available on our Information for pharmacies web page. Pharmacies should note that payments may be remitted earlier than dates indicated in the schedule. Published dates remain the authorized payment dates and should be the guide for claims-related accounting.

Blood glucose test strip annual quantity limits

On January 1, 2025, clients will be assigned their annual limit of blood glucose test strips (BGTS). Beginning January 1, please ensure you use the regular BGTS PINs for claims until clients exceed their annual limit.

All strips purchased by a patient, regardless of the payer, count toward the client’s annual limit.

BGTS information for clients

Information for the public is available online about annual quantity limits for BGTS and in the printable information sheet, Blood glucose test strips – annual limits (PDF, 167KB). (Translations are available in 15 languages on the PharmaCare information sheets web page).

Fair PharmaCare annual deductibles reset in the new year

On January 1, 2025, PharmaNet will be updated with 2025 annual deductible and family maximum amounts. Deductible accumulations will be reset to zero.

Fair PharmaCare coverage levels for 2025 are based on a family’s 2023 net income. Income from Universal Child Care Benefits and Registered Disability Savings Plans and some BC Housing subsidies are not included when determining coverage levels.

Deductible information for patients

This can be a stressful time for Fair PharmaCare beneficiaries as many are paying the full cost of their drugs. Please let them know that they may be eligible for PharmaCare’s monthly deductible payment plan. Once they register, PharmaCare immediately pays for 70% of their eligible drug costs. Fair PharmaCare registrants can get information about their deductible and family maximum by:

  • Requesting a confirmation of Fair PharmaCare coverage letter or
  • Calling us Monday to Friday, 8 am to 8 pm and Saturdays 8 am to 4 pm from the Lower Mainland at 604-683-7151 or from the rest of B.C., toll-free, at 1-800-663-7100

Remind your patients they can pay their Fair PharmaCare deductible in monthly instalments! PharmaCare pays 70% of eligible drug costs right away – as if they have already met their deductible. Patients can call 1-800-663-7100 to ask if they are eligible!

Formulary and listing updates

Limited coverage benefits: mirikizumab (Omvoh®), mavacamten (Camzyos®), atogepant (Qulipta®)

PharmaCare has added the following limited coverage items to the PharmaCare drug list. Special Authority approval is required for coverage.

Drug name mirikizumab (Omvoh®)
Date effective     November 19, 2024
Indication

Adult patients with moderately to severely active ulcerative colitis (UC) who have had an inadequate response, loss of response, or were intolerant to conventional therapy, a biologic treatment, or a janus kinase (JAK)-inhibitor.

DINs 02539861
02539853
02539845
Strength & form 300 mg/15 mL vial
100 mg/1 mL pre-filled syringe
100 mg/1 mL pre-filled pen
Drug name mavacamten (Camzyos®)
Date effective     November 26, 2024
Indication

For the treatment of symptomatic obstructive hypertrophic cardiomyopathy (oHCM) of New York Heart Association (NYHA) Class II-III in adult patients.

DINs 02532549
02532557
02532565
02532573
Strength & form 2.5 mg capsule
5 mg capsule
10 mg capsule
10 mg capsule
Drug name atogepant (Qulipta®)
Date effective     December 3, 2024
Indication

For the prevention of episodic and chronic migraine in adults.

DINs 02533979
02533987
02533995
Strength & form 10 mg tablet
30 mg tablet
60 mg tablet

Non-benefit: avatrombopag (Doptelet®), cenobamate (Xcopri)

PharmaCare has decided not to cover the following drugs for the noted indications. 

Drug name avatrombopag (Doptelet®)
Date effective     November 7, 2024
Drug class For the treatment of thrombocytopenia in adult patients with chronic immune thrombocytopenia (ITP) who have had an insufficient response to a previous treatment.
DINs 02542706 Strength & form 120 mg tablet
Drug name cenobamate (Xcopri)
Date effective     November 14, 2024
Drug class Adjunctive therapy for management of partial-onset seizures (POS) in adults with epilepsy who are not satisfactorily controlled with conventional therapy.
DINs 02538652
02538660
02538725
02538733
02538741
02538768
Strength & form 12.5 mg tablet
25 mg tablet
50 mg tablet
100 mg tablet
150 mg tablet
200 mg tablet

EDRD coverage: berotralstat (Orladeyo®), expansion of coverage for elexacaftor/tezacaftor/ivacaftor (Trikafta®)

Expensive drugs for rare diseases (EDRDs) are drugs that treat uncommon diseases and have a very high per-patient cost. EDRDs are PharmaCare non-benefits, but some drugs and patients may be eligible for coverage on a last-resort case-by-case basis through the EDRD process. Visit Exceptional funding for EDRDs for more information.

Drug name berotralstat (Orladeyo®)
Date effective     November 7, 2024
Drug class Hereditary angioedema
DINs 02527693 Strength & form 150 mg capsule

Effective November 7, 2024, the Ministry of Health initiated funding of berotralstat (Orladeyo®) through PharmaCare’s EDRD process. Clinicians may apply for funding through this process for eligible patients with type 1 or 2 hereditary angioedema. Berotralstat will be distributed through Innomar pharmacies.

Initial applications will be approved for up to six months. The prescribing physician is responsible for requesting continued Ministry funding.

Drug name elexacaftor/tezacaftor/ivacaftor (Trikafta®)
Date effective     November 6, 2024
Drug class Treatment of cystic fibrosis in patients aged two years and older who have at least one mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that is responsive to Trikafta based on clinical and/or in vitro data.
DINs 02517140
02526670
02542277
02542285
Strength & form

elexacaftor 100 mg/tezacaftor 50 mg/ivacaftor 75 mg and ivacaftor 150 mg oral tablet

elexacaftor 50 mg/tezacaftor 25 mg/ivacaftor 37.5 mg and ivacaftor 75 mg oral tablet

elexacaftor 100 mg/tezacaftor 50 mg/ivacaftor 75 mg and ivacaftor 75 mg oral granules

elexacaftor 80 mg/tezacaftor 40 mg/ivacaftor 60 mg and ivacaftor 59.5 mg oral granules

As of November 6, 2024, Pharmacare’s EDRD process has expanded coverage of Trikafta for cystic fibrosis patients. Before this date, Trikafta was covered for eligible patients aged 2 and older if they have at least one F508Del mutation. Now patients who are aged 2 and older will also be eligible for coverage if they have at least one mutation in the cystic fibrosis transmembrane conductance regulator gene that is responsive based on clinical and/or in vitro data. A full list of eligible mutations is available in the product monograph (PDF, 717KB).

Trikafta is packaged as a 28-day supply of tablets or oral granules. As Trikafta is dosed twice daily, a 28-day supply consists of 56 tablets or 56 packages of oral granules. PharmaCare limits supply to 28 days. Refer to  PharmaCare Policy Manual Section 3.18 – Claims for Drug Cost Exceeding $9999.99 for claims information.

Approved claims are usually fully covered by PharmaCare or shared with the patient’s third-party insurer. PharmaCare doesn’t cover any markup on Trikafta but will cover a dispensing fee.

Trikafta is distributed through McKesson Specialty and cannot be ordered through the McKesson/PharmaClik system. If your pharmacy hasn’t already done so, it may need to open an account with McKesson Specialty. They can be reached by email at mckesson.specializeddistribution@mckesson.ca or by phone at 1-877-827-1306. Due to the high cost of Trikafta, the Ministry of Health recommends that pharmacies bill PharmaCare or the patient’s third-party insurer before ordering the medication from McKesson Specialty. Pharmacies should also confirm pickup of the drug with the patient.

Ensure EDRD patients are charged public price for Trikafta

Regardless of DIN, a 28-day supply of Trikafta costs $23,520. Some pharmacies are being charged a higher amount by McKesson Specialty. As such, it appears that PharmaCare is not covering the full amount. McKesson Specialty has an EDRD price and a higher private price it may charge to patients covered by third-party insurance. For EDRD-covered patients, please ensure you are invoiced the public price ($23,520/28-day supply) by McKesson Specialty. Typically, providing McKesson Specialty with the patient’s EDRD number when placing the Trikafta order should be sufficient. However, if you are being charged a higher amount, call McKesson Specialty to remind them to charge the EDRD price.

Your Voice: Input needed for drug decisions

The knowledge and experience of patients, caregivers and patient groups is integral to B.C.’s drug review process. If you know someone who is taking one of the drugs below or who has a condition any of the drugs treat, please encourage them to visit www.gov.bc.ca/BCyourvoice.

Your Voice is now accepting input on the following drugs:

Drug Indication Input window
faricimab (Vabysmo) macular edema secondary to retinal vein occlusion (RVO) November 20 to December 17 at 11:59 pm
garadacimab (Andembry®) hereditary angioedema (HAE) in adult and pediatric patients aged 12 years and older November 20 to December 17 at 11:59 pm
pegcetacoplan (TBC) geographic atrophy (GA) secondary to age-related macular degeneration (AMD) in adults November 20 to December 17 at 11:59 pm

 Did you know? Since 1995, individuals with cystic fibrosis who are registered with a provincial cystic fibrosis clinic receive coverage of eligible digestive enzymes under Plan D. PharmaCare pays 100% of the drug cost and the dispensing fee, up to PharmaCare accepted maximums.

decorative divider

About the PharmaCare Newsletter

PharmaCare newsletters are published on the first Tuesday or Wednesday (if following a long weekend) of each month, with occasional mid-month special releases. Newsletters communicate drug listings, PharmaCare policy, PharmaNet procedures, and other pertinent information for PharmaCare providers. 

Information in previous newsletters is accurate as of the date it was published. Newsletters are not retroactively updated when policy, procedures or other information changes. Refer to the most recent mention of a topic for up-to-date information.

Search past newsletters on the Newsletter search page.

Welcome

The PharmaCare Newsletter team works from the territory of the Lekwungen People, including the Songhees and Esquimalt Nations. Our gratitude extends to them, and all the Indigenous Peoples on whose territories and lands we build relationships.

Cultural safety and humility

BC PharmaCare counts on pharmacy and device providers to practise cultural safety and humility.

To learn more, read Coming Together for Wellness, a series of articles by First Nations Health Authority (FNHA) and PharmaCare, and consider taking the online San’yas Indigenous Cultural Safety course.  

Drug shortages

Active advisories: 

Calcitriol injectionAbatacept (Orencia®)Cholestyramine and colesevelam; Tamsulosin capsules & tablets; Prazosin tabletsSabril®  tablets; nitroglycerin sprays & tablets; Glucagon for injection. 

Visit Drug shortages for full list and details.