PharmaCare Newsletter

Prescribed alternatives witnessing: new requirement

Under changes to the prescribed alternatives program announced by Health Minister Josie Osborne on February 19, 2025, a health professional must witness the consumption of prescribed alternatives. The new requirement is to ensure that each dose is taken by its intended recipient.

The requirement is related to the ongoing investigation of incentives provided to people receiving daily dispensing of opioid agonist treatment (OAT) and diversion of prescribed opioids.

Prescribed alternatives are also referred to as “prescribed safer supply” and “safer alternatives”.

The requirement takes effect immediately for new patients.

For existing patients:

• The Province will work closely with clinicians to transition patients to supervised consumption as quickly as possible, while ensuring continuity of care
• BCCSU will release new clinical resources to support the safe transition from non-witnessed to witnessed doses (expected in a few weeks)
• Until new guidance is issued, clinicians are encouraged to continue to support patients who are currently receiving non-witnessed doses, as described in BCCSU’s clinical resources

Continuing investigations

In June 2024, the Ministry of Health’s Special Investigative Unit and PharmaCare’s audit team, in collaboration with the College of Pharmacists of BC and law enforcement, launched investigations and/or audits in relation to cash incentives paid by pharmacies to clients receiving OAT.

Through the investigation, the Province has received allegations of illegal activity at approximately 60 pharmacies located across the province – a figure representing fewer than 5% of the 1543 pharmacies operating in B.C. Most pharmacies follow the rules and provide quality care.

It is strictly prohibited under section 51 of the Pharmaceutical Services Act (PSA) to offer an incentive as an inducement for a beneficiary to receive a benefit from a particular provider. All PharmaCare providers must fully comply with the Act and its regulations.

If you know or have reason to believe that a pharmacy is not complying with the Act, please contact Incentives@gov.bc.ca

Transition planning

Additional details regarding the program changes announced on February 19 – including any modifications to fees – will be provided as they become available. In the meantime, pharmacists should adhere to the current standards of practice, using their professional judgement to ensure continuity of care and prioritize client safety.

Resources

• Government provides update on pharmacy investigations, prescribed alternatives
• Pharmaceutical Services Act

Registration open for UBC CPPD lab test course

Registration is now open for the UBC Continuing Pharmacy Professional Development (CPPD) course, Introduction to Ordering and Interpretation of Laboratory Tests.

The free, three-credit online course provides an overview of ordering and interpreting laboratory tests for pharmacists, including:

• Which tests to order for monitoring client medications
• How to interpret a laboratory test result and apply findings
• Principles of laboratory stewardship to ensure appropriate use of laboratory tests
• Client scenarios for applied learning

Visit Introduction to Ordering and Interpretation of Laboratory Tests for Pharmacists to enrol. Registration is open from January 15, 2025, to January 15, 2026. An additional course will be offered in March 2025.

Pharmacists must obtain an MSP practitioner number and register with laboratory operators before they can refer for, or order, laboratory tests. Refer to Requirements for laboratory test referrals for details.

Resources

• Introduction to Ordering and Interpretation of Laboratory Tests for Pharmacists
• Requirements for laboratory test referrals

Salbutamol metered-dose inhaler shortage

All brands and DINs of salbutamol 100 mcg metered-dose inhalers are in shortage until late March 2025 due to manufacturing disruptions. During this shortage, BC PharmaCare is temporarily covering the salbutamol 200 mcg inhaler Ventolin^® Diskus^®, manufactured by Glaxo Smith Kline (DIN 2243115) as a regular benefit.

The Ministry of Health is actively working with manufacturers, health care professional associations and Health Canada to mitigate the impacts of this shortage.

To be notified of updates, subscribe to the Drug shortages web page.

Resources

• Drug shortages

Reminder: New PharmaCare registration poster

B.C. residency requirements for MSP and PharmaCare enrolment and coverage

All PharmaCare plans require B.C. residency. Most require enrolment in MSP*.

B.C. residents as defined by the Medicare Protection Act can enrol in MSP. The Act defines a resident as a person who:

• is a citizen of Canada or is lawfully admitted to Canada for permanent residence,
• makes the person's home in British Columbia, and
• is physically present in British Columbia for
  • at least 6 months in a calendar year, or
  • a shorter prescribed period

and includes a person who is deemed under the regulations to be a resident but does not include a tourist or visitor to B.C.

When a person is no longer a resident

If a person fails to maintain residency requirements as outlined in the Act, their MSP and PharmaCare may be cancelled.

For example, a person’s MSP coverage ends on the last day of the month that they make a permanent move out of Canada. If they move within Canada, their MSP coverage ends after the health insurance wait period is over in a new province or territory. PharmaCare coverage ends on the day that a person leaves the province, whether to move within or outside Canada.

Residents must contact Health Insurance BC to report a permanent move outside of B.C. to ensure their MSP and PharmaCare coverage is cancelled appropriately.

Indicators of non-residence can include:

• Inconsistent pattern of medical claims
• Contact information outside of B.C./Canada
• Requests to have prescriptions mailed elsewhere
• Employment outside of B.C.
• Expired identification
• Immediate family/dependents reside outside of B.C.

If a pharmacy believes that a client does not meet the definition of a resident as required for coverage, they may contact the Ministry’s Eligibility, Compliance and Enforcement Unit (ECEU) at 604-660-2406 or by email at Hlth.InvestigationsUnit@gov.bc.ca.

The ECEU conducts residency and identity investigations based on residency criteria and initiates the recovery of medical and PharmaCare benefits during ineligible periods. They work collaboratively with Health Insurance BC, ICBC, and health authorities to prevent misuse of MSP and PharmaCare budgets.

*Exceptional Plan G coverage and Plan Z coverage is available for some medications for people in the MSP wait period. Exceptional Plan G coverage must be applied for by a patient’s prescriber.

Resources

• Application for Health and Drug Coverage
• MSP brochure
• Leaving B.C. booklet
• BC Medical Services Plan (MSP) – First Nations Health Authority

Policy spotlight: Pharmacist-initiated SA requests

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
November 2024		February 3, 2025

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 PharmaCare Provider Payment Schedule (PDF, 165KB)
• 2025 PharmaCare Provider Payment Schedule (PDF, 120KB)

Purpose of coverage modification: Adding new DIN.

Drug name	Secukinumab (Cosentyx®)
Date effective	January 28, 2025
Indication	Treatment of adults with moderate to severe plaque psoriasis, active ankylosing spondylitis, and active psoriatic arthritis.
DINs	02547724	Strength & form	150 mg/mL pre-filled syringe
Special notes	Previously, DIN 02438070 was used to represent the 150 mg/mL pre-filled pen and pre-filled syringe. Once available on the market (anticipated in April 2025), DIN 02547724 will be assigned to the 150 mg/mL pre-filled syringe while DIN 02438070 will remain assigned to the 150 mg/mL pre-filled pen.

Non-benefits: Efgartigimod Alfa (Vyvgart^®)

PharmaCare has decided not to cover the following drug for the noted indication. 

Drug name	Efgartigimod Alfa (Vyvgart®)
Date effective	January 8, 2025
Drug class	As an add-on therapy for acetylcholine receptor antibody positive (AChR-Ab+) generalized myasthenia gravis (gMG) adult patients whose symptoms persist despite adequate treatment with acetylcholinesterase inhibitors (AChEIs), corticosteroids (CSs), and/or non-steroidal immunosuppressants (NSISTs).
DINs	02541599	Strength & form	400 mg/20 mL (20 mg/mL) solution, for intravenous use

Plan P benefit: Oxycodone controlled-release (Apo-oxycodone CR)

A controlled-release (CR) formulation of oxycodone manufactured by Apotex Inc. (Apo-oxycodone CR 5 mg) has been added to the PharmaCare Plan P formulary.

Drug name	Oxycodone HCL CR (Apo-oxycodone CR)
Date effective	January 16, 2025
Drug class	For the management of pain severe enough to require daily, continuous, long-term opioid treatment that is opioid-responsive, and for which alternative options are inadequate.
DINs	02366746	Strength & form	5 mg tablet

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
omaveloxolone (TC)		Friedreich’s ataxia (FA) in adults and adolescents aged 16 years and older	January 29 to February 25 at 11:59 pm
crovalimab (TBC)		Paroxysmal nocturnal hemoglobinuria (PNH)	January 29 to February 25 at 11:59 pm

Your Voice has extended the input window for the following drugs:

Drug		Indication	Input window
donanemab (TBC)		Alzheimer's disease in patients with mild cognitive impairment or mild dementia stage of disease	December 23 to February 19 at 11:59 pm