PharmaCare Newsletter

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

• Publicly funded vaccines web page for vaccine PINs, DINs
• Drug administration fee

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

• Pharmacist registration form – Provincial Laboratory Medicine Services
• Pharmacists ordering lab tests
• Requirements for laboratory test referrals

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

• Programs – UBC CPPD

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

• Drug shortages
• Paxlovid – information for health professionals

PharmaCare contact information poster

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

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

When ordering Trikafta for an EDRD-covered patient, pharmacies should be sure to provide the EDRD Patient ID to McKesson Specialized Distribution to ensure they are charged the public price ($23,520/28-day supply). If McKesson doesn't have the ID, they will charge the pharmacy the higher private price (for patients covered by third-party insurance), and it will appear that PharmaCare is not covering the full amount. If a pharmacy is incorrectly charged the higher amount for an EDRD-covered patient, the pharmacy should contact McKesson to have it resolved. 

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