7.13 Assurance (Plan Z)

General Policy Description

The Assurance Plan provides 100% coverage of any included product for any eligible beneficiary.

The Full Payment Policy applies to Plan Z. Providers must not charge patients any costs associated with the dispense of a Plan Z benefit.

Policy Details

Patient eligibility

All residents of B.C. with active Medical Services Plan (MSP) coverage are eligible.

Exceptional coverage

Plan Z coverage is available exceptionally in some situations.

Exceptional Plan Z coverage is processed and activated by Special Authority (SA) or Health Insurance BC (HIBC), depending on the drug. Exceptional Plan Z coverage is entered in PharmaNet (usually for 3 months; 6 months for OAT) and a response faxed back to the pharmacy or prescriber. If the call is on a weekend, HIBC enters the coverage, but still alerts Special Authority. Visit the Plan Z web page for the complete procedure.

Exceptional coverage is available for:

• Contraceptives
  • B.C. residents who have completed the Application for Health and Drug Coverage (AHDC), presented their identification at an ICBC driver licensing office and are in the wait period for MSP
  • up to 3 months

• Mifegymiso (mifepristone and misoprostol) for:
  • B.C. residents who have completed the Application for Health and Drug Coverage (AHDC), presented their identification at an ICBC driver licensing office and are in the wait period for MSP
  • up to 3 months

• Medical assistance in dying (MAiD) for:
  • individuals who have public health coverage in another Canadian province or territory, or
  • B.C. residents who have completed the Application for Health and Drug Coverage (AHDC) and presented their identification at an ICBC driver licensing office prior to needing MAiD but at still in the MSP wait period
  • up to 3 months
• Opioid agonist treatment (OAT) for:
  • B.C. residents who are not yet enrolled in MSP, or
  • B.C. residents who have completed the Application for Health and Drug Coverage (AHDC) and presented their identification at an ICBC driver licensing office but are still in the wait period for MSP
  • up to 6 months
• Paxlovid (nirmatrelvir/ritonavir) for treatment in B.C., for:
  • patients who live in another province, territory, or country, or
  • B.C. residents who have completed the Application for Health and Drug Coverage (AHDC) and presented their identification at an ICBC driver licensing office but are still in the wait period for MSP
  • up to 3 months
• Tecovirimat for:
  • patients who live in another Canadian province or territory
  • B.C. residents who have completed the Application for Health and Drug Coverage (AHDC) and presented their identification at an ICBC driver licensing office but are still in the wait period
  • up to 3 months
  • Note: Tecovirimat is dispensed through the Product Distribution Centre only. A pharmacist or prescriber contacts HIBC at 604-682-7120 or 1-800-554-0225 
    Resource: Guidance for the Treatment of Monkeypox

Resources:

• Full procedures for exceptional Plan Z are on the Plan Z web page for health professionals
• Exceptional Plan Z Coverage eForm
• HLTH 5829 - Application for Exceptional Plan Z coverage for OAT
• HLTH 5499 - Application for Exceptional Plan Z Coverage for Mifegymiso (PDF)
• HLTH 5830 - Application for Exceptional Plan Z Coverage for Contraceptives (PDF)