7.8 Palliative Care (Plan P)

Coverage is provided for individuals, rather than families.

Coverage does not extend to patients in acute care.

The benefits are available to B.C. residents with active Medical Services Plan (MSP) coverage¹ who:

• Are living at home (defined, for the purposes of this program, as wherever the patient is living, whether in their own home or with family or friends, or in a supportive or assisted living residence, or a hospice unit in a long-term care facility (e.g., a community hospice bed that is not covered under PharmaCare Plan B),
• Have been diagnosed with a life-threatening illness or condition,
• Have a life expectancy of up to six months, and
• Consent to the focus of care being palliative rather than treatment aimed at cure

An individual’s physician or nurse practitioner confirms a patient’s medical eligibility for palliative care benefits.

A patient’s physician or nurse practitioner must certify that the patient meets the criteria for BC Palliative Care Benefits by faxing an application to PharmaCare for drug benefits under PharmaCare Plan P (PDF, 389KB) and a copy of the application to the local health authority (for the Palliative Medical Supplies and Equipment Component of the program).

¹ In some instances, PharmaCare may consider extending coverage to Canadian citizens/permanent residents who are new B.C. residents and do not yet have Medical Services Plan coverage.

Coverage under Plan P begins as soon as Health Insurance BC (which delivers operational services for PharmaCare) processes the application and enters the information in the PharmaNet system.

BC Palliative Care Drug Benefits coverage continues for as long as the person is diagnosed as requiring palliative care.

Plan P coverage cannot be provided retroactively.

[Updated March 17, 2017] Plan P provides 100% coverage of the eligible costs of the prescription and over-the-counter (OTC) drugs listed in the Plan P Formulary and dispensing fee costs (up to the maximum drug cost and dispensing fee recognized by PharmaCare).

Products not included in the Plan P formulary may be covered under the patient’s primary PharmaCare plan (i.e., Fair PharmaCare, Plan C, Plan F or Plan W).

Drugs are selected for inclusion in the Plan P formulary based on the following criteria:

• The prescription or OTC drug is prescribed for pain and symptom control; and
• The prescription or OTC drug is prescribed to improve quality of life for palliative care patients; and
• Provision of the drug to palliative care patients supports and enables them to remain at home

To receive coverage of an OTC drug in the Plan P Formulary, a prescriber must write a prescription for the drug and the pharmacy must enter the drug in the PharmaNet system, which enables PharmaCare to reimburse the eligible costs.

Note: needles and syringes for administration of injectable medications are provided by the Health Authorities as medical supplies and equipment benefits.

Products not covered under Plan P automatically adjudicate under the patient’s primary PharmaCare plan (i.e., Fair PharmaCare or Plan C)

Patients should register for the Fair PharmaCare plan if they have not already done so. Fair PharmaCare covers PharmaCare benefits not included in the Plan P Formulary.

Under specific circumstances, PharmaCare will consider a request for Special Authority coverage of a drug that is not included in the Plan P Formulary.

Payment of drug costs

When a prescription drug or over-the-counter medication prescription for an individual registered for the BC Palliative Care Drug Plan is processed, the pharmacy enters a claim for the prescription on PharmaNet. PharmaCare will then pay the pharmacy directly for:

• Drug costs up to the PharmaCare maximum price, and
• A dispensing fee (up to the maximum allowable dispensing fee)

For patients who do not meet the criteria for Plan P, coverage options through other government insurers (such as Veterans Affairs Canada) and private insurers can also be considered.

Please note that individuals covered by the Non-Insured Health Benefits (NIHB) Program of Health Canada or Veterans Affairs Canada (VAC) require coverage under Plan P only if a medication is not covered by NIHB or VAC.

Members of the Canadian Forces receive coverage through their employers and are, therefore, not eligible for this drug plan.

Once a physician or nurse practitioner has certified that a patient meets the medical criteria, the physician or nurse practitioner completes the HLTH 349 - BC Palliative Care Benefits Registration Form (PDF, 593KB) and faxes it to both Health Insurance BC (for drug coverage) and the applicable Health Authority (for assessment for palliative medical supplies and equipment).

The Freedom of Information and Protection of Privacy Act requires that the patient or the patient’s legal representative consent to the release of personal information such as basic demographic data and diagnosis. For this reason, the patient or their legal representative must sign the registration form.

To avoid delays in patient coverage, please complete all sections of the registration form. Incomplete information will require Health Insurance BC and/or the Health Authority to return the form to obtain the missing information.

Physicians must fax the form to:

• Health Insurance BC at 250-405-3587, and
• Home and Community Care office of the local Health Authority

>> See Tools and Resources.

Coverage under Plan P begins as soon as Health Insurance BC processes the registration and enters the information in the PharmaNet system. Please allow up to 12 hours for processing.

To confirm enrolment in Plan P, a pharmacist can contact the PharmaNet Help Desk. Physicians and nurse practitioners can confirm coverage using the Palliative Care Coverage Confirmation Line as described in the Prescriber Guide (PDF, 1MB) available at Palliative Care Benefits—Information for Prescribers.

Once the registration is processed, prescriptions can be filled at any pharmacy in British Columbia.

PharmaCare will consider a request for Special Authority Plan P coverage if a drug is needed to alleviate patient discomfort and:

• The drug is not included in the Plan P formulary
• The drug is not covered under another PharmaCare plan
• There is no substitute for that drug in the formulary

1. A physician or nurse practitioner must send a completed HLTH 5328 - General Special Authority Request Form (PDF, 656KB) by fax. The Special Authority Program fax number can be found on the request form. Fax is the quickest method.
2. The prescriber should clearly mark “For Palliative Care Registrant” on the request form to ensure it receives priority attention.
3. Adequate documentation must be included with the request. A decision on coverage may be delayed if PharmaCare needs to call the prescriber for additional information.

PharmaCare Plan P patient information sheet (PDF, 475KB) provides details about the plan.

Contact a physician, nurse practitioner, the local health authority or the British Columbia Hospice Palliative Care Association.

Consult the Plan P Formulary or call Health Insurance BC.

Prescriber guide, registration form, Plan P formulary, and patient information sheet

Visit Palliative Care Benefits—Information for Prescribers.

Medical supplies and equipment component

Information regarding medical supplies and equipment—Contact the Home and Community Care (HCC) office of your local health authority. Contact information may be obtained by calling 8-1-1 or searching “home and community care” at HealthLinkBC.

Other palliative care information

• BC Guidelines – Palliative Care
• Palliative Care Consultation Line—Physicians throughout B.C. have access to a 24/7 toll-free phone line for palliative care consultation. The phone line is staffed by palliative care physicians who offer timely clinical advice on pain and symptom management. For this physician-to-physician palliative care consultation, call 1-877-711‑5757.