[Policy revisions effective April 1, 2019]
The Low Cost Alternative (LCA) program, established under the Drug Price Regulation, is intended to ensure the best value is obtained for expenditures on multi-source drugs. The program limits PharmaCare reimbursements for drugs subject to an LCA price.
Drugs in the LCA Program may be subject to the Reference Drug Program (RDP). Unlike the LCA program, the RDP applies to drugs with different active ingredients that are in the same therapeutic category and treat the same conditions.
General LCA program policies
The LCA program groups drugs into categories of products with the same active ingredient or combination of active ingredients, and the same strength.
Each category is assigned an LCA price.
The maximum PharmaCare reimburses for drugs within the same LCA category is the lesser of the:
Under the LCA program, generic drugs are reimbursed as full benefits.
Brand drugs are covered as partial benefits unless their list price is equal to, or less than, the LCA price for the category, in which case they are reimbursed as full benefits. (some exceptions apply)
For information about drugs LCA drugs, categories, prices, and benefit status, refer to the Low Cost Alternative (LCA) and Reference Drug Program (RDP) Data Files.
Pharmacists may also call the PharmaCare Help Desk for information.
The LCA price includes an 8% mark-up or, for drugs that are subject to the High-Cost Drugs Policy, the maximum mark-up indicated in the List of Designated High-Cost Drugs.
The LCA price may be based on a pre-determined maximum accepted list price (MALP), may be granted an exception to the MALP, or may be based on pricing resulting from the pan-Canadian Pharmaceutical Alliance (pCPA) generic initiative, effective April 1, 2018.
Submission types
As described in the following sections, under the LCA program, PharmaCare accepts two types of drug submissions from manufacturers:
For each LCA category, PharmaCare determines a MALP for generic drugs within the category.
Calculation of the MALP differs depending on when an LCA category was established.
PharmaCare may grant an exception to the MALP under certain circumstances.
For LCA categories established on or after April 1, 2013, an LCA comparator is designated and used to determine the MALP for generic drugs in each LCA category.
The designated LCA drug comparator is the:
Under Section 4 of the Drug Price Regulation, the MALP is calculated as a percentage of the manufacturer list price for the LCA comparator for that category.
Effective April 1, 2019, MALPs for LCA categories established on or after April 1, 2013, are calculated as follows:
If an LCA category contains no brand drugs, the MALP for that LCA category is calculated as a proportion, by strength, of the MALP for the LCA category to which the designated LCA comparator belongs.
Refer to 2019 Amendments to B.C. Drug Price Regulation (PDF, 258KB).
For LCA categories established before April 1, 2013, a base price has been established in the Schedule to the Drug Price Regulation.
Under Section 5 of the Drug Price Regulation, the MALP is calculated as a percentage of the base price for each LCA category.
Effective April 1, 2019, MALPs for LCA categories established before April 1, 2013, are calculated as follows:
If a drug in an LCA category had, as of July 1, 2010, a lower manufacturer list price than the calculated MALP for the LCA category to which it belongs, the MALP for that LCA category will be the manufacturer list price of that drug as of July 1, 2010.
In certain circumstances, PharmaCare may increase the effective MALP for a category from the one initially calculated (e.g., where proper documentation indicates that a manufacturer’s cost to produce and distribute a generic product is greater than the MALP).
PharmaCare will not consider a request for an exception if the drug is being supplied or is intended to be supplied in another jurisdiction in Canada at a list price that is equal to or lower than the MALP as initially calculated by PharmaCare, or at a list price higher than the list price submitted in another jurisdiction.
If no manufacturer commits to sell a generic drug at or below the calculated MALP for an LCA category, or if PharmaCare has significant concerns with the sufficiency of supply offered by the manufacturers committing to sell at or below the MALP, PharmaCare will review the exception requests and prices submitted by manufacturers for generic drugs in the category. Based on its review, PharmaCare may, at its sole discretion, take whatever action it deems appropriate, which may include, without limitation, one or more of the following:
A generic drug that is, or would be, assigned to an LCA category and that has a manufacturer list price exceeding the applicable MALP is not eligible for PharmaCare coverage, unless an exception to MALP is granted on a provisional basis.
If a generic drug is deemed ineligible for PharmaCare coverage because the manufacturer list price exceeds the MALP, the manufacturer may resubmit the drug for reconsideration at any time. Temporary coverage may be provided to certain drugs under Section 16 of the Drug Price Regulation.
Drugs subject to the LCA Program that are determined to be ineligible for PharmaCare coverage are published in the “Non-Benefits” worksheet in the Low Cost Alternative (LCA) and Reference Drug Program (RDP) Data Files.
On January 29, 2018, the pan-Canadian Pharmaceutical Alliance (pCPA) and the Canadian Generic Pharmaceutical Association (CGPA) announced a five-year initiative with participating provinces and territories, including British Columbia. Under this initiative, the prices of nearly 70 of the most commonly prescribed generic drugs were reduced effective April 1, 2018.
See specific pricing for drugs included in the initiative.
PharmaCare uses the LCA Program to implement pricing under this initiative.
PharmaCare does not cover a generic product subject to this initiative if its price exceeds that established under the initiative.
Products and pricing under this initiative are identified in the Low Cost Alternative (LCA) and Reference Drug Program (RDP) Data Files
LCA Program and RDP data files
The PharmaCare website provides regularly updated LCA Program and RDP drug information in downloadable Excel spreadsheets updated on the first Thursday of every month. Visit Low Cost Alternative (LCA) and Reference Drug Program (RDP) Data Files
PharmaCare typically provides at least 14 days prior notice of any changes to categories, included products, Tiered Pricing Framework price adjustments, reimbursement limits and product benefit status in the LCA/RDP Updates Workbook on the website.
On occasion, a change to the LCA program or RDP may come into effect between the regular monthly updates, including but not limited to the
If a change comes into effect between the regular monthly updates, PharmaCare publishes updated versions of the LCA and RDP spreadsheets and the LCA/RDP Updates Workbook online. Check the website on the first Thursday of the month and then again in the middle of the month to ensure you always have the most recent LCA/RDP information.
Interchangeability
The LCA and RDP spreadsheets should not be considered an endorsement by PharmaCare of the interchangeability of any products identified. The College of Pharmacists of B.C. has delegated the responsibility for determining the interchangeability of products to B.C. pharmacists. Pharmacists are advised to consult with the prescriber to obtain the appropriate legal authority to dispense an LCA or RDP product.
Client impact
If a client’s prescription is for a partial benefit product, the pharmacy is encouraged to make the client aware that there is a full benefit LCA or RDP product that provides the same or similar therapeutic treatment.
If the client chooses the partial benefit product, they will be required to pay any cost in excess of the LCA or RDP price.
When being dispensed a drug subject to the LCA program, clients have three choices:
Special Authority approval for LCA drugs
If a client has an allergy or intolerance to the non-therapeutic ingredients in the majority of generic products in an LCA category, a physician may apply to PharmaCare for Special Authority approval for full benefit coverage of a brand name product in that category.
When a Special Authority is granted, coverage is provided up to the PharmaCare maximum price for the drug, as reflected in the Maximum Pricing Policy.
A Special Authority does not override plan deductibles or co-payments.
Learn more at Special Authority.
Manufacturer shortages
Shortages of a particular full benefit product in an LCA category may be addressed by stocking a different full benefit product within the same category for the duration of the shortage.
If a shortage impacts all of the full benefit products within an LCA category, PharmaCare will verify the shortage with the manufacturers and determine the expected duration. When such a shortage may impact the availability of a sufficient supply of full benefit products, PharmaCare will implement measures to ensure supply needs are met. These measures will be communicated to pharmacies and may include:
It is recommended that pharmacies confirm the anticipated duration of a shortage before ordering an inventory of a drug provided a temporary change in benefit status. When a shortage is over, PharmaCare will rescind temporary changes in benefit status with minimal notice.
Pharmacies should contact the PharmaCare Help Desk to report shortages or inquire about measures being taken to address a shortage.