More topics

6.4 Collaborative Prescribing Agreements

Last updated on September 25, 2026

General Policy Description

For some Limited Coverage drugs, specialists who commonly prescribe the drug can enter a Collaborative Prescribing Agreement (CPA), which makes them exempt from the requirement to submit a request for Special Authority (SA) coverage of those drugs.

A practitioner may be invited by PharmaCare to enter a CPA. For some drugs, the agreement can be downloaded from the limited coverage criteria webpage.

Policy Details

Physicians who enter into a CPA are exempt from submitting the SA request for a specific drug and are subject to the terms of the CPA. Their prescriptions automatically have SA coverage.

SA coverage through a CPA is linked to Prescriber ID instead of the patient's PHN.

When a prescriber enters a CPA, they agree to:

  • Prescribe according to the criteria specified in the CPA
  • Allow PharmaCare to assess whether they are adhering to the prescribing criteria
  • Annotate prescriptions for patients who do not meet the criteria so the pharmacy will not bill PharmaCare for the drug

The CPA indicates the clinical criteria for prescribing the drug. If a patient does not meet the SA criteria, the CPA requires the physician to either:

  • Write "Submit as zero cost to PharmaCare"/"PharmaCare pays zero" on prescriptions, or
  • Submit a Special Authority request for exceptional coverage.

Pharmacists filling prescriptions marked as "Submit as zero cost to PharmaCare"/"PharmaCare pays zero" must enter the intervention code DE – Adjudicate to $0.00 as requested to ensure PharmaCare does not cover the cost.

Procedures for Pharmacists

Processing prescriptions that state "Submit as zero cost to PharmaCare"

When you receive a prescription with this note, submit the claim with the intervention code DE – Adjudicate to $0.00 as requested.

This ensures appropriate PharmaCare coverage and accurate prescribing feedback to physicians.

Tools and Resources