6.4 Collaborative Prescribing Agreements

General Policy Description

For some Limited Coverage drugs, PharmaCare invites physicians to sign a Collaborative Prescribing Agreement (CPA).

A CPA may be offered to specialists who commonly prescribe a medication for patients who meet PharmaCare coverage criteria.

Policy Details

Physicians who enter into a CPA are exempt from completing Special Authority requests for a specific drug and are subject to the terms of the CPA.

The CPA indicates the specified criteria for prescribing the drug.

If a patient does not meet the criteria set out in the CPA, 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

• Coverage criteria, forms, and Collaborative Prescribing Agreements for Limited Coverage drugs are provided on the drug coverage criteria pages accessible from the list of Limited Coverage drugs on the Special Authority web page
• Limited coverage drugs webpage