COVID-19 Information for Prescribers

This page will be regularly updated with COVID-19 information specific to prescribers.

Last updated: February 5, 2021

Due to supply concerns related to COVID-19, drug wholesalers and drug manufacturers put limits on the distribution of some drugs. These limits were put in place to preserve stock and avoid stockpiling. Every level of the drug supply chain is working to ensure sustainable drug distribution in B.C., given the current situation.

For up-to-date information on any drug shortages, see Drug Shortages Canada for shortages and drug discontinuations in Canada, or the PharmaCare Drug Shortages Information website for PharmaCare coverage options in response to drug shortages in B.C. If you have concerns about a patient's ability to obtain a prescribed drug, please call a local pharmacy to discuss options with a pharmacist.

New patients

Patients starting oral anticoagulation treatments no longer need to trial warfarin before getting approved for a DOAC. Warfarin is the long-established anticoagulant for preventing ischemic strokes in patients with atrial fibrillation (AF) and for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). Its use requires frequent lab testing when therapy is started, which was not possible with most social distancing measures. DOACs are as effective as warfarin in treating the indications mentioned above, and do not require frequent lab testing.

Patients on warfarin

International normalized ratio (INR) testing options for patients on warfarin are available, as most labs have re-opened, though often with adjusted hours.

Larger centres such as the Lower Mainland or southern Vancouver Island have functioning collection sites for INR. For remote patients or those with mobility issues that preclude more than usual travel, the following options may be available:

  • Home collection (available in some locations - please contact LifeLabs for details)
  • Mobile testing clinics (contact your local health authority for more information)
  • CoaguChek® device (exceptional coverage may be considered in some cases)
  • Private point-of-care testing (not funded)

Please note that collection sites and protocols may differ for patients assessed as vulnerable during the COVID-19 crisis.  LifeLabs, Valley Medical Laboratories, Hospital Laboratories, and Health Authority Laboratories will keep their websites updated with pertinent information and instructions for immunologically vulnerable populations

If no INR testing is feasible for patients, consider switching them to a DOAC if appropriate.

Antiplatelet coverage

Clopidogrel is now a regular benefit and no longer requires Special Authority approval for coverage. Note: brand Plavix® is a partial benefit and requires SA for full coverage.

From March 26, 2020 to October 1, 2020, Special Authority (SA) applied extensions for a variety of select drugs to ensure efficient access to medications and promote patient safety during the COVID-19 pandemic.

Effective December 1, these extensions are no longer available.

If the health emergency again requires extensions, SA will consider posting again here.

Accommodations due to decreased access to laboratory testing

SA criteria that require patients to visit a lab or undergo any non-essential diagnostic test may be waived, to reduce patient contact with others and enable better adherence to social distancing requirements.

Patients will still need to meet other criteria points on a given application form for approval. These allowances are exceptional and will be reassessed when restrictions are reduced. Instances will be considered on a case-by-case basis and include the following examples:

Insulin Pumps

2 A1C values are still required for adjudication. Time period has been expanded to 1 A1C value within the past 6 months, and 1 A1C value within the past 12 months.

Dalteparin, tinzaparin for treatment of venous thromboembolism in cancer patients

Requirement of a trial of warfarin, or rationale to avoid warfarin is waived. Dalteparin and tinzaparin will be first-line treatment options.

 

Care for people with substance use disorder during dual public health emergencies

Prior to the COVID-19 pandemic, British Columbia was experiencing a public health emergency in the form of the opioid overdose crisis. This crisis is ongoing and has been further complicated by the COVID-19 situation. While the COVID-19 pandemic affects the ability of everyone to interact safely with others, people with substance use disorder (SUD) are especially vulnerable due to the combination of co-morbidities (often respiratory), their high risk of contracting or spreading the COVID-19 virus while obtaining their drugs, and the risks associated with withdrawal from those drugs.

To support the Provincial Health Officer’s orders for social distancing and self-isolation related to COVID-19, including people with previously-untreated substance use disorders, the British Columbia Centre on Substance Use (BCCSU) has prepared a Clinical Guidance for Risk Mitigation in the Context of Dual Health Emergencies. This document is intended to guide prescribers assisting people with SUD to access safe alternatives to illicit substances they were using prior to the pandemic.  All measures are intended to reduce barriers to access, interpersonal contact, and the risk of either health emergency worsening the other. Prescribers and pharmacists are urged to keep this intent in mind when interacting with people with SUD. These measures are a public health approach to help reduce the spread of COVID-19 and reduce its impacts on people with SUD, our communities, our health system, our healthcare workers, and all British Columbians.

Telemedicine is covered by MSP in British Columbia, and patients may connect with physicians using such a service to obtain a prescription appropriate to prevent withdrawal during self-isolation and/or to enable social distancing. Prescribers may now fax or phone these prescriptions to a pharmacy identified by the patient, and subsequently deliver the original paper duplicate prescription to the pharmacy for the pharmacy’s required record-keeping. 

In addition to existing therapies for alcohol use disorder and opioid use disorder, the BCCSU guidance provides guidance on the use of:

  • 8 mg hydromorphone tablets for opioid use disorder;
  • methylphenidate or dextroamphetamine for stimulant use disorder; and
  • lorazepam or diazepam for benzodiazepine use disorder.

Except where noted in the guidance document, the specified medications are regular benefits under Fair PharmaCare and Plans C, G, and W.

Please note the Plan G registration process permits physicians to sign on patients’ behalf if they are unable to do so; consultation in a telemedicine or otherwise remote fashion with a patient fits this definition. 

Delivery of controlled substances (including OAT)

To prevent unnecessary personal interactions, a temporary exemption to the federal Controlled Drugs and Substances Act has been issued to allow pharmacy staff to deliver controlled substances.

The College of Pharmacists of British Columbia updated PPP-71 (PDF, 386KB) on March 17, 2020, allowing pharmacists to initiate delivery of OAT medications when appropriate, rather than requiring prescriber pre-approval. For OAT medications, pharmacists must notify prescribers as soon as is practical that delivery has commenced, and delivery must cease if the prescriber indicates it is not permitted.

BC Centre for Disease Control

Cancer

Crohn's and colitis

Drug shortages

Colchicine

On January 29, 2021, the BC COVID-19 Therapeutics Committee has released an important memorandum regarding colchicine for treatment of non-hospitalized COVID-19 patients. You can read the memo here (PDF, 351KB).