Smoking Cessation Program – Information for Prescribers

On this page…

• Overview
• Option 1—Nicotine replacement therapy (NRT)
• Option 2—Prescription smoking cessation drugs
• Resources

Overview

The Smoking Cessation Program helps eligible B.C. residents to stop smoking or using other tobacco products by helping with the cost of smoking cessation aids. Each calendar year, the program offers coverage for one of two treatment options to eligible B.C. residents:

• Option 1—Non-prescription nicotine replacement therapy (NRT) products or
• Option 2—Prescription smoking cessation drugs

Option 1—Nicotine Replacement Therapy

To be eligible for nicotine replacement therapy coverage, patients must have valid, active Medical Services Plan (MSP) coverage.

Each calendar year, PharmaCare will cover 100% of the cost of a single continuous course of treatment lasting up to 12 consecutive weeks (84 days). 

See the recent list of nicotine replacement therapy products eligible for coverage (PDF) under the program.

How does your patient get their NRTs?

• Patients do not need a prescription for NRTs.
• Patients should obtain NRTs from their local pharmacy. They do not need to call HealthLink BC at 8-1-1 to register.
• At the pharmacy, the patient must sign a declaration form before they can receive their NRTs.

Option 2—Prescription Smoking Cessation Drugs

PharmaCare covers prescription smoking cessation drugs for patients who have valid, active MSP coverage and who are covered by Fair PharmaCare or one of the following PharmaCare plans:

• Residential Care (Plan B)
• B.C. Income Assistance (Plan C)
• Psychiatric Medication (Plan G)
• First Nations Health Benefits (Plan W)

Each calendar year, PharmaCare will cover a single continuous course of treatment lasting up to 12 consecutive weeks (84 days) of bupropion (Zyban®) or varenicline generics*. Each fill is limited to a 28-day supply.

The actual coverage a patient receives depends on the rules of their PharmaCare plan, as follows:

• PharmaCare covers 100% of the eligible cost of buproprion (Zyban®) or varenicline (generics) for patients covered under Plan B (Residential Care), Plan C (B.C. Income Assistance), Plan G (Psychiatric Medications) or Plan W (First Nations Health Benefits).
• For patients covered by the Fair PharmaCare plan, the amount PharmaCare covers depends on whether the patient has met their annual deductible and/or family maximum.

* Champix® (varenicline brand name) is now only a partial benefit under PharmaCare. See the PharmaCare formulary for low cost alternatives.

How does your patient get their prescription smoking cessation drug?

• Physicians do not need to request Special Authority coverage for an initial 12-week course of treatment with Zyban® or varenicline generics.
• Patients do not need to register with HealthLinkBC.
• Patients do need a prescription and the prescription must specify:
  1. "smoking cessation" as the indication
  2. "no substitutions"
  3. "dispense in 28-day supply"
• At the pharmacy, your patient will need to sign a Declaration and Notification form (HLTH 5464) (PDF) when filling their prescription.

Important: PharmaCare covers only the Zyban® version of bupropion for smoking cessation (Wellbutrin®, Wellbutrin XL® and generic bupropion are not covered for this indication). To make sure your patient receives coverage, please indicate the brand name Zyban® and "smoking cessation" on the prescription.

What if your patient needs to change or extend their course of treatment?

Patients can supplement Smoking Cessation Program coverage by paying any additional cost themselves or by claiming the additional cost through their extended health plan. Under exceptional circumstances, PharmaCare may permit a change in the currently covered course of treatment (e.g., switching from a NRT to a prescription smoking cessation drug or vice versa).

To help PharmaCare process the request quickly and reduce the need for us to contact you for clarification—provide as much information as possible, including:

• patient diagnosis
• current therapy (e.g., nicotine gum)
• benefits of changing the current course of treatment (e.g., severe COPD)
• reasons for the change (e.g., intolerance, co-existing disease)
• length of treatment needed
• name and dosage of the alternate product, if applicable

Important: Special Authority coverage is not retroactive.

Resources

For Health Professionals

• Prescription for Health Program—recognizing the importance of helping smokers develop a personalized smoking cessation strategy, the Ministry of Health supports physicians through the Prescription for Health Program, part of the Healthy Families BC strategy.
  
  Under current MSP billing rules, physicians can conduct brief interventions for tobacco cessation during a regular office visit (series 0100) only if the patient is already seeing the physician for an underlying medical condition. Physicians cannot bill for an office visit if the sole purpose of that visit is to discuss tobacco cessation or to write a prescription under the B.C. Smoking Cessation Program.
  
  However, under the Prescription for Health Program, physicians may bill a Personal Health Risk Assessment visit for an at-risk patient to develop a health promotion and illness prevention plan tailored to the individual's medical needs and personal situation. Patients who smoke or use other forms of tobacco are considered to be at risk.
  
  Physicians may provide Personal Health Risk Assessments for up to 100 patients per year. For further details on patient eligibility, refer to the billing guide on the General Practice Services Committee website.
  
  The smoking cessation plan may or may not include the use of smoking cessation prescription and/or non-prescription medication aids or other strategies, at the discretion of the prescriber and patient.
  
  For information on program objectives, activities and funding, refer to the Personal Health Risk Assessment Incentive on the General Practice Services Committee website.
• List of eligible smoking cessation medications (PDF)
• Special Authority criteria for bupropion
• Special Authority criteria for varenicline
• Potential drug interactions with smoking and quitting (PDF)—chart of common drug interaction issues connected to the using, or discontinuing use, of tobacco.
• CADTH Smoking Cessation Pharmacotherapy – Summary for Health Care Providers (PDF)—based on the Canadian Agency for Drugs and Technologies in Health (CADTH) report, Pharmacologic-based Strategies for Smoking Cessation: Clinical and Cost-Effectiveness Analyses.
• Quit Now resources for healthcare professionals—includes a fax referral service (PDF) to help you refer patients to QuitNow By Phone, no-cost materials (posters, brochures, pens and fridge magnets), videos demonstrating tips and techniques for addressing tobacco-use issues with your patients.
• Resources for educators - posters and patient information sheets in 8 different languages

For Patients

• Smoking Cessation Program Patient Information Sheets.
• Smoking Cessation Program online information—explains eligibility, coverage and registration procedures for the nicotine replacement therapy products.
• The QuitNow.ca website—offers many resources for planning and managing smoking cessation, including the QuitNow Services NRT guide (PDF, 526KB), QuitNow library and videos on how to use nicotine gum and patches.