SA is experiencing heavy request volumes. Expected turnaround is 1 business day for urgent requests and 12-16 weeks for regular requests. Consider alternatives to SA coverage, such as LCA or RDP substitutes.
Special Authority (SA) grants coverage to a drug, medical supply or device that otherwise would not be eligible for full coverage. Coverage is provided for patients with specific medical circumstances. Reimbursement depends on the patient’s PharmaCare plan rules, including annual deductible requirements. In rare cases, SA coverage is available for non-benefit items (see SA drug types).
Read up on the new Special Authority eForms system.
Note: SA approval must be in place before a patient pays for a prescription. Coverage cannot be provided retroactively.
PharmaCare’s Special Authority program is going digital! It will soon be easier for prescribers to submit and track SA Requests, and requests may be approved more quickly, with improved security, more information for patients, and recordkeeping at the stroke of a key.
Once complete, Special Authority requests will no longer be faxed but submitted online or directly from an electronic medical record. The new process is being developed by the Ministry of Health and the Provincial Health Services Authority. It will require no special software, will be phased in over a few months, and will result in improvements from end to end.
What will this mean for prescribers and clinical pharmacists?
- SA requests will be submitted online through the PHSA eForms platform or directly from an electronic medical record (EMR)
- Notification and status updates, allowing prescribers to keep patients informed of progress
- A lighter workload, because of improved efficiency
- Less back-and-forth with the SA team, because of improved data collection
To stay up to date with the project, subscribe to this web page (subscription box on the right) and to the PharmaCare Newsletter, if you haven’t already.
- February 2021: Decision notifications now digitized. With our SA team now electronically adjudicating SA requests, you may notice a change in the appearance of SA approval or denial notifications about SA coverage decisions, specifically for ARBs, PPIs, as well as bupropion and gliclazide. See example in righthand box.
- April 2021: The Special Authority team is near the end of its journey to digitize Special Authority (SA). As the team devotes energy to this last push, you may see longer wait times for non-urgent requests. As soon as the Special Authority Transformation project is complete, adjudication times will be quicker than ever. The turnaround time for urgent Special Authority requests is not affected by the Special Authority Transformation project.
When can I submit Special Authority forms online?
We have piloted the Special Authority eForms system with lots of positive feedback. For certain medications, requests that previously took up to 10 days can now be approved within hours.
If you work for a health authority, you will be able to use eForms in the coming weeks. Each health authority will have a contact to help you enrol. They will collect information from you and submit it to PHSA. They will then send you a link once you are enrolled, which you will use to submit SA requests online. Watch this page for details.
We are integrating EMRs and the new SA eForms system. We’ll be working with each EMR vendor in the coming months. Details to come.
If you work in a private community health practice, we are developing a technical solution that will allow you to access the system. This should be available in a few months. Details to come.
For now, you will be able to continue to fax in SA requests, if needed. Note that if you fax in requests, they will not be auto-adjudicated and your patients will not be able to track the request in Health Gateway. Faxes are also less secure than eForms, take longer to submit, and are adjudicated more slowly.
What are eForms?
An eForm is an online version of a paper form. The new Special Authority system is user-friendly–as simple as ordering a product online. Some form fields automatically complete, saving you time. You can check off criteria from drop-down menus or enter comments in comment boxes. eForms are more secure than faxes and protects patient privacy.
Watch a short tutorial online.
Do you have questions about the Special Authority Transformation project? Send them to SATransformation@gov.bc.ca.
SA approval may be granted for the following drug types:
Medications that generally aren’t first-line therapies or have more cost-effective alternatives. See criteria and forms below.
Non-reference (partially covered)
For patients who experience an adverse reaction or treatment failure on the reference drug. See criteria and forms below.
For patients unable to use the low cost alternative drug due to an allergy.
Drugs not marketed in Canada
For instance, Health Canada’s Special Access Programme drugs are covered in exceptional circumstances only. See PharmaCare Policy Manual—Section 6.2.
Biologics and biosimilars
Most biologics require SA approval. Those that have biosimilars are generally covered on an exceptional basis only, for patients who cannot take a biosimilar for documented medical reasons. See Biosimilars Initiative for Prescribers.
Non-benefit drugs (exceptional requests)
Non-benefit drugs are considered for coverage on an exceptional, last-resort basis, generally when all available PharmaCare benefit options have been tried without success or are unsuitable for the patient and no other coverage options (e.g., Extended Health – Blue Cross) are available.
Such requests must be submitted in two parts: the General SA Request form (with Sections 1, 2 and “Requested drug exemption” portion of Section 3 completed), AND a signed letter from the prescriber.
The letter must include:
- Patient diagnosis or indication
- List of all medications tried to date, including dose; duration of trial; and either patient response to medication OR, if medications not tried, reasons for not doing so
- Anticipated outcome(s) of treatment with requested drug (e.g., physical symptoms, quality of life/function)
- Confirmation that patient has no other insurance that would cover any part of the drug’s cost
- Any additional pertinent information
Exceptional approvals are usually of limited duration.
Exceptional funding of EDRDs
For PharmaCare’s expensive drugs for rare diseases (EDRD) program, expensive drugs are defined as drugs with an approximate annual cost of more than $100,000 per patient and a rare disease is defined as a condition that:
- Is life-threatening, seriously debilitating, or both serious and chronic in nature; and
- Affects a relatively small number of patients (incidence of less than 5 in 10,000, but typically closer to 1 in 100,000); and
- Is often genetically based, with onset at birth or early childhood, and leads to a shortened lifespan
EDRDs are considered PharmaCare non-benefits, but in exceptional cases, coverage may be requested by a treating physician through the EDRD patient review process. Requests are assessed for approval on a case-by-case, last-resort basis.
- Special Authority Request Forms
- How to submit a Special Authority Request
- Special Authority patient information sheet (PDF, 175KB)
- Special Authority Requests – Prescriber Checklist (PDF, 158KB)
- PharmaCare drug review process & results
- Information for patients about SA: Drugs Requiring Pre-Approval.
- For questions about SA, contact HIBC and ask to be transferred to the SA team.
- For questions about the Special Authority Transformation project, contact SATransformation@gov.bc.ca
The table below lists all drugs that require SA approval. Click the drug name for SA coverage criteria and form(s). Note that SA is required for Insulin Pumps. Related resources are Formulary Search and SA Request Forms.