Special Authority

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.

SAT news

  • 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.

Faxes

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:

Limited coverage

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.

Alternative products

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 drug list

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

This table can be sorted by brand or generic name or SA category.
Generic Drug Name Brand Drug Name Special Authority Category
abatacept for polyarticular juvenile idiopathic arthritis Orencia® LCD
abatacept for rheumatoid arthritis Orencia® LCD
abobotulinumtoxinA Dysport Therapeutic™ LCD
acamprosate Campral® LCD
acetaminophen 500 mg Tylenol 500 mg® LCD
aclidinium Tudorza™ Genuair™ LCD
aclidinium-formoterol Duaklir™ Genuair® LCD
adalimumab Amgevita®, Hadlima®, Hulio®, Humira®, Hyrimoz®, Idacio® LCD
alemtuzumab Lemtrada® LCD
alendronate 10/70 mg Fosamax® 10 mg / 70 mg LCD
alendronate with vitamin D 10/70 mg Fosavance® 70 mg / 5600 IU LCD
alendronate 40 mg Fosamax® 40 mg LCD
alitretinoin Toctino® LCD
ambrisentan Volibris® LCD
apixaban for atrial fibrillation Eliquis® LCD
apixaban for the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) Eliquis® LCD
apomorphine Movapo™ LCD
apixaban for venous thromboembolism Eliquis® LCD
aprepitant Emend® LCD
aripiprazole Abilify® LCD - Psychiatric Medications Plan (Plan G)
aripiprazole monohydrate Abilfy Maintena® LCD
asenapine Saphris™ LCD
atomoxetine Strattera® LCD
aztreonam Cayston™ LCD
baclofen intrathecal Lioresal® Intrathecal LCD
benazepril Lotensin® RDP - ACE Inhibitor Drugs
benzydamine Tantum® LCD
benralizumab Fasenra® LCD
bosentan Tracleer® LCD
botulinum neurotoxin type A, free from complexing proteins, also known as incobotulinumtoxinA Xeomin® LCD
botulinum neurotoxin type A, with complexing proteins, also known as onabotulinumtoxinA Botox® LCD
brexpiprazole Rexulti®  LCD - Psychiatric Medications Plan (Plan G)
brivaracetam Brivlera® LCD
budesonide capsules Entocort Capsules® LCD
budesonide enema Entocort Enema® LCD
budesonide-formoterol Symbicort® LCD
budesonide nebules Pulmicort® LCD
buprenorphine Sublocade™ LCD
bupropion Wellbutrin® SR and XL, Zyban® LCD - Psychiatric Medications Plan (Plan G)
candesartan Atacand®, Atacand Plus® LCD
captopril Capoten® RDP - ACE Inhibitor Drugs
carvedilol Coreg® LCD
celecoxib Celebrex® LCD
certolizumab for the treatment of ankylosing spondylitis Cimzia® LCD
certolizumab for the treatment of psoriatic arthritis Cimzia® LCD
certolizumab for the treatment of rheumatoid arthritis Cimzia® LCD
chlorambucil Leukeran® LCD
chloroquine Aralen® LCD
ciclopirox 1% Loprox® LCD
cilazapril with/without HCTZ Inhibace®, Inhibace Plus® RDP - ACE Inhibitor Drugs
cimetidine - prescription strength Tagamet® RDP - H2 Blocker Drugs
ciprofloxacin ophthalmic Ciloxan® LCD 
clioquinol topical Locacorten  Vioform
Vioform Hydrocortisone
LCD
clobazam Frisium® LCD - Psychiatric Medications Plan (Plan G)
clotrimazole Canesten Topical® LCD
codeine sustained release Codeine Contin® LCD
continuous glucose monitor Dexcom G6®  
cyclosporine Neoral® LCD
cyproterone Androcur® LCD - Psychiatric Medications Plan (Plan G)
dabigatran Pradaxa® LCD
dalteparin Fragmin® LCD
deferasirox Exjade® LCD
deferiprone Ferriprox® LCD
denosumab Prolia® LCD
desmopressin oral DDAVP Tablets®, DDAVP Melt® LCD
dextroamphetamine-amphetamine Adderall XR® LCD
diclofenac IR/SR Voltaren®, Arthrotec® LCD
diclofenac IR with misoprostol Arthrotec® LCD
dienogest Visanne® LCD
diflunisal Dolobid® LCD
dimethyl fumarate Tecfidera™ LCD
diphenoxylate HCI-atropine sulfate Lomotil® LCD
dipyridamole-acetylsalicylic acid Aggrenox®  LCD
donepezil Aricept® LCD
dorzolamide-timolol preservative free Cosopt non-preserved® LCD
dronedarone Multaq® LCD
duloxetine generics LCD
dutasteride Avodart® LCD
edaravone Radicava™ LCD
elbasvir-grazoprevir Zepatier™ LCD
empagliflozin and empagliflozin-metformin Jardiance®, Synjardy® LCD
enalapril without HCTZ Vasotec® RDP - ACE Inhibitor Drugs
enalapril with HCTZ Vasotec Plus® RDP - ACE Inhibitor Drugs
enoxaparin Lovenox® LCD
entacapone Comtan® LCD
entacapone/levodopa/carbidopa combination tablet Stalevo® LCD
entecavir Baraclude® LCD
epoprostenol Caripul®, Flolan® LCD
eprosartan with/without HCTZ Teventen®, Teveten Plus® RDP - ARB Drugs LCD
eslicarbazepine acetate Aptiom™ LCD
esomeprazole Nexium® RDP - PPI Drugs LCD
estradiol patches Climara®, Estalis®, Estalis-Sequi®, Estracomb®, Estraderm®, Estradot®, Oesclim®, Vivelle® LCD
estradiol transdermal gel Divigel®, Estrogel® LCD
etanercept Enbrel®, Brenzys™, Erelzi™ LCD
evolocumab Repatha™ LCD
ezetimibe Ezetrol®, generics LCD
famotidine Pepcid® RDP - H2 Blocker Drugs
febuxostat Uloric® LCD
felodipine Plendil®, Renedil® RDP - Calcium Channel Blockers
fentanyl patch Duragesic® LCD
fentanyl tablet Fentora® LCD
fidaxomicin Dificid® LCD
filgrastim Grastofil® LCD
finasteride Proscar® LCD
fingolimod generics, Gilenya® (partial benefit) LCD
fluconazole oral solids Diflucan® LCD
flurbiprofen Ansaid®, Froben® LCD
fluticasone furoate-umeclidinium-vilanterol Trelegy® Ellipta® LCD
fluticasone furoate-vilanterol Breo® Ellipta® LCD
fluticasone propionate-salmeterol Advair® LCD
fluvastatin Lescol® RDP - Statin Drugs
formoterol Foradil®, Oxeze® Turbuhaler® LCD
fosinopril Monopril® RDP - ACE Inhibitor Drugs
gabapentin Neurontin® LCD - Psychiatric Medications Plan (Plan G)
galantamine Reminyl® LCD
glatiramer acetate Copaxone® LCD
glecaprevir-pibrentasvir Maviret™ LCD
gliclazide Diamicron® LCD
glycopyrronium Seebri® Breezhaler® LCD
golimumab Simponi® LCD
goserelin Zoladex® LCD
granisetron Kytril® LCD
glycerol phenylbutyrate Ravicti® LCD
glycopyrronium-indacaterol Ultibro® Breezhaler® LCD
hydromorphone controlled release Hydromorph Contin® LCD
hydromorphone injection Hydromorphone HP 50 LCD
hydroxyurea Hydrea® LCD
hydroxyzine Atarax® LCD - Psychiatric Medications Plan (Plan G)
icatibant Firazyr® LCD
indacaterol Onbrez® Breezhaler® LCD
indapamide Lozide® LCD
indomethacin Indocid® LCD
infliximab Avsola®, Inflectra™, Renflexis™, Remicade® LCD
insulin detemir Levemir®, Levemir® FlexTouch® LCD
insulin glargine Basaglar™ LCD
interferon alfa Intron A® LCD
interferon beta-1a Avonex®, Rebif® LCD
interferon beta-1b Betaseron®, Extavia® LCD
ipratropium nebules Atrovent® LCD
ipratropium and salbutamol combination nebules Combivent® UDV LCD
irbesartan with/without HCTZ Avapro®, Avalide® RDP - ARB Drugs LCD
iron isomaltoside Monoferric® LCD
iron sucrose Venofer® LCD
isavuconazole Cresemba® LCD
itraconazole Sporanox® LCD
ivabradine Lancora™ LCD
ixekizumab Taltz™ LCD
ketoconazole 2% cream Nizoral® LCD
ketoprofen enteric-coated Orudis E® LCD
ketoprofen SR Orudis® LCD
lacosamide tablets Vimpat® LCD
lactulose Laxilose® LCD
lamivudine Heptovir® LCD
lansoprazole 15 mg or 30 mg Prevacid® RDP - PPI Drugs + LCD
ledipasvir-sofosbuvir Harvoni™ LCD
leflunomide Arava® LCD
letermovir Prevymis™ LCD
leuprolide Lupron® LCD - Psychiatric Medications Plan (Plan G)
levetiracetam Keppra® LCD
levodopa-carbidopa Duodopa® LCD
linagliptin and linagliptin-metformin Trajenta™, Jentadueto™ LCD
linezolid 600 mg tablet Zyvoxam® LCD
lisdexamfetamine Vyvanse® LCD
lisinopril with or without HCTZ Prinivil®, Zestril®, Zestoretic® RDP - ACE Inhibitor Drugs
loperamide Imodium® LCD
losartan Cozaar®, Hyzaar® LCD
lovastatin Mevacor® RDP - Statin Drugs
meloxicam Mobicox® LCD
mepolizumab Nucala® LCD
mercaptopurine Purinethol® LCD
methotrexate injection Methotrexate® injection LCD
methylphenidate extended-release Concerta® LCD
miconazole 2% topical Micatin Cream® LCD
miconazole topical Monistat Derm Cream® LCD
modafinil Alertec® LCD
mometasone-formoterol Zenhale™ LCD
mometasone nasal spray Nasonex® LCD
mycophenolate mofetil CellCept® LCD
nabumetone Relafen® LCD
nadroparin Fraxiparine® LCD
naltrexone ReVia® LCD
naproxen enteric-coated Naprosyn EC® RDP - NSAIDs
naproxen SR Naprosyn® RDP - NSAIDs
natalizumab Tysabri® LCD
netupitant-palonosetron Akynzeo® LCD
nifedipine Adalat® RDP - Calcium Channel Blockers
nintedanib Ofev® LCD
nitisinone Orfadin® LCD
nizatidine Axid® RDP - H2 Blocker Drugs
obeticholic acid Ocaliva® LCD
ocrelizumab Ocrevus® LCD
ocriplasmin Jetrea® LCD
ofloxacin ophthalmic drops Ocuflox® LCD
olanzapine Zyprexa®, Zyprexa Zydis® LCD - Psychiatric Medications Plan (Plan G)
olmesartan Olmetec®, Olmetec Plus® LCD
oseltamivir Tamiflu® LCD
omeprazole 20 mg Losec® 20 mg RDP - PPI Drugs +​ LCD
ondansetron Zofran® LCD
paliperidone palmitate injection Invenga Sustenna®
Invega Trinza®
LCD - Psychiatric Medications Plan (Plan G)
pamidronate Aredia® LCD
pantoprazole magnesium Tecta® RDP - PPI Drugs +​ LCD
pantoprazole sodium 40 mg Pantoloc® 40 mg RDP - PPI Drugs +​ LCD
pentazocine Talwin® LCD
perampanel Fycompa™ LCD
perindopril Coversyl® RDP - ACE Inhibitor Drugs
pimecrolimus cream Elidel® cream LCD
pioglitazone Actos® LCD
pirfenidone Esbriet® LCD
piroxicam capsule Feldene® LCD
pramipexole Mirapex® LCD
prasugrel generic LCD
pravastatin Pravachol® RDP - Statin Drugs
propranolol hydrochloride Hemangiol® LCD
prostaglandin compounded injection Prostaglandin® LCD
quinapril with HCTZ Accuretic® RDP - ACE Inhibitor Drugs
rabeprazole Pariet® RDP - PPI Drugs +​ LCD
raloxifene Evista® LCD
ribavirin Ibavyr™ LCD
rifaximin Zaxine® LCD
risedronate 30 mg Actonel® 30 mg LCD
risedronate 5/35 mg Actonel® 5 / 35 mg LCD
risperidone microspheres Risperdal Consta® LCD
rituximab Rituxan®
Truxima™, Riximyo and Ruxience
LCD
risankizumab Skyrizi™ LCD
rivaroxaban for atrial fibrillation Xarelto® LCD
rivaroxaban for concomitant coronary artery disease and peripheral artery disease Xarelto® LCD
rivaroxaban for prophylaxis of venous thromboembolism Xarelto® LCD
rivaroxaban for the treatment of venous thromboembolic events (DVT or PE) Xarelto® LCD
rivastigmine Exelon® LCD
ropinirole ReQuip® LCD
rotigotine Neupro® LCD
rufinamide Banzel® LCD
sacubitril-valsartan Entresto LCD
salbutamol nebules Ventolin® LCD
salmeterol Serevent® LCD
sarilumab Kevzara® LCD
saxagliptin and saxagliptin-metformin Onglyza®, Komboglyze™ LCD
secukinumab Cosentyx® LCD
selexipag Uptravi® LCD
semaglutide Ozempic® LCD
sildenafil Viagra® LCD
simvastatin Zocor® RDP - Statin Drugs
sodium cromoglycate nebules Intal® nebules LCD
sodium phenylbutyrate Pheburane® LCD
sofosbuvir Sovaldi® LCD
sofosbuvir-velpatasvir Epclusa® LCD
sofosbuvir-velpatasvir-voxilaprevir Vosevi™ LCD
solifenacin generics only LCD
somatropin Genotropin®, Humatrope®, Norditriopin Nordiflex®, Nutropin AQ®, Omnitrope®, Saizen® LCD
stiripentol Diacomit™ LCD
sulindac Clinoril® LCD
sumatriptan injection Imitrex® Injection LCD
supportive care for cancer treatment Grastofil(R) pre-filled syringe LCD
tacrolimus ointment Protopic® Ointment LCD
tadalafil 20 mg Adcirca® LCD
telmisartan without HCTZ Micardis® RDP - ARB Drugs +​ LCD
telmisartan with HCTZ Micardis Plus® RDP - ARB Drugs +​ LCD
telmisartan + amlodipine combination Twynsta® RDP - ARB Drugs +​ LCD
tenofovir Viread® LCD
tenoxicam Mobiflex® LCD
terbinafine tablets Lamisil® tablets LCD
teriflunomide Aubagio™ LCD
testosterone cypionate Depo-testosterone® LCD
testosterone enanthate Delatestryl® LCD
tiaprofenic acid regular release Surgam® LCD
ticagrelor Brilinta® LCD
ticlopidine Ticlid® LCD
tinzaparin Innohep® LCD
tiotropium Spiriva® Handihaler® LCD
tiotropium-olodaterol Inspiolto® Respimat® LCD
tizanidine Zanaflex® LCD
tobramycin Tobi®, Tobi® Podhaler® LCD
tocilizumab for the treatment of giant cell arteritis Actemra® LCD
tocilizumab for the treatment of active polyarticular juvenile idiopathic arthritis Actemra® LCD
tocilizumab for the treatment of active systemic juvenile idiopathic arthritis Actemra® LCD
tocilizumab for the treatment of rheumatoid arthritis Actemra® LCD
tofacitinib for the treatment of rheumatoid arthritis Xeljanz® LCD
tofacitinib for the treatment of ulcerative colitis Xeljanz® LCD
trandolapril Mavik® RDP - ACE Inhibitor Drugs
treprostinil Remodulin® LCD
tretinoin topical Rejuva-A Cream®, Retin-A Cream®, Stieva-A Cream®, Vitamin A Acid Cream® LCD
umeclidinium-vilanterol Anoro® Ellipta® LCD
ustekinumab Stelara® LCD
valganciclovir Valcyte® LCD
valsartan Diovan®, Diovan HCT® RDP - ARB Drugs +​ LCD
vancomycin oral Vancocin® LCD
varenicline Champix® LCD - Psychiatric Medications Plan (Plan G)
vedolizumab Entyvio® LCD
voriconazole Vfend® LCD
vortioxetine Trintellix™ LCD
zanamivir Relenza® LCD
ziprasidone Zeldox® LCD - Psychiatric Medications Plan (Plan G)
zoledronic acid Aclasta™ LCD
zopiclone Imovane® LCD - Psychiatric Medications Plan (Plan G)