Special Authority is experiencing heavy request volumes. For urgent medications, expected turnaround is 1 business day. For regular medications, turnaround can be 5 to 8 weeks while we digitize our request system. See How to avoid delays.
Special Authority Transformation Project (SAT)
The Special Authority Transformation Project (SAT) is in full swing at the Ministry of Health. Once complete, Special Authority requests will no longer be faxed but submitted online or directly from an electronic medical record. The new, entirely digital process will require no special software, will be phased in over a few months, and will result in improvements from end to end. Watch the PharmaCare Newsletter for updates.
For information on PharmaCare benefit medications, visit the Formulary Search.
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).
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, fewer faxes, and recordkeeping at the stroke of a key.
To support healthcare providers and improve quality of care for British Columbians, through access to drugs and medical supplies and devices, the Ministry of Health and the Provincial Health Services Authority (PHSA) are developing a streamlined path for processing SA Requests.
SA Requests will soon be submitted online rather than by fax, which means improved efficiency, simpler processes, and less paper. No special software is needed.
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
- 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
The transformation will be phased in. Users can expect to see changes in early 2021. PharmaCare will announce new functionalities in the PharmaCare Newsletter and on this web page. To stay up to date with the project, subscribe to this web page (see subscription box to 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). It will soon be much easier to submit and track requests. 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.
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 funding of EDRDs
Expensive drugs for rare diseases (EDRDs) are considered PharmaCare non-benefits, but in exceptional cases, coverage may be approved. Requests are assessed on a case-by-case basis.
Expensive drugs for rare diseases (EDRDs) are drugs with a very high per-patient cost —more than $100,000 each year— that treat rare diseases. All EDRDs are considered non-benefits, but some drugs and patients may be eligible for coverage on a case-by-case, last-resort basis.
EDRDs are generally associated with limited clinical information about both the disease and treatment. Because of this, therapies must be carefully reviewed by specialized clinicians. Clinician experts assess which patients are most suitable for a therapy, and ensure that the drugs are working for each patient.
If a patient meets the EDRD process patient eligibility requirements and their prescriber believes their medical circumstance warrants the use of a specific EDRD, the physician submits a request on behalf of their patient.
- 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.