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 in specific medical circumstances and depends on the patient’s PharmaCare plan rules, including 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. 

New!Special Authority is going digital. Read up on the new eForms system.

Are you looking for resources for your patients? See the Special Authority web page for patients.


On this page: SA drug types | Special Authority Transformation (SAT) project (eForms) | Resources


SA drug types

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.

Non-reference (partially covered)

For patients who experience an adverse reaction or treatment failure on the reference drug. See criteria and forms.

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 Health Professionals.

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. Exceptional approvals are usually of limited duration.

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

On a case-by-case, last-resort basis, PharmaCare covers expensive drugs for rare diseases (EDRDs) that have an approximate annual cost of more than $100,000 per patient.


Special Authority Transformation (SAT) project

PharmaCare’s SA program is going digital. Soon prescribers will be able to submit and track SA requests online or directly from an electronic medical record, rather than fax. The new process requires no special software. Requests may be approved more quickly and securely, with more information available to patients. For certain medications, requests that previously took up to 10 days can now be approved within hours.

With the SA team now electronically adjudicating SA requests, you may notice a change in the appearance of notifications for, especially, ARBs, PPIs, bupropion and gliclazide.

For prescribers and clinical pharmacists, submitting SA requests online means:

  • Notifications and status updates so patients can be informed of progress
  • Less back-and-forth with the SA team, because of improved data collection
  • A lighter workload because of improved efficiencies

Watch this space and the PharmaCare Newsletter for updates. Send questions to SATransformation@gov.bc.ca

What are eForms?

An eForm is an online version of a paper form. The new SA 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 dropdown menus or fill out comment boxes. eForms are more secure than faxes and protects patient privacy. 

SA requests will be submitted online through the PHSA (Provincial Health Services Authority) eForms platform or directly from an electronic medical record (EMR).

Watch a short tutorial.

Faxes

You can continue to fax in SA requests, if needed. Note that if you fax in requests, they won't be auto-adjudicated and your patients won't 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.

When can I submit SA forms online?

We are currently integrating EMRs with the new SA eForms system. We’ll be working with each EMR vendor in the coming months. 

If you work in a private community health practice, we're developing a technical solution that will allow you to access the system. This should be available in a few months. 

Enrolment information and more details to come. 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.


Resources