How to Submit a Special Authority Request

PharmaCare approves Special Authority (SA) requests for patients who meet established criteria. Under exceptional circumstances, PharmaCare may cover patients who do not meet the pre-defined criteria.

SA coverage is valid from the date approval is entered into a patient's record on PharmaNet. The duration of coverage depends upon the specific drug and the condition being treated.

An approved SA normally grants full coverage to a drug that would otherwise not be covered or be only partially covered.

Note that full coverage differs from actual reimbursement. Actual reimbursement depends on a patient's PharmaCare plan rules, including any annual deductible and co-payment requirements, and is subject to pricing policies such as the Maximum Pricing Policy, the Low Cost Alternative (LCA) Program or the Reference Drug Program (RDP).

For certain drugs, some prescribers can enter agreements that exempt them from submitting an SA request for each patient. See Collaborative Prescribing Agreements (CPAs) for more information.

  1. Go to the Special Authority drug list. The list includes only those medications for which SA approval is required. It does not include regular PharmaCare benefits. Note: SA approval must be in place before the patient purchases the prescription. Coverage cannot be provided retroactively.
  2. Click on the drug name to view the drug criteria page where you can access the appropriate SA request form. You can also click on the SA category to see a description of the reimbursement program the drug is included under.
  3. On the drug criteria page:
    1. Review coverage criteria and see if a Practitioner Exemption is available. If yes, and you are in the exempted group, you do not need to submit a SA form for your patient; their prescription will be covered automatically
    2. See if a Collaborative Prescribing Agreement (CPA) is available. ​If you are eligible to enter into a CPA, after the CPA is granted, you do not need to submit a SA request when prescribing according to the terms of the CPA
    3. If you are not eligible for an exemption or a CPA, select the SA request form linked at the bottom of the criteria page and complete the form, documenting how your patient meets the coverage criteria. For details on how to complete the form, see Prescriber Checklist (PDF, 158KB)
  4. Sign the SA request form and fax it to 1-800-609-4884 (toll-free in B.C.)

Note: PharmaCare may use PharmaNet records to verify criteria have been met. If you provided samples for medication trials, documentation may be required.

The Low Cost Alternative (LCA) Program ensures British Columbians get the best value on multiple-source drugs. Each LCA category consists of drugs with the same active ingredient(s) and the same strength. PharmaCare covers only those drugs that meet a set price.

If your patient is allergic, or has an intolerance, to the non-therapeutic ingredients used in the fully covered drugs within an LCA category, you can submit a PharmaCare SA request for full coverage of another drug (including an alternate generic brand of the same drug) in that category.

Please see the list of the multiple-source drugs that PharmaCare covers. In column F, a "P" indicates a partial benefit, and "F" indicates a full benefit. Drugs not listed in the data file are not covered. Only drugs marked "P" require SA to be covered.

To submit a request:

  1. Complete a General Special Authority Request (PDF, 656KB) form, documenting your patient's clinical need for the drug. Be sure to list all the fully covered products they have trialed. For details on how to complete the form, see Prescriber Checklist (PDF, 158KB)
  2. Sign the SA request form and fax it to 1-800-609-4884 (toll-free in B.C.)

SA requests are prioritized by date received and by urgency. Once the request is processed, PharmaCare will notify you (the prescriber) of the decision unless:

  • You have indicated you did not require confirmation, or
  • The office fax number you provided is illegible or incorrect

To ensure continuity of coverage, you may wish to schedule an appointment with the patient for re-evaluation so that, if a request for renewal is required, you can submit the request for renewal at least 2 weeks before the expiry date.

Turnaround times

You may be seeing longer wait times for non-urgent requests. As soon as the Special Authority Transformation (SAT) project is complete, adjudication times will be quicker than ever.

The turnaround time for urgent SA requests is not affected by the SAT project. As always, they are processed within 24 hours.

SA requests can be deemed urgent depending on medication required (this could include anticoagulants, oral antifungals, antibiotics, psychiatric and chemotherapy drugs, or for substance use disorder) and circumstances (e.g., hospital discharge, palliative treatment, MAiD, acute mental health or life-threatening conditions). 

Some individual prescribers and specialists can enter into Collaborative Prescribing Agreements (CPAs) with PharmaCare. These agreements exempt them from submitting an individual request for coverage of specific drugs.

How CPAs work

By entering into a CPA, a prescriber:

  • Agrees to prescribe according to the Limited Coverage criteria specified for the drug in the CPA
  • Is exempt from submitting SA requests for patients who meet the criteria
  • Agrees to annotate prescriptions for patients who do not meet the criteria in such a way that the pharmacy will know not to bill PharmaCare for the drug
  • Agrees that PharmaCare may assess their adherence to the prescribing criteria

CPAs save time on the part of prescribers and the SA team. However, CPAs are viable only if prescribers adhere to their terms.

To ensure CPAs continue to be offered, PharmaCare reserves the right to:

  • Require prescribers to renew CPAs
  • Discontinue a CPA if the prescriber is not adhering to the coverage criteria specified in the CPA

How to know if a CPA is available for a specific drug

Visit Special Authority to review the drugs that require SA approval for coverage through PharmaCare.

Click on a drug name to see the drug's criteria page. If a CPA is available, it will be noted in the Practitioner Exemptions section.

Note: PharmaCare coverage is not retroactive. SA approval or a current, valid prescriber SA exemption must be in place before a patient fills a prescription.