Submitting a Special Authority Request
PharmaCare approves Special Authority Requests for patients who meet established criteria. Under exceptional circumstances, PharmaCare may cover patients who do not meet the pre-defined criteria.
Special Authority 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 Special Authority 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).
Collaborative Prescribing Agreements (CPAs) are available for a number of drugs and allow prescribers who agree to prescribe according to PharmaCare coverage criteria to do so without submitting a Special Authority Request for each patient.
- Access the Special Authority Drug List. The list includes only those medications for which Special Authority approval is required. It does not include regular PharmaCare benefits. Note: Special Authority approval must be in place before the patient purchases the prescription. Coverage cannot be provided retroactively.
- Click on the drug name to view the drug criteria page where you can access the appropriate Special Authority Request form. You can also click on the Special Authority category to see a description of the reimbursement program the drug is included under.
- On the drug criteria page:
- Review coverage criteria and see if a Prescriber Exemption is available. If yes, and you are in the exempted group, you do not need to submit a Special Authority form for your patient; their prescription will be covered automatically
- 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 Special Authority Request when prescribing according to the terms of the CPA
- If you are not eligible for an exemption or a CPA, select the Special Authority 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)
- Sign the Special Authority 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 Special Authority 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 (XLS). 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 Special Authority to be covered.
To submit a request:
- Complete a General Special Authority Request (PDF) 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)
- Sign the Special Authority Request and fax it to 1 800 609-4884 (toll-free in B.C.)
Special Authority 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.
The usual turnaround time for non-urgent Special Authority requests is ten business days.
The usual turnaround time for urgent Special Authority requests is one business day.
Special Authority 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).