Special Authority (SA)

The Low Cost Alternative (LCA) Program ensures B.C. residents get the best value on multiple-source drugs. The LCA program groups drugs that contain the same active ingredients in the same strength and formulation, and assigns a maximum price PharmaCare will cover for all products in each category.

PharmaCare fully covers the drugs that are priced at or below the PharmaCare maximum price. These are usually generic drugs. PharmaCare partially covers drugs priced above the maximum price—up to the maximum price. These are usually brand-name drugs.

LCA alternative

If your patient is allergic to or has an intolerance to non-therapeutic ingredients in the fully covered drugs within a Low Cost Alternative (LCA) Program category, prescribers can submit a SA request for full coverage of another drug in that category (including an alternative generic version of the same drug).

1. Review the LCA Master Spreadsheet. In column F, a P indicates a partial benefit and F indicates a full benefit. Only drugs marked P require SA approval for coverage.
2. Submit a General Special Authority request in SA eForms. If you aren’t enrolled in eForms, enrol now, or complete the General Special Authority Request (PDF, 656KB)
   Document your patient's clinical need for the drug and list all the fully covered products they have tried.

RDP alternative

In case of adverse reaction or treatment failure on the reference drug, SA may provide full coverage of a partially covered (non-reference) drug in the Reference Drug Program (RDP) 

All non-reference drugs have an SA request form linked in criteria and available on eForms.

For some benefits, certain specialists are exempt from applying for SA coverage or can enter a Collaborative Prescribing Agreement (CPA), which also makes SA coverage automatic.

The clinical criteria for each SA drug has a section titled Practitioner Exemptions, which indicates if an exemption or CPA is available.

Prescriber exemptions

For some benefits, the SA criteria explains that certain specialists are exempt from submitting a SA request. Their prescriptions for the benefit automatically have SA coverage. The SA coverage is linked to their Prescriber ID, instead of the patient's PHN. Such exemptions can extend to a patient’s new prescriber. Learn more at Assumed Special Authority below.

Collaborative Prescribing Agreements (CPA)

For some benefits, prescribers can enter a Collaborative Prescribing Agreement (CPA) to become exempt from submitting SA requests for the benefit; their prescriptions automatically have SA coverage. The coverage is linked to their Prescriber ID, instead of the patient's PHN.

When a prescriber enters a CPA, they agree to:

• Prescribe according to the criteria specified in the CPA
• Allow PharmaCare to assess whether they’re adhering to the prescribing criteria
• Annotate prescriptions for patients who do not meet the criteria so the pharmacy will not bill PharmaCare for the drug

Some CPAs are available for download on the drug criteria web page. Some CPAs are by invitation only.

CPAs save time for both prescribers and Special Authority. However, CPAs are viable only if prescribers adhere to their terms.​​

CPAs and “zero cost” notes

Usually when a prescriber writes “Submit as zero cost to PharmaCare” or “PharmaCare pays zero” on a prescription, it means the patient is not eligible for SA coverage.

Occasionally, this note means that a CPA is in place and the patient does not meet the associated conditions. Pharmacists filling a prescription with a “zero cost” or “pays zero” note for this reason should enter the intervention code DE Adjudicate to $0.00 as requested. This is the same code used when a patient is not eligible for coverage.

Assumed Special Authority

Many practitioner exemptions extend to subsequent prescribers. This means the patient has indefinite SA approval if the prescription was written by a prescriber with an exemption, and other practitioners do not need to submit a SA request to maintain the coverage. This is called an "assumed SA".

Practitioners renewing a medication with prescriber SA exemptions can call the PharmaCare Help Desk to check if the medication was initially prescribed by a specialist with exemption. If so, they can choose not to submit a SA request.

If a pharmacist notes in a client's PharmaNet profile that a benefit previously had SA coverage, and the pharmacist thinks an assumed SA should be in place, the pharmacist should call the PharmaCare Help Desk.

If a client has several prescribers

Since CPAs and practitioner exemptions are tied to the prescriber ID in PharmaNet, if a different prescriber who does not share the specialty or CPA rewrites a prescription and their ID is entered in PharmaNet as the prescriber, the patient will not have SA coverage for that prescription.

If this happens, pharmacists can check the patient’s PharmaNet profile and/or ask the patient for more information. If another prescriber is identified, who can prescribe under a CPA or practitioner exemption, the pharmacist should contact that prescriber, confirm they intend for the patient to receive the prescription, and request that prescriber issue a prescription. The prescription information can be confirmed by phone, but any change to the Prescriber ID must be documented on the original prescription.

SA coverage is available in exceptional circumstances, usually for a limited time.

Exceptional SA coverage of non-benefit drugs

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 are available (e.g., third-party insurance). Exceptional approvals are usually for a limited duration.

If faxing, requests must include a General SA Request form (PDF, 656KB) with Sections 1, 2 and 3 completed AND a signed letter from the prescriber that includes:

• Patient diagnosis or indication
• A list of all medications tried to date, including dose, duration of trial and patient response to medication, OR, if medications not tried, reasons for not doing so
• The anticipated outcome(s) of treatment with the requested drug (e.g., physical symptoms, quality of life/function)
• Confirmation that the 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 last-resort basis, PharmaCare covers expensive drugs for rare diseases (EDRDs) that have an estimated annual cost of more than $100,000 per patient. Requests for exceptional, last-resort coverage must be submitted in writing, in a letter containing the following details: baseline objective measurements that determine the patient’s response to treatment, duration of treatment, current dose, rationale for treatment, specific quantitative results considered to be indicators of success, and a list of all therapies that have been previously tried.

• Refer to Exceptional funding for EDRDs

Other exceptional SA coverage

• Drugs not marketed in Canada
• Biosimilars and their biologic originators

Clients in rural and remote areas

Rural or remote pharmacists can call the PharmaCare Help Desk to request an SA exemption to the PharmaCare 30-day maximum supply limit for patients residing in rural or remote areas when travel to the pharmacy is a significant barrier. The exemption is entered into PharmaNet as a one-day SA.

Patients with chronic conditions

Medical practitioners can submit a SA exemption to the 30-day maximum supply policy for short-term drugs if the patient has a chronic condition. Short-term drugs include all narcotics, all antibiotics, antifungals, sedatives, sleeping pills, barbiturates and all medications in the Palliative Care Drug Plan (Plan P) Formulary. Approval may be granted to allow a maximum 100-day supply.

If you have questions about PharmaCare’s drug review process, contact PharmaCare Formulary Management at drugreviewprocess@gov.bc.ca.

If you have questions about SA criteria, email FM.GenericMailbox@gov.bc.ca.

78% of SA requests are approved. General information about appealing a SA decision is on the Drugs that require Special Authority web page.