Prescribed alternatives

B.C.’s prescribed alternatives (PA) program oversees prescribing and provision of regulated, pharmaceutical-grade medications of known concentration to people at high risk of harm from the unregulated drug supply.

On this page:

• Witnessed dosing
• Pharmacy witness fees
• PharmaNet entry procedures

Witnessed dosing

B.C. has mandated that all PAs must be consumed under the direct supervision of a health professional. The policy supports efforts to ensure these medications are used by their intended recipients as part of harm reduction strategies, and to prevent diversion to illicit markets. This applies to benzodiazepines and stimulants when used for PA, as well as opioids. The policy change does not apply to opioid agonist treatment (OAT).

On December 2, 2025, The Ministry of Health released the Access to Prescribed Alternatives in British Columbia: Policy Direction, which outlines updated witness requirements for clients taking prescribed alternatives (PA).

The policy direction requires that all clients who have a PA prescription must transition to witnessed dosing by December 30, 2025. This builds on previous requirements for witnessed dosing for new PA clients, as described in the February 2025 PharmaCare Newsletter (PDF, 448KB). 

There are limited exemptions to witnessed dosing for clients in exceptional circumstances. These include:

• Clients from rural, remote and Indigenous communities who do not have routine access to a pharmacy
• Clients with employment or educational obligations, who may be permitted unwitnessed doses during work or school hours when they have achieved clinical stability
• Clients titrating onto opioid agonist treatment (OAT)

Full details on exemptions to witnessed dosing can be found in the new policy direction. Clinicians should consult BCCSU's 24/7 line for case-based support at 778-945-7619.

Pharmacy witness fees

The Ministry is working on a new payment system to pay pharmacies a fee for witnessing doses of PAs. Pharmacies can expect to receive payments in spring 2026, once the new payment system is ready to be implemented. Pharmacies will receive retroactive payments for witnessed doses of PA recorded in PharmaNet from June 18, 2025, onwards.

Pharmacies will be paid a fee for each eligible dose of witnessed PA medications up to a daily maximum. Fee amounts are based on the type of medication. 

To be eligible for a PA witness fee, the dose must be:

• An eligible PA drug from the table below
• Witnessed oral ingestion or topical application on June 18, 2025, or later
• Witnessed by a pharmacist in a community pharmacy according to provincial policy instructions and BCCSU protocols

PharmaCare will pay a maximum number of daily witness fees per client per day, as detailed on the drug list below. Witnessed doses must be notated with the PharmaNet intervention code "VS – Other outcome or intervention".

Claims must be submitted on the day the PA was dispensed and witnessed. Claim reversals will not be paid. Claims submitted on a different date than the actual dispense will not be paid and/or will be subject to recovery. 

PharmaNet entry procedures

If there are no instructions about witnessing on the prescription, pharmacists must confirm with the prescriber before dispensing.

"SA" notation

Prescribers are requested to write “SA” on all PA prescriptions (for “safer alternative”). They must not use "SA" for opioid, stimulant or benzodiazepine drugs when they are prescribed for non-PA indications.

If “SA” is not written in the original prescription, but there is reason to believe it is a PA prescription based on dispense history or other sources of information, the pharmacist should confirm with the prescriber that it is intended as PA. If so, the pharmacist should denote it as a PA prescription by inputting the associated intervention codes (below).