BC PharmaCare Special Authority Program

The BC PharmaCare Special Authority program is an important component of British Columbia's public drug coverage system. This comprehensive guide explains what the program is, how it works, and who can benefit from it.

What is the Special Authority Program?

The BC PharmaCare Special Authority program is designed to ensure that British Columbia residents receive appropriate, medically necessary drug coverage while maintaining the sustainability of the public drug plan. Certain medications are designated as Special Authority drugs, meaning they require prior approval from PharmaCare before coverage is provided.

Why was the program created?

• To ensure coverage is provided to patients who will benefit most from specific medications
• To manage costs of expensive specialty drugs
• To promote appropriate prescribing and use of medications
• To align coverage with clinical evidence and best practices

Who Qualifies for Special Coverage?

British Columbia residents registered with the Medical Services Plan (MSP) and enrolled in Fair PharmaCare may be eligible for Special Authority coverage. This includes:

• Individuals residing in BC who meet MSP eligibility requirements
• Those enrolled in the Fair PharmaCare plan with a registration that provides drug coverage
• Patients with specific medical conditions as defined by the Special Authority criteria

How Does the Process Work?

The Special Authority process involves several key steps:

1. Identification: Your healthcare provider identifies that a medication requires Special Authority
2. Application: Your healthcare provider completes the Special Authority request form
3. Submission: The application is submitted to PharmaCare with supporting medical documentation
4. Review: PharmaCare reviews the request against established clinical criteria
5. Decision: A coverage decision is typically made within 2-3 weeks

Common Medications Requiring Special Authority

Many medications available under the BC PharmaCare program require Special Authority. These typically include:

Drug Category	Examples
Biologics	Humira, Enbrel, Remicade, Stelara
Specialty Diabetes Medications	Ozempic, Trulicity, Victoza
Specialty Cancer Treatments	Keytruda, Opdivo, Tagrisso
Hepatitis C Treatments	Harvoni, Epclusa, Vosevi
Multiple Sclerosis Therapies	Gilenya, Tecfidera, Ocrevus

Understanding the Criteria

Each medication requiring Special Authority has specific clinical criteria that must be met for coverage approval. These criteria are developed with input from clinical experts, healthcare providers, and health economists. The criteria typically include:

• Diagnosis confirmation: Medical evidence confirming your specific condition
• Treatment history: Documentation of previous treatments attempted
• Clinical parameters: Specific test results or measurements
• Prescribing qualifications: Requirements for specialist prescribing

Benefits of Special Authority Coverage

For eligible patients, the Special Authority program provides significant benefits:

• Access to expensive medications that might otherwise be unaffordable
• Financial protection with reduced pharmacy costs
• Coordinated care that ensures appropriate medication use
• Coverage that travels with you throughout BC
• Potential for 100% coverage for those with low incomes under Plan C

Tips for Successful Applications

To increase the likelihood of a successful Special Authority request:

• Ensure all required medical documentation is included with the initial application
• Use the most current form available on the PharmaCare website
• Include relevant laboratory results and clinical notes
• Document any previous treatments that were unsuccessful
• Consider having a specialist physician submit the application if required by the criteria

Resources for Patients

If you need more information about the Special Authority program, several resources are available:

• BC PharmaCare website: Official information about all PharmaCare programs and formularies
• HealthLink BC: Call 8-1-1 to speak with a health service navigator
• Your pharmacist: Often knowledgeable about Special Authority requirements
• Patient advocacy groups: Many disease-specific organizations provide guidance on accessing treatments

Frequently Asked Questions

How long does Special Authority coverage last?

Most Special Authority approvals are valid for one year, though some may be valid for longer or require periodic renewal. Check your approval letter for the specific duration of your coverage.

Can I appeal a denied Special Authority request?

Yes, if your request is denied, you have the right to request a reconsideration. Your doctor can submit additional information or request that a PharmaCare physician review your case.

Do I need to pay for my medication while waiting for Special Authority approval?

In most cases, yes. Unless you have special emergency coverage approved, you would need to pay the full price of the medication at the pharmacy. If approved afterward, you may be eligible for reimbursement.

Can Special Authority be transferred when I change doctors or pharmacies?

Yes, your Special Authority approval is attached to your Personal Health Number (PHN), not to a specific doctor or pharmacy.

Contacting BC PharmaCare

If you have questions about Special Authority that cannot be answered by your healthcare provider or pharmacist, you can contact PharmaCare directly:

• Phone: 604-683-7151 (Lower Mainland) or 1-800-663-7100 (elsewhere in BC)
• Email: pharmanet@gov.bc.ca
• Mail: PharmaCare, PO Box 9638 Station Prov Govt, Victoria, BC V8W 9V2

The BC PharmaCare Special Authority program plays a vital role in ensuring equitable access to necessary medications for British Columbia residents. By understanding how the program works and working closely with your healthcare providers, you can navigate the process effectively and potentially access medications that would otherwise be financially out of reach.