Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life.Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX: Learn how at SA eForms.BOTOX may cause serious side effects that can be life threatening. If you submit an eForm, turnaround is often quicker. The current turnaround for regular faxed SA requests is 6 - 8 weeks. Note (November 30, 2023): Urgent SA requests are usually processed within one business day. The duration of coverage depends on the drug and the condition being treated. SA coverage is valid from the date the approval is entered in a patient's record on PharmaNet. Approval must be in place before a patient fills a prescription, as coverage won’t be provided retroactively. In these cases, all efforts are made to expedite the turnaround time. SA requests may be deemed urgent for specific medications (e.g., anticoagulants, oral antifungals, antibiotics, psychiatric and chemotherapy drugs, or drugs for substance use disorder) and circumstances (e.g., hospital discharge, palliative treatment, MAiD, acute mental health conditions or life-threatening conditions). Some drugs are eligible for auto-adjudication, which returns immediate decisions. It is strongly recommended that prescribers submit requests through eForms, if applicable, as turnaround times are generally much quicker. If using a paper form, fax it to 1-80 (toll-free in B.C.). Be sure to list all the fully covered products they have tried. If you aren’t enrolled in eForms, complete the fillable PDF version: General Special Authority Request (PDF, 656KB)ĭocument your patient's clinical need for the drug. Complete a general Special Authority request in eForms.Only drugs marked P require SA approval to be covered. In column F, a P indicates a partial benefit and F indicates a full benefit. See the LCA Master Spreadsheet that lists the multiple-source drugs that PharmaCare covers.If your patient is allergic to or has an intolerance to non-therapeutic ingredients in the fully covered drugs within an LCA category, you can submit a Special Authority request for full coverage of another drug in that category (including an alternative generic version of the same drug). PharmaCare covers only those drugs that meet a set price.

Each LCA category consists of drugs with the same active ingredient(s) and the same strength. residents get the best value on multiple-source drugs. The Low Cost Alternative (LCA) Program ensures B.C. Confirmation that the patient has no other insurance that would cover any part of the drug’s cost.The anticipated outcome(s) of treatment with the requested drug (e.g., physical symptoms, quality of life/function).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.If faxing, requests must include: a General SA Request form (PDF) with Sections 1, 2 and 3 (“requested drug exemption” portion) completed AND a signed letter from the prescriber that includes: 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. Refer to Health Canada's Special Access Program Drugs - Section 6.2, PharmaCare Policy Manual. Health Canada’s Special Access Program drugs are covered in exceptional circumstances only. The online eForms option is easier and quicker than faxing, and it generally returns decisions more quickly. SA requests can be submitted online via eForms or by fax by most prescribers. Watch the short Got a Minute video about Special Authority !

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

In these cases, the drugs get PharmaCare coverage when prescribed by those specialists. In exceptional circumstances, SA coverage may be provided when patients don’t meet the criteria or for non-benefit items.įor some drugs, prescribers who have a listed specialty are automatically exempt from submitting an SA request, while for other drugs, listed specialists are invited to enter a Collaborative Prescribing Agreement (CPA) that exempts them from submitting an SA request. Coverage is approved for patients who meet the published criteria.

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