British Columbians living with heart failure, liver disease or pulmonary arterial hypertension now have more treatment options available to them to better manage their condition.
Three limited coverage drugs were added to the PharmaCare Special Authority program as of Oct. 30, 2018:
- ivabradine (Lancora) for the treatment of heart failure
- obeticholic acid (Ocaliva) for the treatment of liver disease
- selexipag (Uptravi) for the treatment of pulmonary arterial hypertension — also known as high blood pressure in the arteries of the lungs.
It is anticipated that approximately 950 British Columbians will benefit from this decision over the next three years. The estimated overall cost to add these drugs is approximately $21.7 million over the same timeframe.
Patients requiring limited coverage drugs typically do not respond to first-line treatment or more affordable options. Therefore, not all patients with a condition will be eligible for — or need — a limited coverage drug, which is why coverage is evaluated on a case-by-case basis.
To receive coverage for limited coverage drugs, a patient’s health-care provider must submit a special authority form to PharmaCare. Requests are then reviewed to determine if the limited coverage drug is the best option for the patient.
PharmaCare’s Special Authority program grants full coverage for drugs, medical supplies or medical devices that otherwise would not be covered or only partially covered. Coverage is provided for patients with specific medical conditions and is subject to a patient’s PharmaCare plan, including any annual deductible.
Under B.C.’s drug review process, drugs undergo a rigorous review at both the national and provincial level. The national Common Drug Review evaluates a drug based on its therapeutic value and cost effectiveness, and makes recommendations to provincial drug plans. Then B.C.’s Drug Benefit Council takes that recommendation into consideration when reviewing the drug and makes its own recommendation to the ministry.
B.C.’s drug review process also incorporates patient and health-care provider feedback when evaluating drugs. Eligible patients, caregivers and patient groups can provide input on drug decisions that affect them through the Your Voice platform, which is part of British Columbia’s drug review process.
In addition, beginning Jan. 1, 2019, more lower-income families will get the help they need with prescription drug costs. The Province’s $105-million investment over three years into Fair PharmaCare — the first in 15 years — will reduce or eliminate deductibles and/or family maximums for 240,000 families earning less than $45,000 a year. This means that those families dealing with chronic diseases will have improved access to the medications they need.
For more information on PharmaCare, visit: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents
To register for Fair PharmaCare, visit https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/who-we-cover/fair-pharmacare-plan/register-for-fair-pharmacare
For more information on Your Voice, visit https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/what-we-cover/drug-coverage/drug-review-process-results/your-voice
Drug coverage criteria and forms are available online at: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/prescribers/limited-coverage-drug-program