British Columbians living with certain chronic conditions, including multiple sclerosis, Parkinson’s disease and severe asthma, now have more treatment options available to them to better manage their condition.
Seven limited coverage drugs are now available under the PharmaCare Special Authority program:
- glatiramer acetate (Glatect) and rituximab (Rituxan) for the treatment of relapsing-remitting multiple sclerosis;
- rotigotine (Neupro) for the treatment of advanced stage Parkinson’s;
- mepolizumab (Nucala) for the treatment of severe eosinophilic asthma; and
- ezetimibe (Ezetrol) and evolocumab (Repatha) for the treatment of high cholesterol (heterozygous familial hypercholesterolemia).
Coverage ctriteria was also expanded for:
- the Parkinson’s treatments pramipexole and ropinirole;
- hepatitis B treatments tenofovir disoproxil fumarate and entecavir (Baraclude); and
- vancomycin (Vancocin) for the treatment of colitis.
Duloxetine is now also a limited coverage drug for all PharmaCare plans. Duloxetine treats neuropathic pain and was previously only available to Plan P patients. Plan P is PharmaCare's palliative-care drug plan.
It is anticipated that approximately 4,900 British Columbians will benefit from these listings and coverage expansions over the next three years. The estimated overall cost to add these drugs is roughly $11.8 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. B.C.’s Drug Benefit Council then 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, as of Jan. 1, 2019, lower income families are getting 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 – is reducing or eliminating deductibles and/or family maximums for 240,000 families earning less than $45,000 net income a year. This means that people now 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 here: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/prescribers/limited-coverage-drug-program