IFH prior approval
In extenuating circumstances, a provider can apply for prior approval of a service or medication not routinely covered by the patient's IFH health plan. Forms available on the Medavie Blue Cross website here [1]. Bridge Clinic-specific form here [2].
Plan C Pharmacare Plan for recipients of BC Income Assistance
Refugee claimants are generally eligible to apply for BC Income Assistance. Sometimes the Ministry of Social Development will then provide the successful applicant with Plan C Pharmacare [3], which covers many medications.
No-Charge Psychiatric Medication Plan (Plan G)
Vancouver/Richmond Plan G office
This Pharmacare plan is available to individuals of any age with a mental health diagnosis who demonstrate clinical and financial needs. The program provides coverage of certain psychiatric medications. More information on the Ministry of Health's website here [4].
Registration [5] is required. The application must be completed and signed by the patient and the doctor. The patient must sign that the cost of the psychiatric medication is a significant barrier to his or her taking the medication and that they have no other financial coverage (ie, no IFH, no extended benefits, etc.). Their income must be below $30,000 family adjusted net income.
In Section A of the application there are boxes to insert the patient’s PHN. This does not mean that the patient has to have MSP. Those who have lapsed MSP and those who do not have MSP because of ineligibility can also apply. If the patient has ever had a prescription filled they will have a PHN assigned to them whether or not they have coverage. If you do not know the PHN of the patient or they don’t have MSP call the Plan G office (number above) and talk to the person there. They will arrange to have a PHN assigned to the patient if they confirm that there is no PHN for that patient.
Section B is to be signed by the physician and there are three tick boxes of which one is chosen, usually ‘C’: there may be serious consequences like unemployment, child neglect, etc if the patient does not receive the medication.
The drugs eligible for coverage under the No-Charge Psychiatric Medical Program are listed in the Plan G Formulary [6] by both brand and generic name. Drugs in the formulary identified as “Limited Coverage” require prior Special Authority Approval from PharmaCare. For these medications the physician must submit a Special Authority Request to PharmaCare. Special Authority applications are available on the website above.
To apply for Plan G:
Give the patient the prescription, complete Plan G application with them, fax it immediately, and tell the patient that it should be available within one business day. Usually the Plan G office posts approval for Plan G on Pharmanet within one business day. The patient is not informed directly. The physician is notified in the form of a fax confirming approval and the length of time of the coverage, usually one year. The physician can notify the patient at the next visit of the length of the Plan G coverage. In the meantime instruct the patient to go to the pharmacy (or call ahead) the next day and present the prescription (write Plan G on the Rx) and ask if they are on Plan G yet. If there is a delay ask the patient to contact you so you can then call the Plan G office and see if there are any problems. If the patient does not have a PHN it is best to call the office before faxing the application, to discuss the matter with someone there.
Pharmaceutical patient assistance programs
Pharmaceutical companies often provide assistance programs for patients of limited means. For example, from AstraZeneca Canada [7]:
In Canada, our AstraZeneca Patient Assistance Program is available to patients in financial need who meet the eligibility requirements. Patients interested in this program should have their doctor's office contact our Medical Information Department at 1-800-668-6000 and ask for a Drug Request Form.