Blue RX Limited Benefit Drugs
Certain higher cost or second line drugs require pre-approval before they can be covered under your Blue RX® plan. Depending on the drug, approval may be required either by Pacific Blue Cross or by the BC PharmaCare Special Authority program.
Drugs requiring PBC Prior Approval: forms can be found by selecting the appropriate tab below. Click on the hyperlink beside the drug name to download the appropriate form. Please have your doctor complete the appropriate form and send it to Pacific Blue Cross to determine eligibility.
NOTE: For some drugs, if the prescribing doctor is a specialist in that therapeutic area (e.g. respirologists for asthma), they don’t have to fill out the form. However, you will need to complete the top portion of the form. Be sure to follow the instructions on the form carefully.
Drugs that require BC PharmaCare Approval: A complete list of drugs requiring BC PharmaCare Special Authority can be found by selecting the appropriate tab below and opening the pdf list provided under that tab.
- Follow the link to the BC PharmaCare website to locate the appropriate forms for downloading.
- Have your doctor complete the form on your behalf and submit to BC PharmaCare.
- If approved by BC PharmaCare, you can visit any pharmacy offering real-time Special Authority confirmation to have your prescription claim reimbursed by direct pay. You do not need to send your approval to Pacific Blue Cross for confirmation.
If your pharmacy does not offer real-time Special Authority confirmation, please mail, fax or deliver your confirmation letter to us so we can confirm your coverage before you visit the pharmacy.
Go to pharmacycompass.ca to find your nearest pharmacy offering real-time Special Authority confirmation.
For more information, here's what you need to know about the Blue RX plan
Drugs Requiring BC PharmaCare Approval
Certain drugs require that your doctor apply to BC PharmaCare and be approved for Special Authority before they are eligible with your plan.
If your drug has not been approved
If for some reason coverage of your prescription has not been approved through Blue RX Prior Approval or through the BC PharmaCare Special Authority Program, use the Drug Eligibility Inquiry Form to trigger an inquiry about drug coverage eligibility under your plan.
Drug coverage can vary from plan to plan. Our Pharmacy Services division will review your coverage and the reasons behind denial of your claim to determine if there is any way the drug can be covered under the provisions of your Extended Health Care plan