Limited Coverage Drugs—Limited Coverage drugs are not generally considered 'first line' therapies or have more cost-effective alternatives. For these drugs, PharmaCare Special Authority approval is required before the patient fills their prescription.
Reference Drug Program—Under this program, full PharmaCare coverage is provided only to the identified reference drug. Other drugs within each category are eligible for partial coverage. If a patient has a medical condition preventing use of the reference drug, Special Authority can be requested for full coverage of another drug in the category.
Low Cost Alternative Program—If several drugs have identical active ingredients, PharmaCare set a maximum price ("LCA Price") it will cover for that category of drug(s). Patients can obtain a fully covered low cost alternative or a drug that will be only partially covered. If a patient cannot take the low cost alternative(s), Special Authority can be requested for full coverage of another drug.