Frequently Asked Questions for Pharmacists
1. Are cholinesterase inhibitors now included in the provincial formulary?No. The results of the evaluation of cholinesterase inhibitors will inform future government policy on coverage of cholinesterase inhibitors. As part of the Alzheimer's Drug Therapy Initiative, cholinesterase inhibitors are eligible for limited coverage for the period of the evaluation only, currently anticipated at three years.
2. Which cholinesterase inhibitors are being covered under the initiative?Donepezil (Aricept™), galantamine (Reminyl™), and rivastigmine (Exelon™).
3. Is coverage going to be provided for memantine (Ebixa®)?No, the Alzheimer's Drug Therapy Initiative only provides coverage of the cholinesterase inhibitors donepezil, galantamine and rivastigmine.
4. Are there prescription quantity limits?If approved, cholinesterase inhibitors are covered for a monthly supply, up to 35-days for compliance packaging. If a larger quantity is requested, clients are responsible for purchasing the balance.
5. How long is SA approval in effect?Special Authority approval is granted in 6-month intervals.
6. What is the process for coverage of cholinesterase inhibitors under the ADTI?Coverage of cholinesterase inhibitors under the Alzheimer's Drug Therapy Initiative is being conducted through PharmaCare’s Special Authority process. Two separate forms have been developed for the initiative – initial coverage and renewal/switching coverage. Each form contains the assessment tools needed to determine if the patient qualifies to participate in the initiative. Initial coverage is granted for a 6-month period and the patient is reassessed at 6-month intervals. As long as they remain in the mild to moderate stages of Alzheimer's disease and the prescriber determines that they are responding to treatment, coverage will continue. Pharmacists can check on IVR (interactive voice response) referring to the following DIN’s, to see if a patient’s coverage has been approved.
7. Can all three cholinesterase inhibitors be tried successively?Yes. However, there is no concurrent coverage - PharmaCare only covers one cholinesterase inhibitor at a time, with the exception of providing coverage for two medications when a patient is switching from one to another. If the patient has insufficient medication to cover the transition period, PharmaCare will approve coverage of a two-week supply.
8. Is a washout period necessary when switching for lack of efficacy?The Special Authority form for renewal/switching of cholinesterase inhibitors must be submitted and approved by PharmaCare before a patient can receive coverage for a second cholinesterase inhibitor trial. If a current cholinesterase inhibitor trial is being discontinued due to lack of efficacy, a washout period is required. It may take a washout period of 2 - 7 days before side effects are resolved. If you have a client who is switching cholinesterase inhibitors, please dispense only a two-week supply of the current drug. Please refer to the Reference Guide to Prescribing Cholinesterase Inhibitors included in the Clinician Booklet for detailed dosage instructions.
** Titrate to maximum dose if tolerated and clinically indicated.
9. What warnings/precautions are considered by the prescriber when determining whether an individual should be treated with a cholinesterase inhibitor?The conditions to consider when making this determination are:
10. If a Special Authority form is submitted before the initiative is launched, what will happen to it?ADTI Special Authority forms received before the launch date will be held and processed after the official launch date.
11. What happens to patients who are prescribed a cholinesterase inhibitor but Special Authority approval is denied because they don’t meet ADTI criteria?Individuals not eligible to participate are responsible for their full prescription cost.
12. What happens if the patient was prescribed a cholinesterase inhibitor before the ADTI program started and they come in for a refill?You should advise your client to visit their physician for an assessment to determine if they are eligible to participate in the Alzheimer's Drug Therapy Initiative. If they are, it is important to let them know that coverage is effective from the date PharmaCare’s Special Authority approval is granted and is not retroactive. PharmaCare coverage under the ADTI is subject to the patient's plan, annual deductible and family maximums.
13. Will patients be eligible for coverage of cholinesterase inhibitors while travelling?Special Authority may consider coverage of cholinesterase inhibitors for patients required to travel. For consideration of such requests, please contact the Special Authority Unit directly by fax to 1 800 609-4884.
14. Are nurse practitioners eligible to prescribe cholinesterase inhibitors?Yes, if it is within their scope of practice as determined by the College of Registered Nurses of B.C.
15. Will Special Authority coverage of cholinesterase inhibitors be granted to individuals who are currently covered by the Department of Veterans Affairs?No. PDF Format Some documents on this Web site are in PDF format and require a PDF reader. If you do not have Adobe Acrobat Reader Version 7.0 or the most recent version of another PDF reader, you can download Adobe Acrobat Reader by clicking on the 'Get Acrobat Reader' icon. |
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