What the HLTH 5328 is for
Special Authority is how PharmaCare grants coverage for limited coverage drugs and some devices and supplies when the patient meets clinical criteria. Most limited coverage drugs have their own form with the criteria printed as checkboxes. HLTH 5328 is the general request for everything else, so PharmaCare has to judge it on the case you make in free text. It’s also the route for a palliative patient who needs a drug outside the Plan P formulary.
Who completes it
The prescriber completes and signs every section. Some specialists are exempt from Special Authority for certain drugs, or have a collaborative prescribing agreement, in which case coverage applies without a request.
How to fill in the request
Section 1, prescriber information
Enter your name and mailing address, phone and fax number, and your CPSBC or BCCNM licence number, not your MSP number. The form marks the fax number as critical for a timely response, and PharmaCare can’t return a decision without a fax number or mailing address. Tick Mail Confirmation if you want the reply by mail.
Section 2, patient information
Enter the patient’s family and given names, date of birth, date of application and PHN. The PHN is marked critical for processing.
Section 3, medication detail information
Name the medication and give the dose and regimen, then tick New Request or Renewal. Under indications, give the diagnosis requiring use, the therapies previously tried and the response to each, and any patient-specific contraindications to alternatives. Generic statements like “failed other treatments” are where most general requests stall. Name each drug, dose, duration and outcome.
Signature and consent
The prescriber’s signature is mandatory. By signing, you confirm you’ve told the patient that their information goes to PharmaCare to obtain Special Authority.
Common reasons it’s sent back
- A drug-specific form exists and should have been used instead.
- No prescriber fax number or mailing address, so the decision can’t be returned.
- An MSP number in place of the college licence number.
- Previous therapies listed without doses, durations or responses.
- No diagnosis, or a diagnosis that doesn’t explain why alternatives won’t work.
- A missing signature.
Submitting and who pays
Submit through Special Authority eForms, which you enrol in through OneHealthID, or fax the PDF to 1-800-609-4884. Faxed requests aren’t auto-adjudicated and take longer. PharmaCare notifies you of the decision, and patients can follow eForm requests in Health Gateway. An approval covers the cost under the patient’s own PharmaCare plan, including any deductible, so the patient may still pay part of it.