What the HLTH 5826 is for
Semaglutide injection is a limited coverage drug in BC. The form asks PharmaCare to cover it as part of treatment for type 2 diabetes once metformin at its maximally tolerated dose hasn’t given adequate glycemic control. PharmaCare’s criteria page adds that a trial of at least three months of metformin should be considered.
It’s a short form, but two coverage rules affect what you prescribe. PharmaCare covers up to 1 mg weekly, and only in a pen designed to deliver a 1 mg dose. It also won’t cover semaglutide and a DPP-4 inhibitor together.
Who completes it
The prescriber completes and signs it. PharmaCare lists no practitioner exemptions. The patient has no part to fill in.
How to fill in the form
Section 1, Prescriber information, and Section 2, Patient information
Enter your name, mailing address, College ID and fax number, and the patient’s PHN. PharmaCare can’t reply without a fax number or mailing address.
Section 3, Medication requested
Semaglutide injection is the only option. The note under it repeats the DPP-4 inhibitor rule: if the patient has Special Authority for linagliptin or saxagliptin, approving semaglutide ends it. Tell the patient so they don’t fill both.
Section 4, Criteria for indefinite coverage
Tick the type 2 diabetes diagnosis and inadequate control on the maximally tolerated dose of metformin. If the patient never had a metformin trial, use the rationale box to say why, for example intolerance at a low dose, a contraindication, or an eGFR below the threshold for metformin. A blank rationale with no metformin trial on record leaves PharmaCare nothing to approve.
Signature
Sign the consent statement confirming you’ve told the patient why their information goes to PharmaCare. The signature is mandatory.
Common reasons it’s sent back
- No metformin trial and an empty rationale box.
- A request for weight management rather than type 2 diabetes.
- A 2 mg weekly dose, or 1 mg given as two doses from a 0.5 mg pen, which PharmaCare doesn’t cover.
- Missing fax number, mailing address or PHN.
Submitting and who pays
Submit through PharmaCare’s SA eForms, which can approve semaglutide automatically when the criteria are met, or fax the PDF to 1-800-609-4884 or mail it to PharmaCare, Box 9652 Stn Prov Govt, Victoria, BC V8W 9P4. PharmaCare’s Special Authority page currently gives about five weeks for regular requests. Coverage starts when the approval is entered in PharmaNet and isn’t retroactive.
PharmaCare doesn’t pay for the form. The drug is covered under the patient’s plan rules, including any Fair PharmaCare deductible.