What the HLTH 5856 is for
Finerenone is a limited coverage drug in BC. The form asks PharmaCare to cover it as an add-on to standard care to reduce the risk of kidney failure, sustained eGFR decline and cardiovascular events in adults with both type 2 diabetes and chronic kidney disease. Standard care here means maximally tolerated doses of an ACE inhibitor or ARB together with an SGLT2 inhibitor, unless the SGLT2 inhibitor is contraindicated or not tolerated.
PharmaCare checks every criterion in Section 4. Coverage starts when the approval is entered in PharmaNet and isn’t retroactive.
Who completes it
The prescriber completes and signs it. The prescriber must have experience in diagnosing and managing CKD with type 2 diabetes, or prescribe in consultation with a nephrologist. The patient has no part to fill in.
How to fill in the form
Section 1, Prescriber’s 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
The form lists finerenone 10 mg and 20 mg tablets. Prescribe the 20 mg dose as one 20 mg tablet, because two 10 mg tablets aren’t covered.
Section 4, Criteria for indefinite coverage
Tick each criterion. The patient must have type 2 diabetes and CKD with an eGFR of at least 25 mL/min/1.73 m², and albuminuria of at least 3 mg/mmol (or 30 mg/g). Take both from recent labs and keep the urine albumin-to-creatinine ratio on file.
Confirm maximally tolerated doses of an ACE inhibitor or ARB and of an SGLT2 inhibitor. If the patient isn’t on an SGLT2 inhibitor, write the intolerance or contraindication on the line provided.
Then confirm the two exclusions don’t apply: no chronic heart failure of NYHA class II to IV, and no other mineralocorticoid receptor antagonist. A patient on spironolactone needs a plan to stop it before finerenone. The last box confirms prescriber experience or nephrology consultation.
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
- eGFR below 25 or albuminuria below 3 mg/mmol.
- No SGLT2 inhibitor and no intolerance or contraindication given.
- RAS blockade below the maximally tolerated dose.
- Heart failure of NYHA class II to IV in the record.
- Concurrent spironolactone or eplerenone.
Submitting and who pays
Submit through PharmaCare’s SA eForms, or fax the PDF to 1-800-609-4884 or mail it to PharmaCare, Box 9652 Stn Prov Govt, Victoria, BC V8W 9P4. PharmaCare may check PharmaNet records to confirm the ACE inhibitor or ARB and SGLT2 inhibitor fills.
PharmaCare doesn’t pay for the form. The drug is covered under the patient’s plan rules, including any Fair PharmaCare deductible.