The FSDP will operate following rules established by the BC Pharmacare Program for the Reference Based Pricing (RBP) & the Low Cost Alternative (LCA) programs for the listed medications. See Pharmacare website at:

www.healthservices.gov.bc.ca/pharme/sa/criteria/restricted/restrictedtable.html.

However, only a small selection of Pharmacare Benefit Drugs is included in the FSDP Benefit Drug List. Drugs included in the FSDP Drug Benefit List are not necessarily benefits for all patients for all indications; specific conditions may apply. Approval for payment is at the complete discretion of the FSDP. The decision by FSDP is final.

Other medications not listed will be considered only if they are for supportive care for cancer treatment. If approved by FSDP, in most instances, coverage will be to the maximum of an equivalent treatment that is included on the benefit list.

• Patients MUST be registered with the Fair Pharmacare Program to qualify for coverage.
• Patients who qualify for the Palliative Care Benefits Program through Pharmacare do not qualify for FSDP coverage even if the qualification periods overlap.
• Medications requiring Pharmacare Special Authority to qualify for application to the patient's Fair Pharmacare Deductible Limits will NOT be covered unless pre-approved by FSDP and Special Authority has been approved by Pharmacare.
• Non-prescription items require a physician's prescription/note before they will be provided as benefits of the FSDP.
• FSDP does NOT cover the cost of ostomy supplies, needles & syringes, aerochambers or other medication administration devices.
• FSDP does NOT cover smoking cessation medications.

Pharmacy dispensing fees are covered to the same maximum allowable amount covered by BC Pharmacare. Dispensing fees in excess of the Pharmacare maximum are the responsibility of the patient.

ACETAMINOPHEN

Analgesic

Tylenol, Panadol

ACETAMINOPHEN + CODEINE

Analgesic

Tylenol #1,2,3,4, Lenoltec, Emtec, Empracet

ACETAMINOPHEN + OXYCODONE

Analgesic

Percocet, Oxycocet, Endocet, Oxy -12

ACYCLOVIR

Anti-viral

Zovirax, Avirax

ALLOPURINOL

Lowers uric acid levels associated with treatment of cancer

Zyloprim

AMITRIPTYLINE

Depression, Neuropathic pain

Elavil, Novo-Triptyn

AMOXICILLIN/CLAVULANATE

Antibiotic

Amoxil

Up to the cost of oral solid dosage forms only. Patient to pay additional cost of oral liquids. Maximum benefit 14 day course.

ASPIRIN

Analgesic

Aspirin, ASA, Entrophen

Solid, oral dosage forms or suppositories only. Chewable gum formulations not approved.

Does not include low dose (81mg) aspirin products or doses intended for arthritis management.

ASPIRIN + CODEINE

Analgesic

Frosst 292, MEP 282

ASPIRIN + OXYCODONE

Analgesic

Percodan, Oxycodan

AZITHROMYCIN

Antibiotic

Zithromax

Oral tablets or suspension

Pharmacare Low Cost Alternative Brand required.

BENZYDAMINE

Mouth/throat sores due to mucositis

Tantum

BETAMETHASONE

Steroid - topical antiinflammatory

Betnovate, Celestoderm, Diprolene

BISACODYL

Laxative

Dulcolax

CARBAMAZEPINE

Anti-convulsant, neuropathic pain

Tegretol

Not for pre-existing seizures.

CEPHALEXIN

Anti-biotic

Keflex

CHLORPROMAZINE

Anti-nauseant/anti-emetic

Largactil

CIMETIDINE

Anti-ulcer - reduces acid secretion

Tagamet

Oral tablets or liquid formulations up to maximum of 1200mg daily. Not a benefit for pre-existing gastrointestinal conditions.

CIPROFLOXACIN

Anti-biotic

Cipro (Regular release products only.)

CITALOPRAM

Anti-depressant

Celexa

Not for pre-existing conditions. Must be related to cancer diagnosis/treatment. Pharmacare Low Cost Alternative Brand required.

CLARITHROMYCIN

Anti-biotic

Up to the cost of oral solid dosage forms only. Patient to pay additional cost of oral liquids. Maximum benefit 14 day course.

CLINDAMYCIN

Anti-biotic

Dalacin

CLOTRIMAZOLE

Anti-fungal

Canesten, Clotrimaderm

CLOXACILLIN

Anti-biotic

Orbenin

CODEINE

Analgesic

Codeine

COTRIMOXAZOLE

Anti-biotic

Septra, Bactrim, Trimel, Sulfatrim

DEXAMETHASONE

Steroid-antiinflammatory, antinausea

Decadron

DEXTROMETHORPHAN

Antitussive-related to lung cancer only

Novahistex DM, Robitussin DM

Lung Cancer only.

DIAZEPAM

Sedative/hynoptic

Valium

DICLOFENAC

Analgesic/Anti-inflammatory

Voltaren

Not for pre-existing conditions. Must be related to cancer management. Pharmacare Low Cost Alternative brand required.

DIMENHYDRINATE

Anti-nauseant/anti-emetic

Gravol, Travel tabs

DIPHENHYDRAMINE

Anti-histamine - allergic reactions

Benadryl, Allernix

DIPHENOXYLATE

Anti-diarrheal

Lomotil

DIVALPROEX SODIUM

Neuropathic pain

Epival

Not for pre-existing seizures.

DOCUSATE SODIUM

Stool softener

Colace

DOMPERIDONE

Anti-nauseant/anti-emetic

Motilium

ERYTHROMYCIN

Anti-biotic

Erythromid

FENTANYL

Analgesic

Duragesic

FERROUS GLUCONATE

FERROUS SULFATE

Iron supplement

Lowest cost generic brands only.

Not for pre-existing anemias prior to cancer treatments

FLUCONAZOLE

Anti-fungal

Up to the cost of oral solid dosage forms only. Patient to pay additional cost of oral liquids. Maximum benefit 10 day course.

FUROSEMIDE

Diuretic

Lasix

Not for pre-existing condition.

GABAPENTIN

Anti-convulsant, neuropathic pain

Neurontin

Not for pre-existing seizures.

GLYCERIN

Laxative - rectal only

Glycerin

HALOPERIDOL

Anti-psychotic/ anti-nauseant

Haldol

Not for pre-existing conditions. For use as adjuvant for nausea management. Pharmacare Low Cost Alternative Brand required.

HEMORRHOIDAL CREAMS & OINTMENTS

Single-entity or combination products permitted such as:

Protesedyl, Proctomyxin, Anusol, Anusol HC, etc.

Hemorrhoids related to cancer treatments.

Not permitted for pre-existing conditions. Must be related to cancer diagnosis/treatment.

Maximum of approximately 30-days supply at a time.

Limited to one ointment or cream at a time and every 30 days. Multiple products at one time will not be covered.

For compounded products please contact the FSDP Claim line.

Pharmacare Low Cost Alternative Brand or lowest cost generic over-the-counter products required.

HYDROCODONE

Antitussive -related to lung cancer only

Tussionex, Novahistex DH, Caldomine-DH

HYDROCORTISONE

Steroid - topical antiinflammatory

Cream and Ointment

Enemas and foam products for rectal administration not included.

HYDROMORPHONE

Analgesic

Dilaudid, Hydromorph Contin

HYDROXYZINE

Anti-histamine - allergic reactions

Atarax

IBUPROFEN

Non-steroidal - antiinflammatory

Motrin, Advil

KETOCONAZOLE

Anti-fungal

Nizoral

LACTULOSE

Laxative

Lactulose, Laxilose

LEVOFLOXACIN

Anti-biotic

Up to the cost of oral solid dosage forms only. Patient to pay additional cost of oral liquids. Maximum benefit 7 day course.

LIDOCAINE VISCOUS 2%

Mouth sores, oral stomatitis

Xylocaine

Pharmacare Low Cost Alternative Brand required.

LOPERAMIDE

Anti-diarrhea

Imodium

LORAZEPAM

Sedative/Hynoptic, antinausea

Ativan

MEPERIDINE

Analgesic

Demerol

METHADONE

Analgesic

Methadone

See BC Pharmacare website for list of DIN numbers covered without Special Authority for Fair Pharmacare before dispensing any methadone product. Note that methadone tablets are only covered under the Pharmacare Palliative Benefits Program and therefore are not covered under the Financial Support Drug Program. Methadone is covered for cancer pain management only. It is not covered for treatment of any pre-existing substance abuse conditions. Maximum dispensing quantity permitted limited to 35 days.

METOCLOPRAMIDE

Anti-nauseant/anti-emetic

Maxeran, Reglan

METRONIDAZOLE

Anti-biotic

Flagyl

Compounded liquid up to a maximum benefit 10 day course and total maximum cost (including compounding and dispensing fees) $30.00.

MORPHINE

Analgesic

M-Eslon, Statex, MOS, MS-IR, Morphitec (Note - MS Contin NOT covered)

Mouthwash/Mouth rinse – compounded (other than Pink Lady)

For mouth sores/mucositis only.

FVCC mouthwash

Maximum $30.00 including dispensing & compound fees.

Mouthwash/Mouth rinse – Pink Lady

For mouth sores/mucositis only.

Pink Lady

MOXIFLOXACIN

Anti-biotic

Up to the cost of oral solid dosage forms only. Patient to pay additional cost of oral liquids. Maximum benefit 10 day course.

MUPIROCIN

Topical antibiotic cream or ointment

Bactroban

Pharmacare Low Cost Alternative Brand required

MISOPROSTIL

Gastro-intestinal protectant for use with non-steroidal anti-inflammatory drugs

Cytotec

Not for pre-existing conditions. Pharmacare Low Cost Alternative Brand required.

NABILONE

Anti-nauseant/anti-emetic

Cesamet

When prescribed by a cancer doctor

NAPROXEN

Non-steroidal antiinflammatory

Naprosyn

NORFLOXACIN

Anti-biotic

Up to the cost of oral solid dosage forms only. Patient to pay additional cost of oral liquids. Maximum benefit 10 day course.

NYSTATIN

Anti-fungal

Nilstat, Mycostatin, Nyaderm

ONDANSETRON

Anti-nauseant/anti-emetic

Zofran

Availability to be increased to now include patients registered with the Pharmacare Palliative Care Benefits Program as long as patients are receiving palliative chemotherapy or radiation therapy only.

OXYCODONE regular and extended release

Analgesic

Endodan, Percocet, Oxy-IR, Supeudol

Extended release formulations included as long as they are covered by BC Pharmacare.
Update – March 1, 2012 – per the recent newsletter, OxyContin^R products are being delisted by BC Pharmacare.The Financial Support Drug Program (FSDP) will continue to cover OxyContin^R for existing patients with Pharmacare Special Authority already in place until the end of the patient’s current FSDP benefit year or the Special Authority ends or until February 28, 2013, whichever comes first. Patients whose physicians are able to re-negotiate ongoing Special Authority coverage for OxyContin^R through BC Pharmacare may continue to receive this as a benefit until the end of their FSDP benefit year or until the new Special Authority expires, whichever comes first.
The FSDP will not be offering coverage for the new product OxyNEO^R as it is not currently a benefit item through BC Pharmacare. Coverage for immediate or regular release oxycodone products through the FSDP will continue. Note that the FSDP does not provide coverage for any oxycodone products for palliative patients on PharmaCare Plan P.

OXAZEPAM

Sedative/Hynoptic

Serax

PHENAZOPYRIDINE

Urinary tract analgesic

Pyridium

PENICILLIN V

Anti-biotic

PHENYTOIN

Anti-convulsant - related to brain cancer only, neuropathic pain

Dilantin

Not for pre-existing seizures.

PREDNISONE

Steroid - antiinflammatory

Deltasone

PROCHLORPERAZINE

Anti-nauseant/anti-emetic

Stemetil

Radiation Reaction Skin Cream/Ointment – compounded

For Radiation skin reactions only.

Variety of combinations. Max cost $30.00 including compounding & dispensing fees.

When prescribed by a cancer doctor

RANITIDINE

Anti-ulcer - reduces acid secretion

Zantac, other generic brands. Lowest cost alternative brand required

Up to maximum dose of 150 mg twice daily. Not a benefit for pre-existing gastro-intestinal conditions.

SALBUTAMOL

Bronchial dilation-lung cancer

Ventolin

Lung Cancer only.

SCOPOLAMINE/HYOSCINE BUTYLBROMIDE

Anti-spasmodic for urinary frequency & diarrhea-oral or rectal

Buspar, Buscopan

SENNOSIDES

Laxative

Senna, Senokot, Glysennid

SILVER SULFADIAZINE

Topical antibiotic

Cream, Dermazin

VALACYCLOVIR

Anti-viral

Up to the cost of oral solid dosage forms only. Patient to pay additional cost of oral liquids. Maximum benefit 10 day course.

VALPROIC ACID

Anti-convulsant, neuropathic pain

Depakene

Not for pre-existing seizures.

WARFARIN

Anti-coagulant

Coumadin

Not for pre-existing conditions.