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BC PharmaCare Semaglutide for Diabetes SA (HLTH 5826)

Prescribers use this one-page BC PharmaCare form to request Special Authority coverage of semaglutide injection for type 2 diabetes. Coverage is indefinite when the patient has type 2 diabetes and inadequate glycemic control on a maximally tolerated dose of metformin, with space to explain why metformin trials were avoided. Semaglutide and DPP-4 inhibitor coverage cannot run together.

Who completes it

The prescriber completes the prescriber and patient sections, confirms the section 4 criteria and signs; there is no patient signature.

Submitting and payment

How to submit it
Submit through PharmaCare's Special Authority eForms, or fax or mail the PDF to PharmaCare as printed in its header; faxed requests currently take about five weeks.

Good to know

  • If semaglutide is approved, existing coverage for a DPP-4 inhibitor (linagliptin or saxagliptin) is discontinued, and approval of a DPP-4 inhibitor ends semaglutide coverage.
  • Where metformin was not tried, the form asks for the rationale for avoiding metformin trials.
  • Section 4 sets the criteria for indefinite coverage, and the form has no separate renewal section.
  • PharmaCare may request additional documentation, and reimbursement still follows the patient's PharmaCare plan rules, including any annual deductible.

Get the official form

Download the current version from the source each time; forms change without notice.

Semaglutide for Diabetes (Special Authority request)

Official pagePDF

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Frequently asked questions

Does BC PharmaCare cover semaglutide for type 2 diabetes?

Yes, through Special Authority. The criteria on HLTH 5826 are a diagnosis of type 2 diabetes and inadequate glycemic control on a maximally tolerated dose of metformin. Approved coverage is indefinite, but actual reimbursement still follows the patient's PharmaCare plan rules, including any annual deductible.

Can semaglutide and a DPP-4 inhibitor be covered at the same time?

No. The form states coverage for a DPP-4 inhibitor, such as linagliptin or saxagliptin, is not provided alongside semaglutide. Approving semaglutide discontinues any DPP-4 inhibitor coverage, and approving a DPP-4 inhibitor discontinues semaglutide coverage.

How do I submit the semaglutide Special Authority?

PharmaCare recommends Special Authority eForms, which are easier to submit and return decisions faster. The PDF can also be faxed or mailed to PharmaCare; faxed requests currently take about five weeks, and forms missing information are returned for completion.