Skip Navigation LinksASIC Home > Access For Sight-Impaired Consumers > Resources From A-Z > Health > PROVINCIAL HEALTH SERVICES AUTHORITY (“PHSA”)

PROVINCIAL HEALTH SERVICES AUTHORITY (“PHSA”)

PROVINCIAL HEALTH SERVICES AUTHORITY (“PHSA”)
PROVINCIAL RETINAL DISEASES TREATMENT PROGRAM
EFFECTIVE: APRIL 1, 2013 FOR THE TREATMENT OF WET AGE-RELATED MACULAR
DEGENERATION AND NOVEMBER 1, 2013 FOR THE TREATMENT OF DIABETIC
MACULAR EDEMA AND RETINAL VEIN OCCLUSION
Background:
(a) Wet AMD
Wet age-related macular degeneration (“Wet AMD”) is a serious disease that can strike quickly
and is a leading cause of blindness among seniors. Prior to June 1, 2009, the only
pharmaceutical treatment for Wet AMD for which the Province of British Columbia Ministry of
Health (“MoH”) provided reimbursement was verteporfin (currently sold under the trade-mark
“Visudyne”) with photodynamic therapy; the reimbursement was provided through a program
administered by PHSA. As of June 1, 2009, through the reimbursement program established by
the MoH, the MoH began to provide reimbursement for Wet AMD pharmaceutical treatment with
verteporfin, ranibizumab (currently sold under the trade-mark “Lucentis”) and bevacizumab
(currently sold under the trade-mark “Avastin”) on certain terms and conditions. As of April 1,
2013, the MoH continues to provide reimbursement for these three therapies for Wet AMD.
(b) Diabetic Macular Edema and Retinal Vein Occlusion
Both diabetic macular edema (“DME”) and retinal vein occlusion (“RVO”) are also serious
conditions that cause vision loss, particularly among seniors. DME can cause a severe loss in
central vision and is the major cause of vision loss in people with diabetic retinopathy. Retinal
vein occlusion (“RVO”) can lead to glaucoma and macular edema.
Effective November 1, 2013, MoH wishes to include the reimbursement of Avastin and Lucentis
for the treatment of DME and RVO under the terms of this program.
The Provincial Retinal Diseases Treatment Program (the “Program”) described in this
document replaces all prior British Columbia Wet AMD treatment programs.
PHSA’s mandate is to ensure the planning, coordination, accessibility, quality, efficiency and
effectiveness of selected Province-wide health care programs and services, including the
development and management of expectations and funding allocations for selected health care
programs and services in the Province of British Columbia. The MoH has engaged PHSA to
continue to administer the Program.
The Program was developed by the MoH and PHSA in consultation with the representatives of
the retinal specialist group in British Columbia and, like its predecessor programs, is restricted
to those of that retinal specialist group who agree to fulfill the terms of this Program Document

in order to optimize drug utilization appropriateness, patient care, and cost control, to minimize
drug wastage, and to facilitate data collection, monitoring, measuring and reporting.
In developing the Program, the MoH and PHSA sought advice from representatives of the
Association of BC Retinal Specialists with respect to the projected number of patients in British
Columbia with each of Wet AMD, DME and RVO, anticipated disease trends and, based on the
experience of the members of the Association of BC Retinal Specialists, their opinion on the
best practices on the particular therapeutic products and frequency of retreatment for each of
Wet AMD, DME and RVO. Based on that advice, the MoH anticipates that:
.
in the fiscal year commencing April 1, 2013, there will be approximately 58,250 separate
treatments (doses) for patients with Wet AMD, representing an approximate 15% growth
over the prior fiscal years’ actual treatment numbers; and
.
for the period from November 1, 2013 to March 31, 2014 there will be approximately
12,500 separate treatments (doses) for patients with DME and RVO, combined (based
on an approximate annual volume of 30,000 separate treatments (doses) for patients
with DME and RVO, combined).

The above projections are based on an analysis of historical treatment activity across the
Province. The Retinal Specialists have advised MoH to expect going forward a decline in the
rate of growth of treatments for Wet AMD because growth in new Wet AMD patients as a result
of population aging are expected to be offset somewhat by careful management of the duration
and frequency of treatments administered to those Wet AMD patients.
On a Province-wide basis in fiscal 2013-2014, based on current medical practice in treating
each of those conditions, the Retinal Specialists advised MoH that they expect that, as between
Avastin and Lucentis:
.
Avastin would be used 90% of the time and Lucentis used 10% of the time in treating
Wet AMD;
.
Avastin would be used 65% of the time and Lucentis used 35% of the time in treating
DME and RVO; and

Overall for all three indications (Wet AMD, DME and RVO), Avastin would be used
approximately 85% of the time and Lucentis used approximately 15% of the time.
 

TERMS OF THE PROGRAM APPLICABLE TO ALL LICENSED OPHTHALMOLOGISTS
WITH RETINAL DISEASE FELLOWSHIPS
This Program Document applies to all Program Registrants who wish to make any claim for
reimbursement under, or participate in any way in, the Program and Program Budget.
1. DEFINITIONS:
In addition to the defined terms set out elsewhere in this Program Document, the following
terms will have the following meanings:
(a) “Angiography” means fluorescein angiography;
(b) “Annual Individual Program Management Fee Available Amount” or “Annual
IMFAA” means the maximum amount of all Program Management Fees payable to each
single Program Registrant, which is determined by dividing the Program Management
Fee Global Available Amount by the number of Program Registrants participating in the
Program in that Fiscal Year (prorated for any Program Registrant participating for only a
partial Fiscal Year), as adjusted pursuant to Sections 24 to 25, inclusive, except that in
no event will the Annual Individual Program Management Fee Available Amount or
Annual IMFAA exceed for each individual Program Registrant an amount which is equal
to 2,000 treatments of Eligible Patients multiplied by the amount of the Program
Management Fee (or $250,000);
(c) “Approved Pharmacy” has the meaning given to it in Section 27;
(d) “Avastin” or “Bevacizumab” has the meaning given to it in Section 3(a) (2);
(e) “Committee” has the meaning given to it in Section 22;
(f) “Conflict of Interest Policy” has the meaning given to it in Section 28;
(g) “Database” means the database established pursuant to Section 9;
(h) “Database Consent” has the meaning given to it in Section 10;
(i) “Database Guidelines” means those criteria, purposes and guidelines for the Database
provided by PHSA to the Program Registrants from time-to-time;
(j) “DME” means diabetic macular edema;
(k) “Effective Date” means April 1, 2013 in respect of the application of the Program to Wet
AMD and November 1, 2013 in respect of the application of the Program to DME and
RVO;
(l) “Eligible Drug Costs” has the meaning given to it in Section 11;
(m) “Eligible Patient” means a patient who:

(1) is a resident of British Columbia enrolled as a beneficiary in the Medical Services
Plan;
(2) has been diagnosed with Wet AMD, DME or RVO (except that no Eligible Patient
diagnosed with DME or RVO will be considered eligible under the Program until
November 1, 2013); and
(3) meets the criteria for treatment as set out in the Treatment Guidelines;
(n) “Fiscal Year” means a 12 month period commencing on April 1 of any year and ending
on March 31 of the following year;
(o) “Health Authority” means a regional health board designated under Section 4(1) of the
Health Authorities Act (British Columbia);
(p) “Licensed Ophthalmologist with Retinal Disease Fellowship” means a physician
who has been licensed as an ophthalmologist by the College of Physicians and
Surgeons for the Province of British Columbia AND has successfully completed an
approved Retinal Disease Fellowship of at least 1 year duration. Where PHSA
determines it is appropriate, PHSA may consult with the Retinal Specialist Group to
determine whether the training of a physician meets the foregoing requirements;
(q) “Locum” has the meaning given to it in Section 7;
(r) “Lucentis” or “Ranibizumab” has the meaning given to it in Section 3(a) (1);
(s) “MoH” means the Ministry of Health for the Province of British Columbia;
(t) “OCT” means optical coherence tomography;
(u) “Permitted Cost Increase” has the meaning given to it in Section 24;
(v) “PHSA” means the Provincial Health Services Authority;
(w) “Program” means the the Provincial Retinal Diseases Treatment Program as described
in the background section to this Program Document;
(x) “Program Budget” has the meaning given to it in Section 2;
(y) “Program Document” means this document as modified from time-to-time by PHSA
(subject to any required review and approval by the MoH) and all Appendices to this
program document;
(z) “Program Management Fee” means $125 per single treatment (dosing) of an Eligible
Patient with Avastin, Lucentis or Verteporfin/PDT, subject to adjustment under Sections
15 to 17, inclusive, and Section 24. Notwithstanding anything else to the contrary in this
Program Document, no Program Management Fee will be payable in respect of
treatments administered prior to November 1, 2013 with respect to Eligible Patients
being treated for DME or RVO;

(aa) “Program Management Fee Global Available Amount” in a Fiscal Year is the amount
determined by PHSA which equals the difference between the Program Budget for that
Fiscal Year and the total amount of all Eligible Drug Costs paid or payable under the
Program (irrespective of to whom the Eligible Drug Costs were paid) in respect of the
same Fiscal Year;
(bb) “Program Registrant” means a Licensed Ophthalmologist with Retinal Disease
Fellowship that delivers the signed Acknowledgement to PHSA in the form set out in
Appendix C and who:
(1) obtains and maintains at all times and to the satisfaction of the MoH or PHSA
privileges from the Health Authority having jurisdiction in the region in which that
Program Registrant treats an Eligible Patient (and it is acknowledged by any
potential Program Registrant that a determination by a Health Authority whether
or not to grant such privileges may take into account access to care needs as
determined by that Health Authority); and
(2) complies with all terms and conditions attached to such privileges granted to the
Program Registrant, as such terms and conditions are specified by the Health
Authority granting such privileges;
(cc) “Quarterly Individual Program Management Fee Available Amount” or “Quarterly
IMFAA” means the amount determined by dividing the Annual IMFAA for the same Fiscal
Year by four (4), as adjusted pursuant to Sections 24 to 25, inclusive, except that in no
event will the Quarterly Individual Program Management Fee Available Amount or
Quarterly IMFAA exceed for each individual Program Registrant an amount which is
equal to 500 treatments of Eligible Patients multiplied by the amount of the Program
Management Fee;
(dd) “Quarterly Reimbursement Period” means each of the following periods in any Fiscal
Year:
(1) April 1 to June 24;
(2) June 25 to September 16;
(3) September 17 to December 9; and
(4) December 10 to March 31;
 
as may be adjusted by PHSA from time-to-time;
(ee) “Retinal Specialist Group” means all Licensed Ophthalmologists with Retinal Disease
Fellowships practicing in the Province of British Columbia who are Program Registrants,
as represented by Dr. Derek Godinho on behalf of the Association of BC Retinal
Specialists;
(ff) “RVO” means retinal vein occlusion;

(gg) “Supply Chain Procedures” has the meaning given to it in Section 27;
(hh) “Treatment Guidelines” means the treatment guidelines developed and established by
the group representing the Licensed Ophthalmologists with Retinal Disease Fellowships
and provided to the MoH and PHSA;
(ii) “Verteporfin/PDT” has the meaning given to it in Section 3(a) (3); and
(jj) “Wet AMD” means the Wet form of Age-Related Macular Degeneration.
 
2. PROGRAM BUDGET:
The MoH has made available to PHSA for the operation of the Program a maximum of $15.0
Million for the period from April 1, 2013 to March 31, 2014. If MoH elects in its sole discretion to
renew the Program pursuant to Section 5, the maximum amount of funding for any continuation
of the Program will be in such amounts as may be made available to PHSA from MoH
specifically for the applicable Fiscal Year of the Program. Any funds made available by the
MoH to PHSA for the Program in the applicable Fiscal Year will be referred to in this Program
Document as the “Program Budget”.
The Program Budget, and thus the continued operation of the Program and any subsequent or
replacement programs, is at all times subject to the MoH having provided funds to PHSA for
such purposes for the Fiscal Year in which such funds are required. In addition to its rights
generally to modify or terminate the Program and/or the Program Document, the PHSA
reserves the right to make any changes to the Program or to terminate the Program entirely if
the MoH, or equivalent funding bodies, increases or decreases the funding allocation to PHSA
for the Program or the amount of the Program Budget for a Fiscal Year has been exhausted
prior to the end of the applicable Fiscal Year.
3. PRESCRIPTION DRUG THERAPIES COVERED BY THE PROGRAM:
(a) For Wet AMD (as of April 1, 2013):
(1) Ranibizumab (currently sold under the trade-mark “Lucentis”);
(2) Bevacizumab (currently sold under the trade-mark “Avastin”); and
(3) Verteporfin for Injection (currently sold under the trade-mark “Visudyne”) with
photodynamic therapy (“Verteporfin/PDT”); and
(b) For DME and RVO (as of November 1, 2013):
(1) Ranibizumab (currently sold under the trade-mark “Lucentis”); and
(2) Bevacizumab (currently sold under the trade-mark “Avastin”).

4. PROGRAM GOALS:
The goals of the Program, as established by the MoH, are to:
(a) provide publicly-funded reasonable access to treatment for Wet AMD and, as of
November 1, 2013, for DME and RVO, in each case to Eligible Patients in each Health
Authority, as provided below;
(b) provide mechanisms to ensure that the costs of the Program do not exceed the amount
of the Program Budget; and
(c) establish and maintain a database of information on each of the drug therapies
reimbursed under the Program for the purposes of research, planning and management
of the Program and for such other purposes as described in the Database Consent.
5. TERM AND TERMINATION OF THE PROGRAM:
The Program will be in effect from April 1, 2013 in respect of Wet AMD and November 1, 2013
in respect of DME and RVO and will continue until March 31, 2014 but is subject to renewal for
one or more successive Fiscal Years at the sole discretion of MoH. If renewed, notice of any
such renewal will be provided to all Program Registrants by the MoH or PHSA and is subject to
any changes to the Program directed by MoH or PHSA in accordance with this Program
Document. The Program may also be terminated at any time by PHSA or at the direction of
MoH.
Subject to the direction of MoH and consistent with the annual budget cycle for each Fiscal
Year, PHSA intends to consult with the Retinal Specialist Group and the Health Authorities
regarding the possibility of the renewal of the Program beyond the then current Fiscal Year and
will communicate to the MoH the anticipated financial and other requirements reasonably
necessary to do so. Where reasonably practicable, PHSA or MoH will consult with the Health
Authorities and the Retinal Specialist Group prior to any planned early termination or renewal of
the Program.
6. TREATMENT GUIDELINES:
After review and discussion among the Program Registrants, they or representatives from
among the Program Registrants will from time to time independently develop and recommend
Treatment Guidelines to assist Program Registrants in making appropriate treatment decisions
with respect to their Eligible Patients. If the Treatment Guidelines are so developed and
approved by MoH, those approved Treatment Guidelines will be implemented by all Program
Registrants.
7. PARTICIPATION IN THE PROGRAM:
(a) Program Registrant
If MoH or PHSA, on behalf of MoH, is satisfied that such Licensed Ophthalmologist with Retinal
Disease Fellowship satisfies the criteria to be eligible to be a Program Registrant and that

Licensed Ophthalmologist with Retinal Disease Fellowship is willing to commit to perform the
activities with respect to, and comply with the terms of the Program set out in this Program
Document, then the Licensed Ophthalmologist with Retinal Disease Fellowship must sign and
deliver to PHSA an Acknowledgement in the form set out in Appendix C to evidence such
agreement. By signing and delivering such Acknowledgement to PHSA, such Licensed
Ophthalmologist with Retinal Disease Fellowship agrees to comply with all aspects of the
Program described in this Program Document.
For each Licensed Ophthalmologist with Retinal Disease Fellowship in British Columbia eligible
to be a Program Registrant as of the Effective Date, such Acknowledgement must be signed
and delivered to PHSA by October 30, 2013 if that Licensed Ophthalmologist with Retinal
Disease Fellowship wishes to continue to participate in the Program.
(b) Locum
Notwithstanding the foregoing, PHSA may, on request from a Program Registrant from time-to-
time, permit a Program Registrant to utilize on a short-term temporary basis only and only in the
absence of the Program Registrant, one or more locum physicians who are each a Licensed
Ophthalmologist with Retinal Disease Fellowship (a “Locum”) to perform treatments on behalf
of a Program Registrant provided that the Program Registrant remains responsible to ensure
that such Locum complies with the terms of this Program Document in respect of all Eligible
Patients treated by such Locum, including the requirement to enter all data in respect of Eligible
Patients treated by such Locum into the Database and to ensure that a Database Consent has
been obtained by all Eligible Patients. In addition, as set out in Section 25, since the
responsibility to provide regional access to care under Section 19 and other activities under
Section 20 remains with the Program Registrant (and not the Locum), any Program
Management Fees that may be claimed by the Locum will be deducted from the maximum
Program Management Fees that such Program Registrant would otherwise have been eligible
to receive and such Program Registrant will be responsible for the repayment of any
overpayment or repayment of Program Management Fees made to his or her Locum which are
required under this Program Document.
8. WITHDRAWAL OR REMOVAL AS A PROGRAM REGISTRANT
In the event that a Program Registrant wishes to withdraw from the Program, he or she will
notify PHSA in writing of their decision to withdraw and the effective date of their withdrawal,
which may not be prior to the end of the calendar quarter in which such notice of withdrawal was
given.
In addition, in the event that PHSA or the MoH determines that any Program Registrant is not
complying with their respective obligations under the Program or this Program Document or no
longer meets the criteria to be eligible to be a Program Registrant, PHSA and/or MoH may
remove such Program Registrant from the Program on 15 days’ written notice to such Program
Registrant, unless such non-compliance can be remedied and is remedied by such Program
Registrant to PHSA and MoH’s satisfaction during such notice period.

In order to provide and encourage continuity of the Program and efforts in connection therewith,
once a Licensed Ophthalmologist with Retinal Disease Fellowship:
(i) elects to not register as a Program Registrant in the Fiscal Year in which they are
first eligible to do so;
(ii) if he or she had registered as a Program Registrant, subsequently elects to
withdraw as a Program Registrant; or
(iii) is removed as a Program Registrant for non-compliance with the terms of the
Program or this Program Document or because he or she no longer meets the
criteria to be a Program Registrant;
then PHSA or MoH may, in their sole discretion, refuse to permit such Licensed
Ophthalmologist with Retinal Disease Fellowship to register or re-register as a Program
Registrant, whether in the same Fiscal Year or in any subsequent Fiscal Year. Termination or
withdrawal of a Program Registrant is without prejudice to any rights that MoH or PHSA may
have to recover amounts previously paid to such Licensed Ophthalmologist with Retinal
Disease Fellowship.
9. AMD/DME/RVO PATIENT DATABASE:
PHSA has established a computer database (the “Database”) to assist with monitoring,
evaluation, planning and management of the Program, the treatments covered under the
Program and for such other purposes as the MoH or PHSA may specify from time to time. A
description of the Database is set out in the Database Guidelines. In order to be eligible to
receive any Eligible Drug Costs and/or Program Management Fees under the Program, the
Program Registrant submitting a claim for payment of such amounts must first have entered into
the Database the patient information and treatment data set out in the Database Guidelines for
such patient and treatment, in addition to complying with the other requirements set out in
Section 10 and 11. By submitting a claim for payment of Eligible Drug Costs under the
Program, each Program Registrant is also agreeing to enter into the Database any patient
follow-up data available to that physician as set out in the Database Guidelines.
10. INFORMED CONSENT TO TREATMENT AND TO INCLUSION OF PATIENT
INFORMATION IN THE DATABASE:
Each Program Registrant will be responsible to obtain the informed consent of their respective
patient to all treatment provided to that patient by that physician in such form as that physician
believes is appropriate under the circumstances and in compliance with all applicable laws and
professional standards of practice set out by the applicable professional regulatory body.
In addition to such informed consent to treatment, each Program Registrant will also obtain the
consent of each patient whose information is entered into the Database to the collection, use
and disclosure of that patient’s personal health information for any of the purposes set out in the
Database Guidelines, as may be revised from time to time by PHSA. The form of such informed
consent is set out in Appendix B, as may be revised by PHSA from time-to-time, is referred to in
this Program Document as the “Database Consent”. If the patient is unwilling to sign the

Database Consent, the Program Registrant will be required to note that patient’s objection in the
applicable Database field as described more fully in the Database Guidelines. PHSA has the
right to request that each Program Registrant provide to PHSA copies of all Database Consents
obtained by such physician.
11. REIMBURSEMENT OF DRUG COST:
Subject to adjustment as set out in Sections 15 to 17 inclusive, and provided the other criteria
for reimbursement as set out in this Program Document are met, PHSA will reimburse a
Program Registrant for the actual verifiable out-of-pocket cost incurred by them to purchase the
pharmaceuticals reimbursed under the Program (Avastin, Lucentis and Verteporfin/PDT) for
their Eligible Patients, except that, notwithstanding the actual drug cost, the amount to be
reimbursed under the Program for such pharmaceuticals will not exceed the following:
(a) For one individual syringe of Avastin: $13.13;
(b) For one individual syringe of Lucentis: $598.33; and
(c) For one treatment of Verteporfin/PDT: $1,770;
(referred to as the “Eligible Drug Costs”). The above amounts to be reimbursed apply to a
single treatment (dosing) of an Eligible Patient. For greater certainty and notwithstanding
anything else to the contrary in this Program Document, no claim for reimbursement may be
made, and no reimbursement will be provided, in respect of the administration prior to
November 1, 2013 of either of Avastin or Lucentis for DME and RVO. Verteporfin/PDT
(Visudyne) will not be reimbursed for DME or RVO either before or after November 1, 2013.
As a condition of claiming reimbursement of Eligible Drug Costs and participating in the
Program, each Program Registrant will be responsible for drug supply management for their
Eligible Patients and for reporting and reconciliation of drug costs as required under this
Program Document, including compliance with the Supply Chain Procedures set out in Section
27.
Nothing in this Program Document limits the right of PHSA or MoH to reimburse out of the
Program Budget any Eligible Drug Costs incurred in connection with the treatment outside of
British Columbia of an Eligible Patient, whether such reimbursement is made directly to the
Eligible Patient or their out-of-province medical care provider.
12. SUBMISSION OF A CLAIM FOR REIMBURSEMENT OF ELIGIBLE DRUG COSTS:
In order to obtain any reimbursement for Eligible Drug Costs under the Program, the Program
Registrant must have complied with the following in respect of each claim for reimbursement for
the treatment of a particular patient:
(a) the Program Registrant must first determine and be satisfied that the patient meets the
criteria under the Treatment Guidelines for the type of treatment to be provided;

(b) the Program Registrant must enter into the Database all eligibility and reimbursement
information in the format, and containing the information, required by PHSA from time to
time;
(c) the Program Registrant must confirm by entering into the applicable field in the
Database that the Program Registrant has sought the Database Consent from such
patient and that either (i) the Program Registrant has obtained the Database Consent
signed by such patient, or (ii) such patient has refused to give the Database Consent;
(d) the patient must have received treatment by that Program Registrant in accordance with
any applicable Treatment Guidelines;
(e) the Program Registrant must provide to PHSA each quarter copies of invoices from an
Approved Pharmacy, as requested by PHSA, verifying the actual out of pocket drug cost
expense incurred to substantiate and reconcile with Eligible Drug Costs reimbursed in
that quarter; and
(f) the Program Registrant must certify to PHSA and MoH that the amounts invoiced are
correct.
It is expected that all claims for reimbursement of Eligible Drug Costs under the Program be
submitted within 5 business days after the bi-monthly period during which the treatment giving
rise to such reimbursement claim was performed. Although it is the expectation that all claims
be submitted promptly within the foregoing time-frame, in all cases the maximum allowable time
to submit a claim for reimbursement under the Program is 90 days after the date on which the
treatment giving rise to such reimbursement claim was performed. PHSA may, in its sole
discretion, allow extensions of such time period on a case-by-case basis for individual claims
but any such extension granted will not apply to any future claims.
If all criteria for reimbursement have been fulfilled or satisfied and entered into the Database as
required, PHSA will endeavour to remit payment for such amount properly claimed to the
claimant within an average of 10 business days, although PHSA will not guarantee payment
within that time period. In addition, in order for PHSA to be able to process payments, each
Program Registrant submitting such claim for reimbursement must provide (or have previously
provided) to PHSA a direct deposit form and any other payment processing information required
by PHSA in such format as may be required by PHSA, including an authorization to permit
electronic funds transfer of payments to such Program Registrant’s account.
PHSA may, in its discretion, refuse any claim for reimbursement under the Program of either
Eligible Drug Costs or Program Management Fees where PHSA believes that the criteria for
reimbursement as set out in this Program Document have not been fulfilled or satisfied and/or
pending the results of any audit or investigation into the accuracy of any invoices or claim for
reimbursement or payment.
The Eligible Drug Costs include all drug, supplies, pharmacy processing fees, procedure costs
and costs to perform the activities required in connection with the treatment but exclude the
physician and technical fees for performing the procedure (including the cost of the Program
Registrant performing the intravitreal injection of such drug), OCT interpretation, Angiography

interpretation and corresponding office visit fees that are reimbursed through the fee-for-service
billing arrangements under the British Columbia Medical Services Plan. Except for such
reimbursement as is specifically provided for under this Program Document, the Program
Registrant will continue to be responsible for the provision and cost of all staffing, supplies,
equipment and overhead and all other costs associated with the care and treatment of their
Eligible Patients.
No Program Registrant may charge or accept payment from an Eligible Patient:
.
at any time, in respect of that Eligible Patient’s treatment for Wet AMD, including
for the cost of Avastin, Lucentis or Verteporfin/PDT and any other fees in respect
of that patient’s treatment for wet AMD ; or
.
from and after November 1, 2013, in respect of that Eligible Patient’s treatment
for DME or RVO, including for the cost of Avastin or Lucentis and any other fees
in respect of that patient’s treatment for DME or RVO;

nor may they cause any other individual or entity to charge or accept payment from an
Eligible Patient for any of the foregoing.
13. REPAYMENT OF AMOUNTS IN EXCESS OF THE ELIGIBLE DRUG COSTS AND
OVERPAYMENT OF PROGRAM MANAGEMENT FEES:
In the event that a Program Registrant has received or receives at any time after the Effective
Date, Eligible Drug Costs or Program Management Fees in respect of any period in excess of
those which the particular Program Registrant may be entitled to under this Program Document
(and whether or not such overpayment was the fault of the Program Registrant), including as a
result of:
.
any change made to the amount of the Program Management Fee or Eligible Drug
Costs by MoH or PHSA;
.
a payment in excess of the Program Management Fees to which he or she may be
entitled in any Quarterly Reimbursement Period or Fiscal Year; or
.
other adjustments described in this Program Document;
then PHSA or MoH may require that such excess amount be repaid by Program Registrant to
PHSA within 30 days of a written request to do so by PHSA or MoH.
In the event that such Program Registrant fails to repay such excess amounts within such time
period, then, in addition to any other rights and remedies available to them at law to recover
such amounts, PHSA and/or MoH will have the right to deduct such excess amounts from any
future amounts (including Eligible Drug Costs and/or Program Management Fees) that would
otherwise be payable to the Program Registrant under the Program in the then current Fiscal
Year and/or any future Fiscal Year in which the Program (or a successor program) may be
continued. The rights of PHSA and MoH under this Section 13 will survive the termination or

expiry of the Program and the termination or withdrawal of a Program Registrant from the
Program.
14. RIGHT TO REQUEST INFORMATION TO VERIFY ACCURACY OF
REIMBURSEMENT CLAIMS:
In addition to any rights PHSA and/or MoH may have under applicable laws, PHSA and/or the
MoH have the right to require access to further information from, and/or audit the applicable
books and records of, any Program Registrant and of any pharmacies or suppliers from whom
he or she purchased any of Avastin, Lucentis or Verteporfin/PDT, in each case to confirm the
accuracy of the information provided to PHSA or entered into the Database in connection with
any request for reimbursement under the Program. The foregoing includes PHSA’s right to
request copies of all invoices/receipts to support and/or audit any claim for reimbursement of
Eligible Drug Costs. In addition, where required by PHSA or MoH, such Program Registrant will
provide evidence reconciling the amount of such drugs invoiced under the Program to that
actually administered to his or her patients.
In connection with the foregoing, each Program Registrant who submits a claim for
reimbursement under the Program, hereby consents as a condition of receiving any payment
under the Program, to PHSA and/or MoH obtaining directly from any pharmacy or supplier from
whom such Program Registrant purchased any of Avastin, Lucentis or Verteporfin/PDT all
records that such pharmacy or supplier has with respect to any Avastin, Lucentis or
Verteporfin/PDT purchased by such Program Registrant.
15. ONGOING REVIEW OF PROGRAM TO PREVENT COST OVERRUNS:
In order to ensure that the costs of the Program are maintained within the amount of the
Program Budget, on a regular basis, at such times as PHSA considers appropriate, PHSA will
provide or make available to the Committee (directly or through the Database) non-identifiable
information on the volume of treatments paid for under the Program in that Fiscal Year and the
drug utilization ratios. Where trends indicate the possibility that the cost of the Program may
exceed the Program Budget or that the Expected Drug Utilization Ratios may be exceeded,
PHSA will consult with the Retinal Specialist Group to consider and evaluate corrective
measures. The foregoing will not limit or delay PHSA’s right under Sections 15 to 17, inclusive,
to at any time, with or without such consultation or before such consultation is concluded, make
any changes to the Program and this Program Document or to require repayment of Program
Management Fees pursuant to Section 24.
16. ADJUSTMENTS TO FUNDING UNDER THE PROGRAM:
At any time PHSA may, subject to any required review and approval by the MoH, adjust the
amounts to be paid under the Program in order to:
(a) except to the extent it is a direct result of a Permitted Cost Increase, ensure that the
costs of the Program do not exceed the amount of the Program Budget or to otherwise
adjust the amounts, including as a result of the review undertaken pursuant to
Section 15; or

(b) take into account any new or additional efficacy, utilization, safety, cost-effectiveness,
usage information, treatment regimes or other data concerning any of the drugs then
being reimbursed under the Program and/or any new alternate therapies or regimens for
the treatment of Wet AMD, DME and/or RVO.
17. MODIFICATIONS TO THE PROGRAM:
Subject to any required review and approval by the MoH, PHSA reserves the right at any time to
modify, terminate and interpret all or any aspect of the Program, the Program Budget and the
terms of this Program Document. Where reasonably practicable, prior to initiating any
significant modification to the Program of other than an administrative nature, PHSA intends to
consult with the Health Authorities and Retinal Specialist Group to solicit their input on the
proposed modification.
18. PROGRAM DOCUMENT IS NOT MEDICAL ADVICE:
Nothing in this Program Document is intended to be or should be considered to be a substitute
for or constitute medical advice. All medical decisions are solely the responsibility of the
prescribing physician and patient.
19. REGIONAL ACCESS TO CARE FOR WET AMD, DME AND RVO PATIENTS:
As a condition of receiving Program Management Fees, the Retinal Specialist Group and each
Program Registrant individually commits to the MoH and to PHSA to ensure that the Program
Registrants will make themselves available on a reasonable and timely basis to provide regional
consultation, treatment and follow-up care to Eligible Patients from those sites within each
Health Authority where the required diagnostic and other equipment, including Angiography and
OCT equipment, is or becomes available. MoH will provide public communication with regard to
the Program and its coverage.
Attached as Appendix A is a list of the centres at which such equipment is currently available
and the Program Registrants will attend and provide such care. The Program Registrants
acknowledge that additional locations may be added to that list in order to ensure appropriate
access to care by Eligible Patients. In that regard, in addition to such other efforts or reviews as
MoH may consider appropriate, MoH may request that each Health Authority undertake a
review of access to care for Eligible Patients in the Health Authority’s respective geographic
area. The Retinal Specialist Group will then be responsible for promptly developing and
implementing a strategy to address access to care deficiencies identified by the Health
Authorities and by PHSA and/or MoH (including those particular geographic areas previously
identified by MoH to the Retinal Specialist Group). If the Retinal Specialist Group does not
develop or implement such measures in a manner satisfactory to MoH in order to address those
access to care concerns, MoH may take whatever action it determines is necessary or
appropriate to improve the access to care concerns for Eligible Patients.
The Retinal Specialist Group will also provide to the MoH and PHSA a detailed schedule that
sets out the rotation schedule to be met by all Program Registrants to meet their commitment to
provide reasonable and timely consultation, treatment and follow-up care from the centres
identified in Appendix A and such other locations/centres as may be added in response to

access to care needs. Each Program Registrant will carry equal responsibility for staffing the
rotation schedule as a condition of receiving Program Management Fees.
The establishment and continuation of the Program is contingent on the Retinal Specialist
Group meeting its obligations under this Section 19, Appendix A and that rotation schedule. The
Retinal Specialist Group will make the rotation schedule available to each Health Authority and,
on a regular basis or at the request of PHSA or a Health Authority, will be available to consult
with and advise the Health Authority in the applicable region, MoH or PHSA on any issues
arising with respect to access to or timeliness of care for Eligible Patients within that region. If
any patient access deficiencies are identified by PHSA, a Health Authority or the MoH, then the
Retinal Specialist Group will develop a strategy and revise the rotation schedule to address the
deficiencies.
20. ADDITIONAL ACTIVITIES TO BE PERFORMED BY PROGRAM REGISTRANTS TO
SUPPORT THE PROGRAM:
 
In addition to the specific requirements set out in this Program Document, the Program
Registrants will be expected to:
 
(a) as contemplated in Section 6, participate in the development and updating of the
Treatment Guidelines;
 
(b) keep the MoH and PHSA informed on a regular basis (through Committee meetings or
such other method as requested by PHSA or MoH) of current scientific literature, new
clinical trials and clinical trial results, conference papers or abstracts and other significant
new information or data regarding advances in the prevention, diagnosis and treatment
of Wet AMD, DME or RVO or any of the pharmaceuticals reimbursed under the
Program;
 
(c) assist the MoH and PHSA as requested to continue to develop and support the
Database with the objective to monitor the safety and effectiveness of the different
treatments for Wet AMD, DME or RVO reimbursed under the Program (Avastin, Lucentis
and Verteporfin/PDT);
 
(d) in collaboration with the MoH and PHSA, assist the MoH and PHSA to monitor the
budget and costs of the Program and to advise on different management strategies
needed to ensure that the costs of the Program do not exceed the amount of the
Program Budget while still meeting the care needs of all Eligible Patients;
 
(e) meet their respective commitments to provide regional access to care as set out in
Section 19 and Appendix A;
 
(f) participate in any Program quality assurance to ensure compliance with and
maintenance of standards of care within the Program and review of the performance
within the Program of each Program Registrant, and to assist with research activities
requested by PHSA or the MoH;
 
(g) participate in the review and reporting of adverse events and outcomes experienced
using any of Avastin, Lucentis or Verteporfin/PDT; and
 

(h) participate in the Committee as described under Section 22.
21. FAILURE OF RETINAL SPECIALIST GROUP TO MEET ITS OBLIGATIONS TO
PROVIDE REASONABLE ACCESS TO CARE:
In the event that PHSA determines that the Retinal Specialist Group is unable or unwilling to
meet its obligations under this Program Document, including Sections 19 and 20, then PHSA
will notify the Retinal Specialist Group that such obligations are not being satisfied. In the event
that the Retinal Specialist Group does not, in the opinion of PHSA, propose any satisfactory
plan to meet its obligations under this Program Document, then, without limiting the right the
MoH or PHSA otherwise has to amend or terminate the Program and the Program Document,
PHSA may, in its sole discretion but subject to any required review or approval by the MoH,
amend or terminate this Program Document and the Program and take such measures as they
consider appropriate, including ensuring that reasonable access to medical care is being
provided to Eligible Patients in all regions of the Province of British Columbia.
22. PARTICIPATION OF REPRESENTATIVES OF THE PROGRAM REGISTRANTS IN
THE JOINT ACCOUNTABILITY COMMITTEE:
A Joint Accountability Committee (the “Committee”) has been established to provide a forum
for discussion amongst the MoH, PHSA and the Retinal Specialist Group. The mandate of the
Committee is to:
(a) monitor, review and discuss the effectiveness of the Program;
(b) develop a research agenda for each Fiscal Year and assign activities amongst the
Retinal Specialists Group accordingly, including with respect to:
(1) gathering and analyzing evidence for use of Visudyne in combination treatment
therapy;
(2) gathering and analyzing evidence for effectiveness, efficacy, and/or safety for
Wet AMD, DME and RVO;
(3) publishing in peer reviewed journals and/or presenting at professional
conferences, both of which are encouraged provided the Program Registrant
gives PHSA and MoH an opportunity to review the materials at least 30 days
before submitting to the journal or conference;
(4) undertaking appropriateness monitoring and evaluation for Wet AMD, DME and
RVO, including the frequency and duration of treatment and retreatment. In
particular, given the expectation that the increase in new Wet AMD patient
growth is expected to be offset by careful management of the duration and
frequency of treatments, the Committee will undertake a review of investigational
studies focused on the duration and frequency of Wet AMD treatments and make
recommendations to MoH with respect to revisions that the Committee believes
are appropriate to the Treatment Guidelines based on that review;

(c) by December 1, 2013, review and revise the Treatment Guidelines with respect to the
use of Verteporfin/PDT in the treatment of Wet AMD and providing to MoH and PHSA
any recommended changes to the Treatment Guidelines;
(d) review and revise any other aspect of the Treatment Guidelines as appropriate and
provide to MoH and PHSA any recommended changes to the Treatment Guidelines;
(e) subject to compliance with all applicable privacy laws, review the data obtained through
the Database;
(f) review the costs of the Program and make recommendations to the MoH and PHSA as
to measures to be taken to ensure that the costs of the Program do not exceed the
amount of the Program Budget;
(g) monitor the performance by the Program Registrants in relation to the Program Budget
and under Section 19;
(h) make recommendations to the MoH and PHSA with respect to any changes to the
Program;
(i) make recommendations to the MoH and PHSA with respect to additional audit practices
to be implemented as soon as possible (and within the 2013 Fiscal Year) to ensure that
the requirements of the Program and this Program Document are being adhered to.
These processes will include Program evaluation and research activities, the
assessment and monitoring for the appropriate use of billing fee codes and compliance
with the supply chain requirements set out in Section 27;
(j) as requested by MoH or PHSA, assist the MoH to assess and monitor appropriate use of
billing fee codes, as applicable, related to Wet AMD, DME and RVO;
(k) make recommendations with respect to the disclosure to the Committee, MoH and
PHSA of potential and/or perceived conflicts of interest pertinent to the Program or a
Program Registrant’s participation in the Program; and
(l) consider such other matters related to the Program as may be requested from time-to-
time by the MoH or PHSA.
Unless the MoH agrees from time to time that the Committee may have unequal representation,
the Committee will be comprised of an equal number of representatives from each of PHSA, the
MoH and the Retinal Specialist Group. The representatives of the Retinal Specialist Group will
be comprised of a Program Registrant from each of the five Health Authorities, a Program
Registrant selected by the MoH and/or PHSA as having particular experience with visiting clinic
services and a Program Registrant selected by the MoH and/or PHSA as having particular
experience with research in retinal diseases. PHSA will appoint the Chair of the Committee and
develop the terms of reference under which the Committee will operate. The Committee may
make recommendations with respect to the Program to the MoH and/or PHSA but the
Committee will have no power to make decisions with respect to the Program, nor will the MoH
or PHSA be obligated to adopt any of the recommendations of the Committee.

The Committee will meet at least once in each calendar quarter or more frequently if requested
by the Retinal Specialist Group, the MoH or PHSA. It is anticipated that the regular quarterly
meetings of the Committee will take place in each of July, October, January and April of the
applicable Fiscal Year.
23. PROGRAM MANAGEMENT FEES:
 
In recognition of the activities that they are required to perform under the Program, Program
Registrants will, provided the applicable criteria have been met, be eligible to receive payment
of a Program Management Fee for each single treatment (dosing) of an Eligible Patient with
Avastin, Lucentis or, in respect of Wet AMD, Verteporfin/PDT up to an aggregate maximum
amount equal to the Quarterly IMFAA for the applicable Quarterly Reimbursement Period and
the Annual IMFAA for the applicable Fiscal Year. No person other than a Program Registrant
(and their respective Locum physicians meeting the above criteria) are eligible to receive any
Program Management Fees.
 
The Quarterly IMFAA and Annual IMFAA limit the maximum number of treatments for which any
one Program Registrant may receive Program Management Fees to:
 
.
500 treatments in any Quarterly Reimbursement Period; and
.
2,000 treatments in any Fiscal Year;

 
or such lesser amount as determine after applying the criteria set out in the definition of the
“Quarterly IMFAA” and/or “Annual IMFAA” or as otherwise determined and adjusted by PHSA
pursuant to Sections 24 and 25.
 
Once an individual Program Registrant has received the maximum Quarterly IMFAA in respect
of the corresponding Quarterly Reimbursement Period or the Annual IMFAA in respect of the
corresponding Fiscal Year, the Program Registrant will not be entitled to receive any further
Program Management Fees in respect of that same Quarterly Reimbursement Period or Fiscal
Year, respectively, irrespective of the number of treatments that the Program Registrant
provides in the applicable period. Any overpayment of Program Management Fees in any
Quarterly Reimbursement Period or Fiscal Year will be repaid to PHSA by the Program
Registrant or deducted from future amounts payable to that Program Registrant as provided for
in Section 13.
24. PROGRAM MANAGEMENT FEES – BUDGETS, RECONCILIATION, ADJUSTMENTS
AND REPAYMENT:
 
(a) Budget and Adjustment as a Result of New Program Registrants
 
PHSA will determine (based on the amount of the Program Budget in any Fiscal Year, the
number of treatments of Avastin, Lucentis and Verteporfin/PDT and associated Eligible Drug
Costs that PHSA projects to occur in a Fiscal Year for Eligible Patients and such other factors
as PHSA considers relevant) an estimated amount for the Program Management Fee Global
Available Amount for that Fiscal Year, and based on that amount and the projected number of

Program Registrants anticipated for that Fiscal Year, the estimated Quarterly IMFAA and
Annual IMFAA for that Fiscal Year. Such estimates will be used by PHSA for the purpose of
determining eligibility of payment of Program Management Fees unless and until adjusted by
PHSA in accordance with Section 25.
 
Where one or more new Program Registrants joins the Program within a Fiscal Year, the
Program Fees to which such new Program Registrant may be entitled will come out of the
Program Management Fee Global Available Amount for that Fiscal Year and will result in a
proportional reduction in the Quarterly IMFAA and Annual IMFAA for that Fiscal Year for all
Program Registrants.
 
Within 30 days of the end of each Quarterly Reimbursement Period or at such other times as
may be specified by PHSA, the Committee will meet to review the costs of the Program in the
prior Quarterly Reimbursement Periods in that Fiscal Year and consider projected costs of the
Program for the remainder of the Fiscal Year. The Committee will consider all relevant
information and make a recommendation to PHSA on any adjustments needed to the amount of
the Program Management Fee, Quarterly IMFAA and/or Annual IMFAA or any other aspect of
the Program in order to ensure that the costs of the Program (including both Eligible Drug Costs
and Program Management Fees) in that Fiscal Year do not exceed the amount of the Program
Budget.
 
(b) Adjustments
 
PHSA will consider such recommendations of the Committee and, in addition to its right under
Sections 15 to 17, will have the discretion to determine what adjustments, if any, are needed to
any of the Program Management Fee, Quarterly IMFAA, Annual IMFAA or other aspects of the
Program and will advise the Program Registrants of any such adjustment. Adjustments will not
be made to the Program Management Fee, Quarterly IMFAA or IMFAA to the extent that the
MoH, in its discretion, determines that the costs of the Program in that Fiscal Year exceed the
amount of the Program Budget as a direct result of any of the following events (the “Permitted
Cost Increase”):
 
(i) any incremental drug (or drug packaging/compounding) price increase imposed by a
manufacturer or distributor of Avastin, Lucentis or Verteporfin/PDT or from an Approved
Pharmacy that occurs after commencement of, but within, the same Fiscal Year to which
such Program Management Fee, Quarterly IMFAA or IMFAA relates; or
 
(ii) any additional treatments (doses) administered in the particular Fiscal Year to Eligible
Patients in excess of:
(1) 58,250 separate treatments (doses) in the 2013/14 Fiscal Year for Eligible
Patients diagnosed with Wet AMD; or
(2) either:

(A) for the period from November 1, 2013 to March 31, 2014, 12,500
separate treatments (doses) for Eligible Patients diagnosed with
DME or RVO; or
(B) for Fiscal Years commencing on or after April 1, 2014, 30,000
separate treatments (doses) for Eligible Patients diagnosed with
DME or RVO.
 
The Program Registrants acknowledge that the number of treatments set out in (ii) (1) and (2)
will be reviewed and updated annually by MoH or PHSA in consultation with the Committee.
Notice of the revised treatment numbers will be provided by MoH or PHSA to the Program
Registrants.
 
Where, other than as a result of a Permitted Cost Increase, an adjustment is required to the
Program Management Fee, Quarterly IMFAA or Annual IMFAA in order to ensure that the costs
of the Program in any Fiscal Year do not exceed the amount of the Program Budget, PHSA will
advise the Program Registrants through the Committee.
 
(c) Expected Drug Utilization Ratios
 
The following drug utilization ratios between Lucentis and Avastin were recommended to the
MoH and PHSA by the Retinal Specialist Group (the “Expected Drug Utilization Ratios”):
(i) for Wet AMD- Lucentis used up to 10% of the time in treating Wet AMD, with Avastin
used 90% or more of the time in treating Wet AMD;
(ii) for DME and RVO - Lucentis used up to 35% of the time in treating DME and RVO
(combined), with Avastin used 65% or more of the time in treating DME and RVO; and
(iii) overall (on average) for all three indications (Wet AMD, DME and RVO), Lucentis would
be used up to 15% of the time, with Avastin used 85% or more of the time.
Without limiting the right of the MoH or PHSA under this Program Document to make
adjustments to or require repayment of the Program Management Fees, if as a result of one or
more Program Registrants utilizing Lucentis in excess of the Expected Drug Utilization Ratios
then PHSA or the MoH may require that any additional Eligible Drug Costs incurred as a result
of such utilization ratio not being met be reimbursed to PHSA by the Program Registrants in
proportion to the extent that each particular Program Registrant exceeded the Expected Drug
Utilization Ratio for Lucentis in that particular Fiscal Year, as determined by PHSA or MoH.
PHSA and/or the MoH may consult with the Committee on such reductions or repayments.
 
All adjustments to Program Management Fees may be prospective or retrospective, or both,
and any prior overpayment resulting from a retrospective adjustment will be repaid to PHSA by
the applicable Program Registrant or deducted from future amounts payable to that Program
Registrant as provided for in Section 13 unless the Program Registrants request an alternate
allocation method be used by notice in writing to PHSA signed by a majority of the Program
Registrants and approved by the PHSA and/or the MoH in their discretion. Provided neither

PHSA nor MoH has objections to such alternate allocation method, such method will then be
applied to any such adjustments or overpayment recoveries in respect of that Fiscal Year. If the
Program Registrants fail to repay any Program Management Fees owing utilizing such alternate
allocation method, PHSA retains all rights it otherwise would have had under this Program
Document in order to ensure that the cost of the Program does not exceed the Program Budget.
25. PROGRAM MANAGEMENT FEES – MONTHLY REPORTING, PRORATION, CARRY-
FORWARD AND ADJUSTMENT FOR PROGRAM MANAGEMENT FEES PAID TO
LOCUMS:
 
The following additional terms apply to the calculation and payments of Program Management
Fees:
(a) Monthly Usage Summaries - PHSA will provide to the Program Registrants a monthly
summary showing the amount of Eligible Drug Costs and Program Management Fees
claimed by such Program Registrant under the Program in the prior month and the
number of treatments of Eligible Patients with each of Avastin, Lucentis and
Verteporfin/PDT in that prior month.
(b) Proration for Partial Quarters/Years - In the event that a Program Registrant is not a
Program Registrant for an entire Quarterly Reimbursement Period and Fiscal Year, the
Quarterly IMFAA and Annual IMFAA for that Program Registrant will be prorated
according to the proportion of time in such Quarterly Reimbursement Period and Fiscal
Year in which he or she was a Program Registrant.
(c) Individual Quarterly Carry-Forward - It is recognized that treatment volumes may vary
throughout the course of a Fiscal Year; therefore, in the event that a particular Program
Registrant does not invoice for the maximum amount of the Quarterly IMFAA in respect
of any Quarterly Reimbursement Period, then the balance remaining between the
amount actually paid or payable to that Program Registrant in respect of that Quarterly
Reimbursement Period and the maximum Quarterly IMFAA for that Quarterly
Reimbursement Period may be carried forward in respect of that Program Registrant
and added to the Quarterly IMFAA amounts that such Program Registrant is eligible to
receive during the remainder of that same Fiscal Year. No such amounts may be carried
forward between Fiscal Years nor may they be applied to the Quarterly IMFAA (or Annual
IMFAA) for other Program Registrants.
(d) Locums - PHSA and/or MoH may deduct from the Annual IMFAA and Quarterly IMFAA
to which the Program Registrant may otherwise have been entitled an amount equal to
any Program Management Fees claimed under the Program by Locums engaged or
utilized by that Program Registrant to treat that Program Registrant’s Eligible Patients or
in fulfilling that Program Registrant’s obligations under the rotation schedule set out in
Appendix A to the Program Document. For the purposes of the foregoing, PHSA will
have the sole discretion to determine whether a physician is acting as a Locum for a
particular Program Registrant and to determine the manner in which the amount of the
Program Registrant’s Annual IMFAA and Quarterly IMFAA are adjusted as a result of any
Program Management Fees claimed by a Locum.

26. PROGRAM MANAGEMENT FEES – INVOICING AND PAYMENT:
The terms and conditions applicable to the submission of claims or invoices for, and payment of,
Eligible Drug Costs as set out in this Program Document will also apply to the submission of
claims or invoices for, and payment of, Program Management Fees.
27. SUPPLY CHAIN:
In order to meet quality assurance objectives, all Program Registrants will purchase single dose
syringes of Avastin and Lucentis from a licensed pharmacy located in British Columbia that is
designated in writing to the Program Registrants by MoH or PHSA as an approved supplier to
the Program (an “Approved Pharmacy”). In addition, PHSA may provide to the Program
Registrants written supply chain procurement, storage and other quality assurance
requirements to be complied with by the Program Registrants (the “Supply Chain
Procedures”) that may supplement the safe handling and administration procedures required
by applicable regulatory authorities or recommended by the manufacturers of Avastin, Lucentis
and Verteporfin/PDT and the Approved Pharmacy from whom the drug was purchased by the
Program Registrant. Program Registrants will acknowledge in writing receipt of such Supply
Chain Procedures from PHSA and, as requested from time to time by PHSA or MoH, reconfirm
their compliance with such Supply Chain Procedures.
28. CONFLICT OF INTEREST POLICIES AND PROCEDURES:
If policies and/or procedures are recommended by the Committee and approved by MoH with
respect to the disclosure to the Committee, MoH and PHSA of potential and/or perceived
conflicts of interest pertinent to the Program or a Program Registrant’s participation in the
Program (the “Conflict of Interest Policy”), all Program Registrants will comply with the terms
and conditions of the Conflict of Interest Policy, including making all disclosures in accordance
with the Conflict of Interest Policy.
 
 

PROVINCIAL HEALTH SERVICES AUTHORITY
PROVINCIAL RETINAL DISEASES TREATMENT PROGRAM
APPENDIX A
 
Treatment Centres
City
Retinal Specialist
Abbotsford
Dr. Dhar Dhanda
 
Dr. Simon Lam
Dr. Hugh Parsons
Dr. Leah Wittenberg
Burnaby
Dr. Kelvin Finlay
Cranbrook
Dr. Lica Chui
Dr. Farzin Forooghian
Fort St. John
Dr. Lica Chui
Dr. Farzin Forooghian
Kamloops
Dr. Peter Hopp
Kelowna
Dr. Derek Godinho
Dr. Malvinder Hoonjan
Dr. Peter Hopp
Dr. Kevin Ramsey
Nanaimo
Dr. Elizabeth Hay
Nelson
Dr. Kevin Ramsey
Dr. Malvinder Hoonjan
New Westminster
Dr. Dhar Dhanda
 
Dr. Simon Lam
Dr. Hugh Parsons
Dr. Leah Wittenberg
North Vancouver
Dr. Farzin Forooghian
Dr. Derek Godinho
Prince George
Dr. Andrew Lukaris
Salmon Arm
Dr. Hussein Hollands
 

Treatment Centres
 
City
Retinal Specialist
Surrey
Dr. Dhar Dhanda
 
Dr. Simon Lam
Dr. Hugh Parsons
Dr. Leah Wittenberg
Terrace
Dr. Patrick Ma
Vancouver
Dr. Patrick Ma
Dr. Alan Maberley
Dr. David Maberley
Dr. David Albiani
Dr. William H. Ross
Dr. Lica Chui
Dr. Andrew B. Merkur
Dr. Andrew Kirker
Vernon
Dr. Hussein Hollands
Victoria
Dr. Stan Shortt
Dr. Murray Erasmus
Dr. Andrew Burnett
 
 
 

PROVINCIAL HEALTH SERVICES AUTHORITY
PROVINCIAL RETINAL DISEASES TREATMENT PROGRAM
 
APPENDIX B
DATABASE CONSENT
[NOTE: PRIOR TO NOVEMBER 1, 2013 THE FORM OF DATABASE CONSENT APPROVED
BY MOH FOR USE IN THE AMD TREATMENT PROGRAM FOR FISCAL 2012 MAY BE
USED]
 
PROVINCIAL RETINAL DISEASES TREATMENT PROGRAM
CONSENT FOR COLLECTION, USE AND DISCLOSURE OF INFORMATION
 
As your doctor has advised you, the Ministry of Health Services for the Province of British
Columbia (the “Ministry of Health”) is currently operating a program to be administered by
the Provincial Health Services Authority (“PHSA”) to fund and obtain certain information
about the safety and effectiveness of different treatments for three eye diseases known as:
 
.
wet age-related macular degeneration, or “Wet AMD”;
.
Diabetic Macular Edema, or “DME”; and
.
Retinal Vein Occlusion, or “RVO”.

 
That program is referred to as the "Provincial Retinal Diseases Treatment Program".
 
This form explains what happens to the information that your doctor collects from you
related to you and to your diagnosis and treatment for ________________ [INSERT
WHICHEVER OF WET AMD/DME OR RVO APPLIES] (referred to in this form as your “Eye
Condition”). This form also asks you to agree, or consent, to sending this information to
the Ministry of Health, to PHSA and to the British Columbia Centre for Disease Control (the
“CDC”), which is operated by PHSA. This consent applies only to the collection, use
and disclosure of certain information about you and is in addition to any consent to
medical treatment that you give your doctor.
 

Before you sign this form, please read all pages carefully, or have them read to you, and
talk to your doctor about it. Your doctor can answer your questions and help you
understand what will happen to the information we collect about you.
 
What type of information will you be collecting about me?
 
In the course of your diagnosis and treatment for your Eye Condition, your doctor will be
collecting information about you that is needed to obtain full or partial reimbursement for
your medical care by the Ministry of Health and PHSA as well as health and medical
information about your vision and your diagnosis and treatment. That information may
include:
 
.
your personal health number;
.
your gender, age and date of birth;
.
your postal code;
.
your past and future medical information about your vision and your diagnosis
and treatment for your Eye Condition, including:
o the results of any diagnostic tests your doctor may request or perform in
the course of their evaluation or treatment of your vision and your Eye
Condition;
o the pharmaceutical drugs used to treat your Eye Condition; and
o the type of procedures and frequency of treatment that your
doctor provides as part of your medical care related to your Eye
Condition or your vision;
o information about any other diseases or medical conditions that you have
experienced in the past or experience in the course of being treated by
your doctor that your doctor may consider relevant to the medical care
your doctor provides to you related to your Eye Condition or your vision;
o information about any side effects or reactions that you may experience
while undergoing medical care by your doctor; and
o any other information that your doctor considers relevant to your medical
care.
 

 
What happens to the information that my doctor collects about me?
 

The information described above that is collected by your doctor will be entered into
a secure server, which we refer to as the “Computer Database”, operated by
PHSA. Secure servers are computers that keep your information confidential. Only
authorized persons from or under contract to the Ministry of Health, PHSA and the
CDC will have permission to look at your information that is stored in the Computer
Database and those persons will be required to keep that information confidential.
 
How will my information entered into the Computer Database be used?
 
Your doctor will use the information entered into the Computer Database to provide
you with medical care, to request payment from the Ministry of Health or PHSA for
the medical care your doctor provides to you and for your doctor to study Wet AMD,
DME, RVO and potentially other eye conditions and the safety and effectiveness of
different treatments for Wet AMD, DME, RVO and potentially other eye conditions.
 
The Ministry of Health, PHSA and the CDC will collect, use and disclose some or all
of the information collected from you and other patients which is entered into the
Computer Database for the following purposes:
.
to process and audit payments to your physician related to your medical
care;
.
for research, planning and management of the Provincial Retinal
Diseases Treatment Program and any replacement or other eye
programs;
.
to evaluate and/or publish information related to Wet AMD, DME and/or
RVO and potentially other eye conditions;
.
to evaluate and/or publish information related to the different pharmaceutical
drugs and different procedures used to treat Wet AMD, DME and/or RVO and
potentially other eye conditions, including the effectiveness, safety, use and
outcome of those treatments;
.
to evaluate and respond to any safety concerns that may arise with respect to
one or more of the available treatments for Wet AMD, DME and/or RVO and
potentially other eye conditions;
.
to provide your information to other doctors and/or researchers studying or
researching Wet AMD, DME and/or RVO or the treatments for Wet AMD, DME
and/or RVO, or with other eye conditions;


.
to help develop systems that will enable the Ministry of Health, PHSA and CDC
doctors to deliver better or more economical health care for patients with Wet
AMD, DME and/or RVO, or with other eye conditions.

 
The information in any publication that is issued by the Ministry of Health, PHSA, the CDC
or any doctor or researcher that acquires your information would be in a form that would not
allow others to identify you or to contact you.
 
What if I choose not to consent to having my information entered into the Computer
Database?
 
Certain information about you is required for your doctor to request payment from the
Ministry of Health and PHSA to reimburse your doctor for the costs of your medical care,
including your name, personal health number and the type of medical care provided to you.
You are not required to give your consent to all of the above in order to receive medical
care. If you have concerns about any of the other information listed above being entered
into the Computer Database or how the Ministry of Health, PHSA or the CDC may use your
information, then you should discuss with your doctor those concerns and any additional
limits you would like to place on the collection, use or disclosure of your information.
 
What is the legal authority under which this information is collected and to whom can
I direct any other questions I may have about its collection?
 
The Ministry of Health, PHSA and the CDC are authorized to collect this information under
sections 26(c), 33.1(1) (b), 33.1(1) (i.1) and 33.2(d) of the British Columbia Freedom of
Information and Protection of Privacy Act. If you have questions about the collection, use or
disclosure of your information, you may contact:
 
Ms. Cindy Brice
Corporate Director, Information Access and Privacy
Provincial Health Services Authority
Suite 200 - 601 W. Broadway
Vancouver, British Columbia
V5Z 4C2 Canada
Phone: 604-707-5834
 

CONSENT
 
I agree that the information collected from me as described above can be stored on the
Computer Database operated by PHSA.
 
I also agree that my doctor, the Ministry of Health, PHSA and the CDC may collect, use and
disclose the information collected from me as described above and that such information
will be part of my medical record.
 
 
 
Printed name of patient Signature Date
 
 
 
 
Printed name of Legally Authorized Signature Date
Substitute Decision Maker (if applicable)
 
 
 
Printed name of person getting consent Signature Date
 
 
 

PROVINCIAL HEALTH SERVICES AUTHORITY
PROVINCIAL RETINAL DISEASES TREATMENT PROGRAM
EFFECTIVE APRIL 1, 2013
APPENDIX C
PROGRAM REGISTRANTS
ACKNOWLEDGEMENT AND
TERMS FOR PARTICIPATION AND ELIGIBILITY FOR REIMBURSEMENT
 
To: Provincial Health Services Authority (“PHSA”)
Re: PROVINCIAL RETINAL DISEASES TREATMENT PROGRAM TO BE EFFECTIVE
APRIL 1, 2013 (the “Program”)
Unless stated otherwise, the capitalized terms in this Appendix C have the same meaning as
set out in the Program Document.
The undersigned hereby acknowledges that he/she has been provided with a copy of the
Program Document for the Program that is attached as Exhibit A to this Acknowledgement, and,
as a condition of seeking reimbursement from PHSA under the Program, the undersigned
acknowledges and confirms that:
(a) the undersigned is a physician who has been licensed as an ophthalmologist by the
College of Physicians and Surgeons for the Province of British Columbia AND successfully
completed an approved Retinal Disease Fellowship of at least 1 year duration;
(b) eligibility for reimbursement of any amounts, including Eligible Drug Costs and Program
Management Fees, under the Program is subject to compliance with all terms and conditions for
eligibility and reimbursement set out in the Program Document, as may be amended from time
to time;
(c) the undersigned wishes to be a Program Registrant and participate in the Program, as
described in, and on and subject to the terms and conditions set out in, the Program Document;
(d) the undersigned acknowledges that, as a further condition of participating as a Program
Registrant, the undersigned must:
(i) obtain and maintain at all times and to the satisfaction of the MoH or PHSA
privileges from the Health Authority having jurisdiction in the region in which that
Program Registrant treats an Eligible Patient (and it is further acknowledged by the
undersigned that a determination by a Health Authority whether or not to grant such
privileges may take into account access to care needs as determined by that Health
Authority); and

(ii) comply with all terms and conditions attached to such privileges, as specified by
the Health Authority granting such privileges;
(e) the undersigned acknowledges that PHSA and/or MoH may deduct from the Annual
IMFAA and, as applicable, Quarterly IMFAA to which the undersigned may otherwise be entitled
any Program Management Fees claimed under the Program by Locums engaged or utilized by
the undersigned to assist the undersigned in treating his or her Eligible Patients or in fulfilling his
or her obligations under the rotation schedule set out in Appendix A to the Program Document;
(f) the undersigned acknowledges that PHSA and/or MoH may require repayment from the
Program Registrant of amounts paid to the undersigned and/or the undersigned’s Locum under
the Program on the terms and conditions set out in the Program Document, and the
undersigned agree to comply with such repayment terms, as applicable;
(g) the undersigned is aware of and has agreed to provide care to Eligible Patients in
accordance with the rotation schedule set out in Appendix A to the Program Document, as may
be amended;
(h) the undersigned acknowledges and agrees to the audit and review rights of PHSA and
MoH under the terms of the Program Document;
(i) the undersigned will comply with any conflict of interest policies or procedures
recommended by the Committee and approved and adopted for the Program by MoH, including
the requirement to disclose any actual or potential conflicts of interests in accordance with such
policies or procedures; and
(j) the undersigned agrees to all other terms and conditions set out in the Program
Document.
The undersigned further acknowledges that the Program is subject to modification, adjustment
and/or termination by the Ministry of Health Services for the Province of British Columbia and/or
PHSA. Unless withdrawn by notice in writing to PHSA, this Acknowledgement shall also apply
to any renewal or replacement of the Program after the expiry of the current term of the
Program on March 31, 2014.
DATED ________________, 2013 and effective April 1, 2013.
_______________________________
[.INSERT NAME OF LICENSED OPHTHALMOLOGIST WITH RETINAL DISEASE
FELLOWSHIP]
 
 
 
 

0t

Back to top of page