Please complete and fax the BCCDC NTM clinic referral form and specify your request:
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MD-to-MD virtual consultation with/out a prescription. Indicate consultation by telephone (provide a phone number) or dictated consult note.
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Prescription only. Any BC physician who wishes to establish their patient on NTM therapy is encouraged to provide this care.
To expedite medication access, please provide a completed and signed rifampin/rifabutin and/or ethambutol prescription request with the medication name, specific dosage (not mg/kg), interval, and duration.
In the Lower Mainland, requests must include the shipping address of the community pharmacy dispensing medications to your NTM patient. In all other areas of BC, requests must include the shipping address of the local health unit.
Medications shipped to a community pharmacy in the Lower Mainland may have extra costs applied (e.g., expedited shipments; community pharmacy professional fees; etc.).
BCCDC Pharmacy provides a limited number of medication supplies only. The referring physician is responsible for all care of their NTM patient. The community pharmacy or local health unit must address any clinical concerns (e.g., drug interactions) with the original (non-BCCDC) prescriber.
Pharmacies or local health units reordering NTM medications should include a completed TB Adherence and Medication Re-order Form.
Note: The BCCDC Pharmacy does not provide other NTM medications (including macrolides or Special Access Program drug requests). A local pharmacy can dispense these medications, or physicians can request specialty medications via Health Canada Special Access Program to the community pharmacy.
