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What are Prior Authorization and Special Authorization?

Special Authorization and Prior Authorization are interchangeable terms we use to describe a pre-approval process that helps us determine if certain prescription drugs will be reimbursed under your benefit plan.

Most drugs that require prior authorization are considered high-cost specialty drugs.

What are Prior Authorization and Special Authorization?

Special Authorization and Prior Authorization are interchangeable terms we use to describe a pre-approval process that helps us determine if certain prescription drugs will be reimbursed under your benefit plan.

Most drugs that require prior authorization are considered high-cost specialty drugs.

How do I know if the drug I need requires Prior Authorization?

The first step is to search for the drug name or DIN (drug identification number) on our member portal or on our mobile app.

Suppose the drug you and your doctor are interested in requires Prior Authorization. In that case, you can initiate a request to be approved for the drug by filling out a Prior Authorization Request Form.*

Search for Prior Authorization Request forms

*Please note: these forms apply to private health plans only.

Once the form is completed, you can submit it to us directly or through your doctor. Once we receive the form, we will start reviewing your request for approval.

Can’t find the right form for your drug?

If you can’t find the Prior Authorization Request Form for the drug you’ve been prescribed, you can submit your request using this generic form.

If you’re located in Quebec and can’t find the form you need, please call our customer service team at 1-888-873-9200 to get the appropriate drug-specific form. Generic forms are not accepted in Quebec.

Patient Support Program

Certain medications may require you to enroll in the Patient Support Program before you can be approved for reimbursement. This program is free of charge for the member and will provide you with valuable support related to your medication.

Patient Support Program

Certain medications may require you to enroll in the Patient Support Program before you can be approved for reimbursement. This program is free of charge for the member and will provide you with valuable support related to your medication.