If yes, your prescriber is required to submit a special request for you to request that the medication be covered for you.
Note – If you are an HIV patient or someone receiving palliative care from a recognized prescriber, that prescriber might not be required to submit an EAP for your medication.
In the case of an EAP coverage request, your prescriber must complete and submit a form that includes all relevant medical information. Staff from the drug plan program will evaluate your request based on the specified criteria. In some cases, you may need to use a form that is specific to that medication, which are available online and help your prescriber provide the required information. When an EAP request is approved, you will be told when the coverage starts and expires.
For medications that are not listed on the formulary, your prescriber has to ask for a compassionate review. They request this review by submitting a request to the program using a standardized form available online. When a compassionate review is approved, coverage is available for up to six months.
If the request is approved, then the medicine would be covered for you in the same way as a regular formulary benefit is managed.
If the request is denied, then it would not be covered by the plan. In that case, please click here to learn more.
