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Content type

  • (-) Form 25

Category

  • Medical Professional 10
  • Health 9

Departments and Agencies

  • Health and Wellness 23

Published date

  • 2025 7
  • 2024 15
  • 2023 1
  • 2022 1
  • 2017 1
Displaying 1 - 10 of 25 records for "pharmacare/"
Form

Out-of-Province Travel Declaration Form

2017-10-02

PEI Pharmacare clients travelling outside of the province may be allowed to obtain up to 180 days of their eligible medication prior to leaving the province. If your medication is eligible, complete this form prior to leaving the province and take it to your pharmacy, so they can...

Form

Standard Special Authorization Request Form

2025-11-04

Some medications in the PEI Pharmacare Formulary are approved on a special authorization basis only. If your physician prescribes a drug in this category, you can submit a Standard Special Authorization Request form to have a medication considered for coverage.

Form

Travel Declaration

2024-12-19
Form

Ostomy Supplies Claim Submission Form

2024-04-02

This form is used to submit a claim to the Ostomy Supplies Program.

Form

Home Oxygen Program Application Form

2024-04-02

Complete this form if you have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and have been prescribed oxygen. You may be eligible for coverage of expenses through the Home Oxygen Program.

Form

Rheumatoid Arthritis Special Authorization Request Form

2024-04-18

Special authorization request form to be completed by your physician or diagnosing specialist.

Form

retinal_disease_treatment_special_authorization_form

2024-08-13

Retinal Disease Treatment Special Authorization Form

Form

Semaglutide Special Authorization Form

2025-11-04

Semaglutide Special Authorization Form

Form

Nintedanib / Pirfenidone special authorization request form

2024-04-02
Form

Ankylosing Spondylitis Special Authorization Request Form

2025-08-14

Special authorization request form to be completed by your physician or diagnosing specialist.

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Content type

  • (-) Form 25

Category

  • Medical Professional 10
  • Health 9

Departments and Agencies

  • Health and Wellness 23

Published date

  • 2025 7
  • 2024 15
  • 2023 1
  • 2022 1
  • 2017 1
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