Formulaire
DPP-4 / SGLT2 Inhibitors Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
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Formulaire
Crohn's Disease Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Formulaire
Ankylosing Spondylitis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Formulaire
Rheumatoid Arthritis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Formulaire
Plaque Psoriasis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Formulaire
Enfuvirtide Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Formulaire
Psoriatic Arthritis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Formulaire
Standard Special Authorization Request Form
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.
Publication
Insulin Pump or Insulin Pump plus Glucose Sensor Program Initial Application Form
Fill out this form to register for the first time for either