Special Authority forms by condition

Last updated on August 17, 2026

This page links to Special Authority request forms.

Special Authority eForms are easier to submit and return decisions quicker than faxing paper forms.

Overview

Special Authority requests must be completed by a licensed medical prescriber.

Patients can find out if Special Authority requests have been approved at Health Gateway. Prescribers can call the toll-free Medical Practitioner Line at 1-866-905-4912. Do not send a request by fax.

If you can't find the form you need below, search the Special Authority drugs list.

Special Authority request forms

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General Special Authority request (use only if there is no specific form below)

eForms are simpler and quicker than faxing. Enrol now.

5328	General Special Authority Request (PDF, 656KB)

Atopic dermatitis

abrocitinib, lebrikizumab, upadacitinib

5852	Targeted Systemic Therapies for Atopic Dermatitis (PDF, 656KB)

Alzheimer's disease

donepezil, galantamine, rivastigmine

5465	Donepezil, Galantamine and Rivastigmine (PDF, 350KB)
—	Standardized Mini-Mental State Examination (SMMSE) (PDF, 690KB)
—	Global Deterioration Scale (GDS) (PDF, 198KB)

Antiviral

letermovir

5816	Letermovir Special Authority Request (PDF, 358KB)

Arthritis: ankylosing spondylitis

adalimumab, bimekizumab, certolizumab, etanercept, golimumab, infliximab, secukinumab, tofacitinib

5364	BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) (PDF, 64KB)
5365	Targeted DMARDs for Ankylosing Spondylitis: Initial/Switch (PDF, 242KB)
5366	Targeted DMARDs for Ankylosing Spondylitis: Renewal (PDF, 237KB)

Arthritis: psoriatic

adalimumab, bimekizumab, certolizumab, etanercept, golimumab, infliximab, ixekizumab, secukinumab, tofacitinib, ustekinumab

5360	Targeted DMARDs for Psoriatic Arthritis: Initial/Switch (PDF, 241KB)
5361	Targeted DMARDs for Psoriatic Arthritis: Renewal (PDF, 224KB)
5364	BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) (PDF, 64KB)
5383	Patient Health Assessment Questionnaire (HAQ) (PDF, 528KB)

Arthritis: rheumatoid

For cyclosporine and leflunomide, please use the General Special Authority request (PDF, 656KB).

abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, sarilumab, rituximab, tocilizumab, tofacitinib

5345	Targeted DMARDs for Rheumatoid Arthritis: Initial/Switch (PDF, 604KB)
5354	Targeted DMARDs for Rheumatoid Arthritis: Renewal (PDF, 406KB)
5373	Rituximab for Rheumatoid Arthritis: Initial/Renewal (PDF, 388KB)
5383	Patient Health Assessment Questionnaire (HAQ) (PDF, 528KB)

Attention deficit hyperactivity disorder (ADHD)

mixed-amphetamine salts ER, lisdexamfetamine, methylphenidate ER (Concerta-type generics), atomoxetine

5472	Medication Coverage for Attention Deficit and Hyperactivity Disorder (PDF, 606KB)

Blood disorders

deferiprone, deferasirox, ferric carboxymaltose, iron isomaltoside, iron sucrose, luspatercept

5407	Deferiprone and Deferasirox Coverage: Initial and Renewal (PDF, 360KB)
5818	Intravenous Iron for Iron Deficiency Anemia (PDF, 90KB)
5827	Luspatercept Special Authority Request (PDF, 130KB)

Cancer treatment supportive care

filgrastim

5470	Biosimilar filgrastim Special Authority Request (PDF, 544KB)

Cardiovascular conditions

dabigatran, ticagrelor, ivabradine, sacubitril-valsartan, ARBs (candesartan, eprosartan, icosapent ethyl, irbesartan, losartan, olmesartan, telmisartan, valsartan)

5825	Icosapent Ethyl Special Authority Request (PDF, 344KB)
5391	Dabigatran for Atrial Fibrillation (PDF, 507KB)
5395	Ticagrelor Special Authority Request (PDF, 460KB)
5484	Sacubitril-Valsartan Combination Special Authority Request (PDF, 382KB)
5488	Ivabradine Special Authority Request (PDF, 302KB)
5492	Angiotensin Receptor Blockers (ARBs) – RDP Program (PDF, 672KB)

Diabetes

linagliptin, pioglitazone, saxagliptin, semaglutide. For diabetes-related supplies, visit glucose monitors, insulin pumps, blood glucose test strips

5826	Semaglutide for Diabetes (PDF 770KB)
5481	Third-Line Anti-Diabetic Medications (PDF, 633KB)

Gastrointestinal disorders

proton pump inhibitors, adalimumab, infliximab, rifaximin, vedolizumab, obeticholic acid

5350	Proton Pump Inhibitors (PPIs) (PDF, 472KB)
5368	Targeted Therapies for Crohn’s Disease: Initial/Switch Coverage (PDF, 751KB)
5495	Targeted Therapies for Crohn’s Disease: Renewal Coverage (PDF, 607KB)
5374	Worksheet (based on Harvey-Bradshaw Index) (PDF, 514KB)
5388	Targeted Therapies for Ulcerative Colitis: Initial/Switch Coverage (PDF, 940KB)
5497	Targeted Therapies for Ulcerative Colitis: Renewal Coverage (PDF, 608KB)
5483	Rifaximin Special Authority Request (PDF, 299KB)
5490	Obeticholic Acid Special Authority Request (PDF, 315KB)

General autoimmune conditions

rituximab

5848	Rituximab for Autoimmune Conditions: Initial/Renewal Request (PDF, 725KB)

Graft vs. host disease

ruxolitinib

5850	Ruxolitinib Special Authority Request (PDF, 220KB)

Hepatitis

Hepatitis B: entecavir, interferon alpha, lamivudine, tenofovir
Hepatitis C: asunaprevir, daclatasvir, ledipasvir-sofosbuvir, pegylated interferon plus ribavirin, simeprevir, sofosbuvir, velpatasvir-sofosbuvir, sofosbuvir-velpatasvir-voxilaprevir, glecaprevir-pibrentasvir

5372	Chronic Hepatitis B Special Authority Request (PDF, 189KB)
5473	Sofosbuvir in Combination with Ribavirin (RBV) for Chronic Hepatitis C (PDF, 413KB)
5476	Velpatasvir Plus Sofosbuvir With or Without Ribavirin (RBV) for Chronic Hepatitis C (PDF, 413KB)
5478	Ledipasvir Plus Sofosbuvir With or Without Ribavirin (RBV) for Chronic Hepatitis C (PDF, 419KB)
5486	Sofosbuvir plus Velpatasvir plus Voxilaprevir for Chronic Hepatitis C (PDF, 414KB)
5494	Glecaprevir plus Pibrentasvir Tablets for Chronic Hepatitis C (PDF, 663KB)

Hypercholesterolemia

evolocumab

5493	Evolocumab Special Authority Request (PDF, 586KB)

Inflammatory conditions

tocilizumab

5496	Tocilizumab for Giant Cell Arteritis (PDF, 316KB)

Kidney disease

finerenone

5856	Finerenone Special Authority Request (PDF, 1.4MB)

Metabolic conditions

sapropterin

5815	Sapropterin Special Authority Request (PDF, 734KB)

Migraine

atogepant, eptinezumab, fremanezumab, galcanezumab

5822	CGRP Antagonists for Migraine Prevention (PDF, 1.02MB)

Multiple sclerosis

alemtuzumab, cladribine, dimethyl fumarate, fingolimod, glatiramer, interferon beta, natalizumab, ocrelizumab, rituximab, siponimod, teriflunomide

5351	Disease Modifying Drugs for Multiple Sclerosis (PDF, 785KB)
5385	Natalizumab (Tysabri) for Multiple Sclerosis (PDF, 568KB)
5394	Fingolimod for Multiple Sclerosis (PDF, 323KB)
5482	Alemtuzumab (Lemtrada) for Multiple Sclerosis (PDF, 519KB)
5813	Ocrelizumab for Primary Progressive Multiple Sclerosis (PPMS) (PDF, 594KB)
5821	Siponimod (Mayzent) for Secondary Multiple Sclerosis (PDF, 1MB)

Neurodegenerative conditions

amifampridine, edaravone

5828	Amifampridine Special Authority Request (PDF, 100KB)
5814	Edaravone (Oral Suspension and Intravenous Suspension) for Amyotrophic Lateral Sclerosis (ALS) (PDF, 93KB)

Neuromyelitis optica spectrum disorder (NMOSD)

rituximab, satralizumab, tocilizumab

5812	Satralizumab for Neuromyelitis Optica Spectrum Disorder (NMOSD) (PDF, 707KB)
5851	Biosimilar Rituximab/Tocilizumab for Neuromyelitis Optica Spectrum Disorder (NMOSD) (PDF, 710KB)

Parkinson's disease

levodopa-carbidopa

5810	Vyalev/Duodopa Special Authority Request (PDF, 599KB)

Respiratory conditions

aclidinium, aclidinium/formoterol, dupilumab, glycopyrronium, glycopyrronium/indacaterol, indacaterol, nintedanib, salmeterol, salmeterol/ fluticasone, tiotropium 18 mcg, tiotropium/olodaterol, umeclidinium/vilanterol, umeclidinium/vilanterol/ fluticasone, vilanterol/fluticasone, benralizumab, mepolizumab, nintedanib, pirfenidone

5823	Nintedanib for Progressive Pulmonary Fibrosis (PDF, 398KB)
5362	Inhalers for Chronic Obstructive Pulmonary Disease (COPD) (PDF, 403KB)
5468	Nintedanib and Pirfenidone for Idiopathic Pulmonary Fibrosis (PDF, 532KB)
5489	Benralizumab/Mepolizumab/Dupilumab for Severe Eosinophilic Asthma (PDF, 431 KB)
5824	Asthma Triple Inhaler (ICS-LABA-LAMA) (PDF, 1.1MB)

Skin disorders

adalimumab, bimekizumab, etanercept, infliximab, risankizumab, secukinumab, ustekinumab, ixekizumab

5379	Psoriasis Area and Severity Index (PASI) Worksheet (PDF, 529KB)
5380	Targeted Therapies for Plaque Psoriasis (PDF, 365KB)
5485	Targeted Therapies for Hidradenitis Suppurativa (PDF, 848KB)

Vasculitis

rituximab

5393	Rituximab for Granulomatosis with Polyangiitis or Microscopic Polyangiitis (PDF, 500KB)

Venous thromboembolic disease

dalteparin, enoxaparin, nadroparin, tinzaparin

5338	Dalteparin/Enoxaparin (Biosimilar)/Nadroparin/Tinzaparin Low Molecular Weight Heparin (PDF, 548KB)
5469	Dalteparin/Tinzaparin/Enoxaparin (Biosimilar) for Treatment of Venous Thromboembolism in Cancer Patients (PDF, 573KB)

Glucose monitors, insulin pumps, blood glucose test strips

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Glucose monitoring systems

5817	Glucose Monitoring Systems (Dexcom G6 and G7 and FreeStyle Libre 2 and 3 Plus) (PDF, 92KB)

Insulin pumps

Omnipod system, MiniMed system, Ypsopump system

5375	Continuous Subcutaneous Insulin Infusion (Insulin Pump) Special Authority Request (PDF, 473KB)

Additional blood glucose test strips

5398	Additional Blood Glucose Test Strips Special Authority Request (PDF, 301KB)

Compounded medications

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Compounded medications

5479	Compound Coverage Request (PDF, 536KB)

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The B.C. Public Service acknowledges the territories of First Nations around B.C. and is grateful to carry out our work on these lands. We acknowledge the rights, interests, priorities, and concerns of all Indigenous Peoples - First Nations, Métis, and Inuit - respecting and acknowledging their distinct cultures, histories, rights, laws, and governments.

Special Authority forms by condition

On this page

Overview

Special Authority request forms

Glucose monitors, insulin pumps, blood glucose test strips

Compounded medications