Special Authorization

Special Authorization provides coverage for certain medications that specific subgroups of patients have been proven to benefit from. Special Authorization medications may be covered only if the coverage criteria are met.

Who decides which drugs fall under Special Authorization?

The Expert Committee, comprised of health professionals with expertise in evaluating drugs, provide recommendations to the Minister of Health regarding the special authorization coverage criteria. The Minister of Health makes the final decision regarding the coverage criteria that is published the Alberta Drug Benefits List.

How do constituents receive coverage for these drugs?

If a medication requires Special Authorization, a patient’s prescriber (usually a physician) must submit a Special Authorization Request to Alberta Blue Cross^®. The information provided is assessed against the coverage criteria to determine if drug coverage can be granted. Special Authorization is provided for selected drugs through several processes. These include the following:

Regular Special Authorization

The patient’s physician requests coverage and if coverage is granted, it is granted for a certain period of time. At the end of the approval period, the patient’s physician must submit a Special Authorization renewal request for continued therapy.

Auto-renewal process

The patient’s physician requests coverage and if coverage is granted, the coverage remains in place as long as the patient continues to claim the medication regularly. This eliminates the need for the physician to submit a renewal request.

Step Therapy process

Coverage is provided in instances where other drugs (commonly referred to as first-line therapies) were not effective for the patient or resulted in allergic reactions or intolerable side effects. Coverage may also be provided for the Step Therapy drug if the patient has a medical condition that prevents them from using first-line drugs.

Have questions about Special Authorization? Please contact the Alberta Blue Cross^® Customer Service at 1-800-661-6995.

Further information

Special Authorization forms

These special authorization forms must be completed and signed by an authorized prescriber such as a physician, dentist or optometrist who is requesting coverage on your behalf.

Land acknowledgement

We begin by acknowledging that we are on traditional lands, referred to as Treaty 6, Treaty 7 and Treaty 8 territory, and all the people here are beneficiaries of these peace and friendship treaties.

This territory is the home for many Indigenous Peoples, including the Blackfoot, Cree, Dene, Saulteaux, Ojibwe, Stoney Nakota Sioux, and Tsuut’ina peoples, and the Métis Nation of Alberta and the Métis Settlements.

We respect the Treaties that were made on these territories, we acknowledge the harms and mistakes of the past, and we dedicate ourselves to moving forward in partnership with Indigenous communities in a spirit of reconciliation and collaboration.