Special Authorization Drug Claims
The Special Authorization process has been developed to ensure you have access to a wide range of prescription drug benefits, when you need them. This section has been designed to familiarize you with the Special Authorization process.
How does Special Authorization apply to my prescription drug program?
Your prescription drug program provides you with immediate access to more than 3,000 prescription drugs. Certain other medications require Special Authorization before your prescription is eligible for coverage.
How does Special Authorization affect me?
This new process applies to you if a medication you require falls under the Special Authorization category. It is important to familiarize yourself with these medications and discuss the process with your doctor. Special Authorization is designed to provide you with your required medications as quickly as possible.
Will I need to pay for my prescription myself?
You will only need to pay for your prescription yourself if you purchase the medication prior to receiving Special Authorization approval, or if your request for Special Authorization is denied
How do I apply for Special Authorization?
- If you are currently taking a medication that requires Special Authorization, you should begin the Special Authorization process before your prescription runs out.
- Request a Special Authorization form from your Group Administrator or nearest from your pharmacist. This form requires the prescribing physician's signature.
- If your current medication, or new prescription, requires Special Authorization, have your doctor complete the form. Any costs associated with completing the form are the responsibility of the patient/subscriber.
- Send your completed form to:
P. O. Box 4359, STN "A"
Toronto, ON · M5W 3M8
or FAX your form to Desjardins Financial at 1-416-324-7980, our secured facsimiled location which ensures confidentiality. Desjardins offices may be contacted during regular business hours: Monday to Friday, 8:00 a.m. to 5:00 p.m. Tel: 1-877-838-7763.
What happens to my Special Authorization request once I have sent it to the Insurance Company?
Your request will be confidentially reviewed by an medical consultant, after which you will receive written notification of the decision. Normal turnaround for assessment is seven to ten working days.
In cases where a doctor requires an urgent response due to medical condition, every effort will be made to respond the same day. The patient/subscriber may also wish to purchase the prescription before applying for Special Authorization, recognizing that there is no guarantee that Special Authorization will be granted. If information is incomplete and more details are required, turnaround may be delayed.
If your request is approved, the approval will indicate the specified period of time. You will not be required to apply for Special Authorization each time your prescription is filled within that specified time period. Please check your form carefully for the effective and termination date.
How are Special Authorization claims reimbursed?
Once your request has been approved, have your prescription filled. In the unlikely event your pharmacist will not submit your claim to the insurance company, you will need to forward the Special Authorization approval form and your paid-in-full receipts directly to the insurance company. Reimbursement will be mailed to you directly.
Claims for prescription drugs requiring Special Authorization can be paid either through Pharmacies that are on Point of Sale or through Desjardins Financial Security Claims office in the Customer Service Centre at 430 Topsail Road (Village Mall) , P. O. Box 92, St. John's, A1E 4N1, or you may forward your claims to the Toronto head office (See #4 above).
If you have further questions about Special Authorization, please call the Desjardins Financial Security customer service centre at 1-877-838-7763.
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