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c/glp1canada·posted 6 days ago by u/ahmed_abubakar

[Question] does anyone have the special authorisation criteria in writing

Question

does anyone have the special authorisation criteria in writing. Searched first, found three threads that contradict each other, hence the post.

Special authorization is a documented exception process with published criteria. Applications that answer those criteria explicitly, point by point, fare better than general clinical narratives.

How to write a special authorization request that gets approved.

Get the published criteria for your province. Answer them explicitly, in their own terms, in the same order. Attach what has been documented — what was tried, at what dose, for how long, with what outcome — as dates rather than narrative. Where a criterion cannot be met, have the prescriber say why in the criterion’s own language rather than around it.

Members here who have done this describe a much better hit rate than those who submitted a clinical letter that did not engage with the form. It is an administrative exercise, and treating it as one is the whole trick. None of which is advice — it is what the threads report.

Cash pricing, which people skip because they assume coverage is the only route.

Prices at the counter vary between pharmacies, sometimes substantially, in the same city. Members here have found spreads worth a real amount per month by ringing four places and asking for the cash price of a specific presentation.

That does not make coverage unimportant. It does mean that while an authorization is in process — which can take weeks — knowing the actual cash spread is worth half an hour of phone calls. Post what you find with the province and the month; the comparison threads here work for exactly the same reason the UK pricing tracker does.

Please do not ask me what dose you should be on. I genuinely do not know and neither does anyone else here.

121 up / 42 down74% upvoted11 commentsid yvzxiw23 Jul 2026

11 comments

11 in this archive, depth 5

best — the order this archive was captured in

u/matias_salgado9 points·6 days ago

Formulary criteria are revised, and plan renewal is a natural point at which a previously refused request may succeed without anything about the applicant changing.

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u/oskar_kaufmann4 points·6 days ago

Correction: that is regulatory approval, not coverage. They are separate decisions by separate bodies.

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u/emil_barros3 points·5 days ago

Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.

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u/controversial_only1 point·6 days ago

Was this a denied authorization or a rejected claim?

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u/ahmed_abubakarOP1 point·5 days ago

Confused a rejected claim with a denied authorization for a month and pursued entirely the wrong process.

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u/paper_trail_paulavetting1 point·5 days ago

That is an employer plan process, and the provincial route is different in both form and timeline.

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u/bence_zamora7 points·5 days ago

Is there a quantity limit involved rather than a coverage refusal?

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u/pavel_kravchenko3 points·5 days ago

keep every form, every date, every reference number

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[deleted]2 points·4 days ago

[deleted]

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u/zeynep_duarte1 point·4 days ago

Not convinced. A rejected claim at the counter is not a denied authorization and the next step differs.

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u/milos_vestergaard1 point·4 days ago

the exception drug status route exists in several provinces

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Canadian access: provincial formulary differences, private plan coverage, the special-authorisation process, cross-border pricing arbitrage and why the Ontario answer is not the Alberta answer.

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