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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HLTH5394
for the current year.
Form HLTH5394 Pharmacare Special Authority Request - Fingolimod for Multiple Sclerosis - British Columbia, Canada
Form HLTH5394 Pharmacare Special Authority Request - Fingolimod for Multiple Sclerosis - British Columbia, Canada is used to request special authority for coverage of the medication Fingolimod for the treatment of Multiple Sclerosis in the province of British Columbia, Canada.
The Form HLTH5394 Pharmacare Special Authority Request - Fingolimod for Multiple Sclerosis in British Columbia, Canada is typically filed by the healthcare professional treating the patient.
FAQ
Q: What is the HLTH5394 Pharmacare Special Authority Request?
A: HLTH5394 is a form used to request special authority from Pharmacare in British Columbia, Canada.
Q: What is Fingolimod?
A: Fingolimod is a medication used to treat multiple sclerosis.
Q: What is multiple sclerosis?
A: Multiple sclerosis is a chronic disease that affects the central nervous system.
Q: Why would someone need a special authority request for Fingolimod?
A: A special authority request is required to determine if a patient meets the criteria for coverage of Fingolimod under the Pharmacare program.
Q: Who can submit the HLTH5394 Pharmacare Special Authority Request?
A: The request can be submitted by a healthcare professional, such as a physician or nurse practitioner, on behalf of the patient.
Q: What is the purpose of the special authority request?
A: The purpose of the special authority request is to assess if the patient meets the criteria for coverage of Fingolimod under the Pharmacare program.
Q: What information is required on the HLTH5394 form?
A: The form requires information about the patient's medical condition, previous treatments, and supporting documentation from the healthcare professional.
Q: How long does the special authority request process take?
A: The processing time for a special authority request can vary, but it is typically 2-4 weeks.
Q: Is Fingolimod covered by Pharmacare in British Columbia?
A: Eligibility for coverage of Fingolimod under Pharmacare is determined through the special authority request process.
Q: Can a patient appeal if their special authority request is denied?
A: Yes, if a special authority request is denied, the patient has the right to appeal the decision.
Download Form HLTH5394 Pharmacare Special Authority Request - Fingolimod for Multiple Sclerosis - British Columbia, Canada
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