Form HLTH5388 Special Authority Request - Adalimumab / Infliximab / Vedolizumab / Tofactinib for Ulcerative Colitis - Initial / Switch Coverage - British Columbia, Canada

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form HLTH5388 for the current year.

Form HLTH5388 Special Authority Request - Adalimumab / Infliximab / Vedolizumab / Tofactinib for Ulcerative Colitis - Initial / Switch Coverage - British Columbia, Canada

Form HLTH5388 Special Authority Request - Adalimumab/Infliximab/Vedolizumab/Tofactinib for Ulcerative Colitis - Initial/Switch Coverage in British Columbia, Canada is a document used to request special authority coverage for certain medications (Adalimumab, Infliximab, Vedolizumab, and Tofacitinib) for the treatment of ulcerative colitis. This form is specific to the province of British Columbia in Canada and is used when individuals need to initiate or switch to these particular medications for managing their ulcerative colitis condition. The form helps the healthcare system assess the eligibility and coverage for these medications under the special authority program in British Columbia.

The form HLTH5388 Special Authority Request for Adalimumab/Infliximab/Vedolizumab/Tofactinib for Ulcerative Colitis - Initial/Switch Coverage in British Columbia, Canada is filed by the patient or their authorized representative. The form is used to request coverage for these medications specifically for the treatment of ulcerative colitis.

FAQ

Q: What is a Special Authority Request?
A: A Special Authority Request is a process in which a healthcare professional can request coverage for a medication that is not typically covered under the regular drug benefit program.

Q: What is Adalimumab?
A: Adalimumab is a medication used to treat ulcerative colitis, an inflammatory bowel disease that affects the lining of the colon and rectum.

Q: What is Infliximab?
A: Infliximab is a medication used to treat ulcerative colitis. It works by suppressing the immune system and reducing inflammation in the gut.

Q: What is Vedolizumab?
A: Vedolizumab is a medication used to treat ulcerative colitis. It works by specifically targeting the gut immune system to reduce inflammation.

Q: What is Tofacitinib?
A: Tofacitinib is a medication used to treat ulcerative colitis. It works by suppressing the immune system and reducing inflammation in the gut.

Q: Who can request Special Authority coverage for these medications?
A: Healthcare professionals, such as doctors or nurse practitioners, can request Special Authority coverage for these medications on behalf of their patients.

Q: Why would someone need Special Authority coverage for these medications?
A: Special Authority coverage may be needed for these medications if they are not covered under the regular drug benefit program or if the patient does not meet the regular criteria for coverage.

Q: How can a healthcare professional request Special Authority coverage?
A: A healthcare professional can request Special Authority coverage by completing the HLTH5388 Special Authority Request form and submitting it to the appropriate authority in British Columbia, Canada.

ADVERTISEMENT

Download Form HLTH5388 Special Authority Request - Adalimumab / Infliximab / Vedolizumab / Tofactinib for Ulcerative Colitis - Initial / Switch Coverage - British Columbia, Canada

4.6 of 5 (28 votes)
  • Form HLTH5388 Special Authority Request - Adalimumab/Infliximab/Vedolizumab/Tofactinib for Ulcerative Colitis - Initial/Switch Coverage - British Columbia, Canada

    1

  • Form HLTH5388 Special Authority Request - Adalimumab/Infliximab/Vedolizumab/Tofactinib for Ulcerative Colitis - Initial/Switch Coverage - British Columbia, Canada, Page 2

    2

  • Form HLTH5388 Special Authority Request - Adalimumab / Infliximab / Vedolizumab / Tofactinib for Ulcerative Colitis - Initial / Switch Coverage - British Columbia, Canada, Page 1
  • Form HLTH5388 Special Authority Request - Adalimumab / Infliximab / Vedolizumab / Tofactinib for Ulcerative Colitis - Initial / Switch Coverage - British Columbia, Canada, Page 2
Prev 1 2 Next
ADVERTISEMENT