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Alberta Drug Special Authorization Request (ABC 60015)

Prescribers use this one-page general request to seek special authorization for a drug under Alberta government-sponsored drug programs, administered by Alberta Blue Cross, when no drug-specific form applies. It asks for the drug, dosage and duration, the diagnosis or indication, previous medications and the patient's response, and marks the request as new or a renewal. Approval is not guaranteed.

Who completes it

An authorized prescriber completes and signs the whole form, giving their professional association registration (CPSA, CARNA, ACP, ACO, ADA+C, CDA or other) and the coverage type: Alberta Blue Cross, Alberta Human Services or other.

Submitting and payment

How to submit it
Fax or mail it to Alberta Blue Cross Clinical Drug Services; once a fax transmits successfully, do not mail or re-fax it.

Good to know

  • Check the Alberta Blue Cross list of about 106 drug-specific forms first; this general request is for drugs without their own form.
  • Special authorization criteria are published in section 3 of the Alberta Drug Benefit List, which the Government of Alberta can change without notice through the interactive DBL.
  • A fax number must be provided with each request, and the form asks for the patient's Alberta Personal Health Number and client or coverage number.
  • Alberta Blue Cross says the forms can be filled in online, then printed and signed, or printed and completed by hand.

Get the official form

Download the current version from the source each time; forms change without notice.

Drug Special Authorization Request

Official pagePDF

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

When should I use ABC 60015 instead of a drug-specific form?

Use it when the drug has no drug-specific special authorization form. Alberta Blue Cross lists about 106 drug-specific forms in the ABC 600xx series, such as celecoxib (ABC 60032) or DPP-4, SGLT2 and GLP-1 drugs (ABC 60012), and those forms print their own coverage criteria.

Who can sign an Alberta drug special authorization request?

An authorized prescriber who is requesting coverage on the patient's behalf, such as a physician, nurse practitioner, pharmacist, optometrist or dentist. The prescriber identifies their professional association registration and number on the form, and Alberta Blue Cross notes that some forms also need the patient's signature.

Is approval guaranteed once ABC 60015 is submitted?

No. The form states that a request may or may not be approved by Alberta Blue Cross. It asks for the drug, dosage and duration, the diagnosis or indication, and previous medications with the patient's response, and the criteria for special authorization drugs are set out in section 3 of the Alberta Drug Benefit List.