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Alberta Drug-Specific Special Authorization Forms

Alberta Blue Cross publishes about 106 drug-specific special authorization forms in the ABC 600xx series for Alberta government-sponsored drug programs, from celecoxib (ABC 60032) to DPP-4, SGLT2 and GLP-1 drugs (ABC 60012). Each prints the coverage criteria for its drugs and asks the questions those criteria need. Drugs without their own form use the general request, ABC 60015.

Who completes it

An authorized prescriber, such as a physician, dentist or optometrist, completes and signs each form on the patient's behalf; Alberta Blue Cross notes the patient may also need to sign some forms.

Submitting and payment

How to submit it
Fax or mail the signed form to Alberta Blue Cross Clinical Drug Services as printed on each form; once a fax transmits successfully, do not mail or re-fax it.

Good to know

  • Approval periods are drug-specific: the celecoxib form allows special authorization for six months with auto-renewal, while the DPP-4, SGLT2 and GLP-1 form allows up to 24 months.
  • Criteria for every special authorization drug are in section 3 of the Alberta Drug Benefit List, which the Government of Alberta can change without notice through the interactive DBL.
  • Some entries on the forms list are pricing authorization, consent or patient-list forms rather than drug request forms.
  • Forms such as ABC 60012 and ABC 60032 ask for the coverage type, the patient's Alberta Personal Health Number and a prescriber fax number, which is mandatory.

Get the official form

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

Drug-specific Special Authorization Request Forms (Alberta Drug Benefit List)

Official page

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

Where do I find the Alberta Blue Cross special authorization form for a drug?

On the Alberta Drug Benefit List forms page, which lists drug-specific forms by drug with their ABC numbers, for example montelukast (ABC 60039), fentanyl (ABC 60005), intravenous iron (ABC 60085) and dabigatran or edoxaban (ABC 60019). If no form matches the drug, use the general request, ABC 60015.

Can Alberta special authorization forms be filled in online?

Yes. Alberta Blue Cross says the forms can be filled in online, then printed and signed, or printed and completed by hand. They must be signed by the authorized prescriber who is requesting coverage on the patient's behalf, and some forms also need the patient's signature.

Which programs do these special authorization forms apply to?

Alberta government-sponsored drug programs administered by Alberta Blue Cross under the Alberta Drug Benefit List; the forms note that patients may or may not meet those programs' eligibility requirements. The forms page links to Coverage for Seniors, Non-Group Coverage, Palliative Coverage and the Alberta Child Health Benefit.