Some drugs on the NIHB Drug Benefit List are limited use benefits, covered for First Nations and Inuit clients only when specific criteria are met. Most require prior approval through this request, which the Drug Exception Centre faxes to the prescriber after the pharmacy contacts the Centre. The prescriber shows how the client meets the criteria listed for that drug in the Drug Benefit List.
The licensed prescriber completes the form to show the client meets the drug's limited use criteria; the pharmacy provider starts the request with the Drug Exception Centre.
Download the current version from the source each time; forms change without notice.
Limited Use Benefit Request Form (NIHB)
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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.
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A product listed on the NIHB Drug Benefit List that has specific criteria for coverage, identified in the Drug Benefit List itself. Most limited use benefits need prior approval through the Limited Use Benefit Request Form, though some are approved automatically when the claims system verifies the prerequisite therapy.
The pharmacy provider contacts the Drug Exception Centre when a client is prescribed a product requiring prior approval. The Centre may fax the request form to the prescriber, who completes it with the clinical information showing the criteria are met. Pharmacies can also submit prior approval requests online through their NIHB web account.
A confirmation letter outlining the approval period and prior approval details is faxed or mailed to the pharmacy provider, who should keep it for billing. Approvals are entered electronically, and an approval does not override program policies for claim submissions.