Newfoundland and Labrador's Prescription Drug Program publishes 25 criteria-based special authorization forms for specific drugs or classes, from antiplatelet therapy and inhalers for asthma and COPD to hepatitis C treatment, HIV PrEP, Paxlovid and blood glucose test strips. Each prompts for the clinical information that drug's criteria require, and Pharmaceutical Services assesses requests in the order received.
A health care professional completes the form on the beneficiary's behalf, usually the prescriber; some forms include an optional pharmacist block.
Download the current version from the source each time; forms change without notice.
NLPDP drug-specific Special Authorization Request Forms (25 forms)
If your copy of the form is a fillable PDF, upload it 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.
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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The 25 forms cover antiplatelet therapy, anti-fibrotic therapy, atopic dermatitis, biologics for asthma, nasal polyps and migraine, plaque psoriasis, oral ciprofloxacin, type 2 diabetes with high cardiovascular risk, hepatitis C, HIV PrEP, IBD, inhalers, insulin detemir, post-surgical LMWH, Paxlovid, non-insulin anti-diabetics, ophthalmic VEGF inhibitors, phosphate binders, rheumatoid arthritis, Tamiflu in long-term care, test strips, topical antipsoriatics and Cabenuva.
No. NL's special authorization page says use of the forms is not mandatory but is encouraged to expedite assessment. A request must still be made by a health care professional on the beneficiary's behalf, and coverage is assessed only once the required clinical information is received.
Under the Pharmaceutical Services Act, the prescriber may request an internal review of the decision. If the request is denied again, the prescriber can seek a final review by a designated medical practitioner. The beneficiary and the prescriber receive written notification of the program's decision.