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Nova Scotia Pharmacare Specialized ESD Request Forms

Beyond its standard request, Nova Scotia Pharmacare publishes 58 forms built around the coverage criteria for a specific drug or condition, from rheumatoid arthritis and Crohn's disease to proton pump inhibitors, long-acting insulin analogues and sensor-based glucose monitoring. Prescribers use the matching form to show the patient meets criteria set by the Atlantic or Canadian Expert Advisory Committees.

Who completes it

The prescriber completes each form, including the patient's name, health card number and date of birth, the criteria questions for that drug, and their licence number and signature.

Submitting and payment

How to submit it
Mail or fax the completed form to Nova Scotia Pharmacare Programs as printed on it, or submit online through Ocean if the provider takes part in the Pharmacare ESD Pilot.

Good to know

  • Nova Scotia's exception status drugs page groups forms by category, including arthritis, cardiovascular disease, diabetes, migraines, multiple sclerosis, respiratory and sinus conditions, and skin disorders, with a keyword filter.
  • Some conditions have separate forms for initial approval and renewal, such as Ultomiris for atypical hemolytic uremic syndrome.
  • Forms may be added or changed at any time; each shows a revision date, such as 10/2025 on the ADHD form, so check for the current version.
  • Drugs without a specialized form use the Standard Exception Status Drug request, which asks for diagnosis, drug and dosage, and the reason: contraindication, adverse event, therapeutic failure or other.

Get the official form

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

Pharmacare Programs specialized exception status drug request forms (58 drug/condition-specific forms)

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.

See how Vero Documents works

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

Which conditions have a specialized Nova Scotia exception status drug form?

The 58 forms cover areas such as rheumatoid and psoriatic arthritis, ankylosing spondylitis, ADHD, Entresto, diabetes agents and glucose sensors, asthma and COPD inhalers, migraine prevention, multiple sclerosis, hepatitis C, HIV PrEP, Crohn's disease, ulcerative colitis, psoriasis, hidradenitis suppurativa and atopic dermatitis.

How often do Nova Scotia's exception status drug forms change?

Nova Scotia warns that forms may be added or changed at any time. Each form carries a revision date, and the exception status drugs page shows when each was last updated, so prescribers should download the current version rather than reuse a saved copy.

Can specialized exception status drug requests be sent online in Nova Scotia?

Yes, for providers with an Ocean account, who can send exception status drug requests online through Ocean as part of the Pharmacare ESD Pilot. Other prescribers mail or fax the PDF form to Nova Scotia Pharmacare Programs using the details printed on it.