When a practitioner needs a drug not marketed in Canada for a specific patient with a serious or life-threatening condition, Health Canada's Special Access Program uses Form A. It applies when conventional therapies have failed, are unsuitable or are unavailable in Canada. If authorized, the SAP sends a letter of authorization to the manufacturer, with a copy to the practitioner, permitting the sale of a set quantity.
The requesting practitioner, usually a licensed physician with prescribing privileges in the province, completes every section, from practitioner and shipping details to the clinical rationale and signed attestation; there is no patient section.
Download the current version from the source each time; forms change without notice.
Special Access Program (drugs) – Form A: Patient-specific request
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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 practitioner, usually a licensed physician, who is permitted under provincial or territorial law to treat with unapproved drugs, practises there and has prescribing privileges in that province. The practitioner signs the attestation with a licence or college number and agrees to report results and account for quantities received.
Health Canada's guidance says most requests are processed within one working day of receipt, and time-sensitive requests for immediately life-threatening conditions are typically resolved within hours. Unclear quantities lead to a request being returned, and failing to provide requested information can lead to a denial.
Yes. By signing Form A the practitioner agrees to report the results of use, including adverse drug reactions, and to account for quantities on request. Follow-up goes on Form C, and serious unexpected reactions must be reported within 15 days, or within seven days if fatal or life-threatening.