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NLPDP Special Authorization: Non-Insulin Anti-Diabetic

The Newfoundland and Labrador Prescription Drug Program covers several non-insulin diabetes drugs through special authorization, and this one-page form, revised in October 2026, lists them: DPP-4 inhibitors, SGLT2 inhibitors, metformin combinations and semaglutide (Ozempic). The prescriber documents HbA1c, the metformin trial and insulin use. Pharmaceutical Services assesses requests in the order received.

Who completes it

The prescriber, a physician or other healthcare professional, completes the patient, drug and clinical sections and signs with a licence number; a pharmacist may optionally add their name, pharmacy and signature.

Submitting and payment

How to submit it
Fax or mail the form to Pharmaceutical Services, Department of Health and Community Services, in St. John's; the fax number and mailing address are printed at the top.

Good to know

  • DPP-4 inhibitors and SGLT2 inhibitors will not be funded for patients using insulin, so the form asks directly whether the patient uses insulin.
  • The metformin question asks whether it was tried for at least 3 to 6 months, with dose, start and end dates and outcome, or the reason it was not.
  • Requests normally take about 10 working days. If declined, the prescriber can ask for an internal review, then a final review by a designated medical practitioner.
  • The form also asks whether the drug is combined with other antihyperglycemic agents, listing them; the October 2026 version replaces previous forms.

Get the official form

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

Special Authorization Request Form - Non-Insulin Anti-Diabetic Agents

Official pagePDF

Fill it with Vero

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.

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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

Which drugs are on the NLPDP non-insulin anti-diabetic form?

The form lists linagliptin (Trajenta), saxagliptin (Onglyza), sitagliptin (Januvia), the combinations Jentadueto, Komboglyze, Janumet, Janumet XR and Synjardy, canagliflozin (Invokana), empagliflozin (Jardiance) and semaglutide (Ozempic). The prescriber ticks the drug requested and enters the dose.

Does NLPDP cover SGLT2 inhibitors for patients on insulin?

Not under this form. It states that DPP-4 inhibitors and SGLT-2 inhibitors will not be funded for patients using insulin, and it asks the prescriber to answer yes or no to whether the patient is using insulin, alongside the HbA1c result and its date.

How long does an NLPDP special authorization take?

The form says special authorization requests normally take approximately 10 working days to process. Requests are assessed in the order received, and both the beneficiary and the requesting prescriber receive written notification of the program's decision.