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Canada Life Quebec Exceptional Medications Form (M6453)

Canada Life uses this five-page form to assess a Quebec plan member's claim for a drug on RAMQ's exceptional medications list. The prescribing physician confirms whether the drug is prescribed for an indication matching a RAMQ payment code and, if so, gives the code; otherwise the physician states which exception criteria are met. Canada Life's Drug Claims Management team reviews the completed form.

Who completes it

The plan member completes the Patient Information pages and signs the consent and declaration; the prescribing physician completes the Physician Information section and signs with a licence number.

Submitting and payment

How to submit it
Mail, fax or email all pages to Canada Life's Drug Claims Management team; Canada Life notes email is not a secure medium and suggests other channels for anyone concerned.
Who pays
Any costs incurred to complete the form are the plan member's or patient's responsibility, as stated on its first page.

Good to know

  • If the drug matches a RAMQ exceptional medication code for the indication, the physician enters the code; if not, they list the RAMQ exception criteria met, the diagnosis and the diagnosis date.
  • The physician also gives the dose and regimen, patient weight for weight-based dosing, anticipated treatment dates and where treatment will be administered.
  • Patient pages cover other group coverage, provincial programs (with acceptance or decline documents) and whether the patient receives disability benefits for the condition.
  • Canada Life may audit the information on the form; its page also asks members to have their doctor apply to the RAMQ program.

Get the official form

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

Quebec Exceptional Medications Form

Official pagePDF

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.

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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

What is the RAMQ code on the Canada Life Exceptional Medications form?

Question 6 asks whether the drug is on RAMQ's List of Codes for Exceptional Medications and prescribed for an indication that matches the payment indication for that code. If yes, the physician enters the RAMQ code; if no, they refer to RAMQ's List of Medications and describe the exception criteria met.

How does this form differ from Canada Life's Exception Patient form?

Both are M6453 forms for Quebec plan members with the same patient pages. The Exceptional Medications version (RAMQEXM) asks for a RAMQ code or the exception criteria met, while the Exception Patient version (RAMQEXPP) has 18 detailed questions on functional limitation, prior treatment and therapeutic goals.

Who pays for completing Canada Life's Quebec Exceptional Medications form?

The plan member or patient. The first page states that any costs incurred for completing the form are their responsibility. Canada Life also asks that every question be answered, warning that an incomplete or erroneous form will delay the claim assessment.