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Desjardins Drug Prior Authorization Forms (Group)

Desjardins Insurance group plans require prior authorization (PAD) for certain drugs, with drug-specific forms listed alphabetically, for example Aimovig (12567E), Dupixent (12568E) or Ozempic and Mounjaro (12613E), plus biosimilar forms for Humira, Eylea and Stelara. Drugs not on the list use the general form, 10108E. Correctly completed forms are processed in 5 business days.

Who completes it

The plan member selects the drug's form and completes the member sections; the attending physician completes the Attending physician section of each form.

Submitting and payment

How to submit it
Members return the signed form through the Desjardins secure site or by fax, and physicians can submit online through Desjardins' secure upload page.
Who pays
The plan member pays any fee the doctor charges for the medical statement, which Desjardins notes may qualify for a tax credit or health spending account reimbursement.

Good to know

  • If a provincial health plan covers the drug, claim there first, and if it is denied, submit a copy of the denial with the Desjardins request form.
  • Desjardins communicates one of three decisions, approved, deferred or declined, and the approval notice appears on the secure site under Claims history.
  • Obesity drugs such as Contrave, Saxenda, Wegovy, Xenical and Zepbound may not be covered, so check the plan booklet before submitting.
  • Some drugs are excluded from reimbursement altogether, and Desjardins says its exclusion list may change without notice.

Get the official form

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

Drug prior authorization

Official page

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.

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

How long does Desjardins take to process a prior authorization request?

Five business days from receipt, if the form is completed correctly. Desjardins then communicates whether the request is approved, deferred or declined, and members can view the approval notice on the secure site under Claims history and Processed claims.

Which Desjardins form do I use if the drug isn't listed?

Use the general prior authorization request form, 10108E. Desjardins lists drug-specific forms alphabetically by drug name, and for some listed drugs, such as Ayvakyt, Balversa or Cresemba, the link already points to the general form.

Can the physician send the Desjardins prior authorization form directly?

Yes. Desjardins lets physicians submit online through its secure upload page, while plan members return the completed, signed form through the secure site or by fax. The plan member remains responsible for any fee the doctor charges for completing the medical statement.