Industry initial medical statement used for Saskatchewan Blue Cross disability claims.
- Completed by
- Attending physician or other medical provider
- Issued by
- Saskatchewan Blue Cross
- Format
- Language
- English
Sask Blue Cross Special Authorization Form (CLMS-1006)
Saskatchewan Blue Cross group plans need this 2-page request before covering drugs on their Special Authorization list, which includes Exception Drug Status (EDS) drugs, specialty and high-cost therapies, and drugs with cheaper alternatives. A physician documents the diagnosis, dosing and treatments already tried. Saskatchewan residents with an EDS approval letter usually send that letter instead.
Who completes it
The member or patient completes page 1 (member, patient and coordination of benefits) and signs the consent, while the physician completes page 2's specialty drug details and signs the Physician Statement. A patient support program, physician or pharmacist coordinating the request fills in the coordinator section.
Submitting and payment
- How to submit it
- Send the form and supporting medical documentation to the Saskatchewan Blue Cross Claims Department by email, fax or mail, or upload it with the member portal or app's Submit a Document tool. Most complete requests receive a decision within 10 business days.
Good to know
- Wegovy, Saxenda, Contrave, Xenical and Zepbound use the separate Chronic Weight Management Special Authorization form (CLMS-1007), not CLMS-1006.
- Outside Saskatchewan, a decision letter from a comparable provincial special access program is accepted. If none exists, Blue Cross reviews this form against Saskatchewan's EDS criteria.
- Page 2 asks which other treatments were tried and their results, plus lab data or scores supporting the diagnosis and severity. Incomplete forms cause delays or requests for more information.
- A denied request can be appealed within three months with a written explanation and further clinical information. Most appeal decisions arrive within one month.
Get the official form
Download the current version from the source each time; forms change without notice.
Prescription Drug Special Authorization Form
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.
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
Does my patient need this form if they already have EDS approval?
Usually not, for Saskatchewan residents. Saskatchewan Blue Cross follows the Saskatchewan Drug Plan's medical criteria, so an EDS approval letter from the Drug Plan and Extended Benefits Branch, showing the drug and its effective and expiry dates, satisfies Special Authorization. The patient sends a copy of that letter instead of the form.
How long does a Saskatchewan Blue Cross special authorization review take?
Most Prescription Drug Special Authorization Request Forms receive a decision within 10 business days once complete documentation arrives. When an EDS decision letter is sent instead, Blue Cross typically updates its system within 5 business days. Missing information on the form leads to delays or requests for more details.
Where can I find Saskatchewan Blue Cross special authorization criteria?
Saskatchewan Blue Cross doesn't publish them, because criteria vary by drug and change over time; it asks members and providers to contact it about a specific drug. For drugs listed with EDS, the criteria match the Saskatchewan Drug Plan's. Members can check a drug's status in the member portal or mobile app.