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WCB Nova Scotia Mandatory Generic Exemption Request

Prescribers use this one-page form when a worker with a WCB Nova Scotia claim medically requires a brand-name drug instead of the generic. It sets out the diagnosis, the drug, strength and dosage requested, the generic or brand products already tried with dates, duration and outcomes, and a description of any adverse reaction. Medavie Blue Cross, which processes WCB drug claims, evaluates the request.

Who completes it

The prescriber completes the whole form, including worker and injury details, and signs it with their licence number; the prescriber's fax number is mandatory.

Submitting and payment

How to submit it
Fax or mail it to Medavie Blue Cross, not to WCB; complete requests are reviewed in about seven business days, according to WCB's special authorization process sheet.
Who pays
WCB's special authorization billing sheet lists fee code WCB22 for this form, billed through MSI with WCB responsibility, although the May 2019 form prints WCB23; other prescribers invoice WCB directly.

Good to know

  • WCB will not cover or reimburse the cost difference between a brand-name and generic drug unless a Mandatory Generic Exemption is approved, even if a drug company card covers it for a time.
  • The medication history table asks for each generic or brand product tried, the date and duration of therapy and the outcome, plus the nature, extent and severity of any adverse reaction.
  • Form completion fees are separate from office visits, which are billed with their own fee codes, according to WCB's special authorization billing information.
  • If the request is approved, Medavie Blue Cross sends you a letter with the coverage terms and mails the patient a letter too; WCB legislation does not allow an appeal of the evaluation.

Get the official form

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

Mandatory Generic Exemption Request

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.

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Frequently asked questions

When does a WCB Nova Scotia patient need a Mandatory Generic Exemption?

When the patient medically requires a brand-name drug instead of the generic, as WCB's drug formulary page puts it. Without an approved exemption, WCB will not cover or reimburse the cost difference, even if the patient uses a drug company card that covers it for a time.

Which fee code do physicians use for the Mandatory Generic Exemption form?

WCB's special authorization billing information lists WCB22 for the Mandatory Generic Exemption form and WCB23 for the non-opioid special authorization form, billed through MSI with WCB responsibility. The May 2019 exemption form prints WCB23, and the billing sheet notes that rate changes are communicated through MSI's Physician Billing Manual. Other prescribers invoice WCB directly.

Where do I send the Mandatory Generic Exemption request?

To Medavie Blue Cross, which processes WCB Nova Scotia drug claims, by fax or mail as printed on the form. Include the correct WCB claim number, because some workers have more than one claim and drug coverage is tied to the formulary assigned to each injury.