Prescriber's request for an exemption from WCB's mandatory generic drug policy.
- Completed by
- Prescriber
- Issued by
- WCB Nova Scotia
- Format
- Fillable PDF
- Language
- English
WCB NS Non-Opioid Special Authorization Request
Prescribers use this one-page form to ask WCB Nova Scotia to cover a non-opioid medication that is not automatically covered in the worker's formulary, or a dose above its quantity limit. It records the diagnosis, the requested product, directions and duration, the expected benefit to recovery or, for renewals, the functional improvement seen, and the medications and non-drug therapies already tried. Opioids have their own form.
Who completes it
The prescriber completes the whole form and signs it with their licence number; the medications-tried table and the prescriber's fax number are mandatory.
Submitting and payment
- How to submit it
- Fax or mail it to Medavie Blue Cross, which reviews complete requests in about seven business days and sends written notice of the decision.
- Who pays
- Physicians bill fee code WCB23 through MSI for the completed form, separately from the office visit, and other prescribers such as nurse practitioners invoice WCB directly.
Good to know
- Workers are assigned a formulary by nature of injury, so a drug that is an open benefit on one claim may need special authorization on another, even for the same patient.
- WCB's quick reference guide lists gabapentin, pregabalin and Cymbalta as special authorization drugs for musculoskeletal and nerve injuries, while esomeprazole is not a benefit for any injury type.
- Original requests explain the expected benefit to recovery and can cite a contraindication, adverse event or therapeutic failure; renewals outline clinical effectiveness or functional improvement.
- WCB legislation does not allow an appeal of Medavie Blue Cross's evaluation, but you can resubmit with more information if the criteria were not met.
Get the official form
Download the current version from the source each time; forms change without notice.
NON-OPIOID Special Authorization Request 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.
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Frequently asked questions
When is a non-opioid special authorization needed for a WCB Nova Scotia claim?
When the medication is not automatically covered by the worker's formulary, which depends on the type of injury, or when the prescribed amount exceeds the drug's quantity limit. If the requested drug is an opioid, use the opioid special authorization form instead. Medavie Blue Cross can confirm a drug's coverage status if you have the claim number.
How long does WCB Nova Scotia special authorization take?
WCB's special authorization process sheet says complete submissions should take a maximum of about seven business days, handled first in, first out, with priority for antibiotics, antivirals, cancer medications and addiction medications. If significant sections are incomplete, Medavie Blue Cross contacts you for the missing information first.
Can a WCB patient pay for the drug and claim it back?
WCB's guidance says not to encourage this: receipts for drugs outside the worker's formulary need an approved special authorization before reimbursement can be processed. If coverage is denied at the pharmacy, the patient is referred back to you for an alternative, a covered drug, or a special authorization request.