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SPECIAL AUTHORIZATION REQUEST From The Newfoundland and Labrador Prescription Drug Program (NL PDP) For Continuation of Coverage of Cholinesterase Inhibitor Pharmaceutical Services Department of Health

How to fill out nlpdp special authorization form

How to fill out NLPDP Special Authorization Form:

1. Obtain the NLPDP Special Authorization Form: The form can be obtained from your healthcare provider, pharmacy, or directly from the Newfoundland and Labrador Prescription Drug Program (NLPDP) website.
2. Fill out personal information: Provide your full name, date of birth, address, and contact information in the designated fields on the form.
3. Specify the medication: Indicate the name of the medication for which you are seeking special authorization. Include the dosage strength and form (e.g., tablet, capsule, injection).
4. Provide medical details: In the relevant section, describe the medical condition for which the medication is being prescribed. You may need to provide details such as the diagnosis, duration of the condition, and any previous treatments attempted.
5. Attach supporting documents: Attach any supporting documents that are requested on the form. This may include medical records, test results, or a letter of recommendation from your healthcare provider. Make sure to include all the necessary documents to strengthen your case.
6. Complete the prescriber section: If the medication was prescribed by a healthcare provider, ensure they fill out their information, including their name, contact details, and professional credentials.
7. Submit the form: Once you have filled out the form and gathered all the necessary documents, submit it to the NLPDP through the specified method. This could be via mail, fax, or online submission, as indicated on the form.

Who needs NLPDP Special Authorization?

1. Patients prescribed high-cost medications: The NLPDP Special Authorization is typically required for medications that are considered high-cost or have specific coverage criteria. It ensures that these medications are only provided to eligible patients who meet certain medical requirements.
2. Individuals with specific medical conditions: The authorization form is often required for medications that are used to treat complex or rare medical conditions. These conditions may necessitate a more thorough review of the patient's medical history and treatment options.
3. Patients seeking coverage for non-formulary drugs: Non-formulary drugs are medications that are not typically covered by the standard drug plan. If you are prescribed a non-formulary drug, you may need to obtain special authorization to have it covered under the NLPDP.

Remember, specific eligibility criteria and coverage requirements may vary, so it is important to consult with your healthcare provider or the NLPDP directly to determine if you require special authorization for your medication.

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What is nlpdp special authorization for?

NLPDP special authorization is a process that allows patients to access certain medications or healthcare services that are not typically covered by their provincial drug plan.

Who is required to file nlpdp special authorization for?

Patients who require medications or healthcare services that are not covered by their provincial drug plan are required to file NLPDP special authorization.

How to fill out nlpdp special authorization for?

To fill out NLPDP special authorization, patients usually need to provide their personal information, medical history, prescribing physician's information, and supporting documentation from the physician.

What is the purpose of nlpdp special authorization for?

The purpose of NLPDP special authorization is to ensure that patients can access necessary medications or healthcare services that are otherwise not covered by their provincial drug plan.

What information must be reported on nlpdp special authorization for?

The information that must be reported on NLPDP special authorization usually includes personal information of the patient, medical information, prescribing physician's information, and supporting documentation.