Obtaining special authorization is the first step toward coverage for certain medications through your ASEBP drug plan. Before your provider submits the request form, take a few minutes to review these helpful tips to stay informed and avoid delays.
What to know before your health care provider appointment
Before you ask your provider to submit a request on your behalf, consider the following:
- Know which drugs are covered: Coverage details can be found by logging into your My ASEBP account or reviewing the ASEBP drug plan. For example, ASEBP covers Health Canada-approved weight loss medications (i.e. Wegovy, Saxenda, Contrave, and Orlistat), but most require special authorization first.
- Check your coverage details: Your Extended Health Care plan level affects how much is reimbursed for medications. Find your plan level by logging into your My ASEBP account or looking at the back of your printed ASEBP ID card.
- Review the form to understand the criteria: Special authorization typically requires clinical information. For example, weight loss medications may request your body mass index (BMI) and other relevant weight-related health conditions such as cardiovascular disease or Type 2 diabetes.
- Ensure your provider submits the correct form: Your provider must fill out the specific special authorization request form for the medication requested. Please double check that your health care provider has the proper paperwork. For weight loss medications, special authorization requests must be submitted using this specific form which your provider will not be able to access on their own. ASEBP highly recommends that you print a copy to bring to your appointment.
Tips for completing the special authorization form
- Provide your legal name and ASEBP ID number. Using your correct legal name and providing your ID number will ensure that requests are accurately matched and processed, reducing the likelihood of submission issues.
- Bring accurate health details to your health care provider appointment. Give recent medical history and relevant information to your provider to help them correctly complete the form.
- Ask about expectations. Some medications have specific requirements such as follow-up checks with your health care provider after starting the drug. Clarify with your health care provider what follow-up is needed. More details about ongoing authorization and monitoring, specific to weight loss medication, can be found in the Ask Our Pharmacist article, Understanding Your Coverage for Weight Loss Medications.
- Understand processing times. Special authorization requests and renewals can take up to 14 business days once your health care provider submits the completed form. ASEBP will not have any information specific to your request until a decision has been made and recommends checking your My ASEBP account within the 14-day period to see if your decision has been returned to you. If further information is required after the provider has submitted, resubmissions or new requests may take up to an additional 14 days to process. Please take care to submit renewal requests in time to ensure your treatment plan is not impacted.
- Use My ASEBP to follow up on the decision. Once the special authorization is reviewed, you will find the decision in My ASEBP under Documents > Drug Special Authorizations. You will also receive an alert to the email associated with your My ASEBP account when the decision is ready. To protect your privacy, ASEBP benefit specialists do not receive specific reasons or details about the decision. Please contact your health provider for more information.
For more information about special authorizations for weight loss medications specifically, check out ASEBP’s Ask Our Pharmacist article coverage for weight loss medications. You can also submit your own questions to ASEBP’s pharmacist on this or any other topic via the online form or email.