All Special Authority eForms
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Download 19827
File Size 3.60 MB
File Count 24
Create Date April 25, 2020
Last Updated May 26, 2024
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Description

Do Not Use the DOWNLOAD button above. Click on"ATTACHED FILES" above,then download  the individual ZIP files that you need.

 

Thanks to Gunther Klein for cleaning up the side-menu in the SA Generic eFORM, V37_Jan10_2023.

Thanks to Stan Hurwitz, the 2023 Special Authority form for Empagliflozin/Semaglutide for Diabetes has been added.  This one has wet signature option.

SA_Empagliflozin_Semaglutide_V1_Jan8_2023 - has signature stamp option.

SA_3rd_Line_DM_Meds_V1_Jan8_2023 - replaces the previous 3rd line eFORM, as SGLT2 and GLP1 (injectables at least) are now 2nd line!

SA_COPD eForm updated latest 2022/10/17 background.  SA_COPD_V7_Nov8_2022 - to accommodate the new TripleRx product, Breztri

Updated 2021-Feb-19 16:26 3rd Line DM form changed between October and December of 2020. SA_Generic eForm updated to version 29 to accommodate

Updated January 7th 2021 - new signature script added

Updated December 22th 2020 to accommodate the newest 3rd line DM med eFORM. With content update per HerbC. If a specific one is required, there should be link. Please do not rename, as the links will break. You will have to "delete" (archive) your existing SA generic eFORM to allow this one to zip in.

Updated Dec 17 2020 - new coverage of diabetic medication also requiring new generic form.

Update Jul2020 - another major upgrade needed due to introduction of TWO new eFORMS - for COPD inhalers and ARBs. Some drugs no longer SA - e.g. Plavix. If a drug requires a specific form, you will automatically be shifted to the correct form. If you wish to go back to the main (generic) form, there is a link at the top of each eFORM. For this to work properly, you will need ALL the forms updated. Gotta get them all!

For medication coverage in BC. All other Special Authority eForms are linked to the SA Generic eFORM. This replaces the old Special Authority 2015 eFORM and has been fully updated. A few names are updated, so they will not link with older versions. Most of the names are the same, so if an eFORM does not zip import, please delete/archive the older version with the same name and try again.

SA_Analogue_Insulin is a request to Pharmacare to provide a list of patients who have been prescribed Insulin Lispro (Humalog) or Aspart (NovoRapid).  These insulins will no longer be covered fully, unless switched to their biosimilar products Admelog or Trurapi.

SA_DM_V9_Jan13_2022 - bug fixed that resulted in side warning being printed.

SA_Generic_V33_Apr21_2022.zip - fix broken link to Formulary Search

New SA form for Dapagliflozin for use in HFrEF now available.  Note - this requires additional measurement of LVEF, which may not be available on your system.  It will be evident if the eFORM does not save and you get a red-highlighted pop-up indicating this.  SA_Dapagliflozin_HFrEF_V1_Aug23_2022.zip

Plan P (aka BC Palliative Care Benefits Registration) is in a separate page now.

https://oscargalaxy.org/download/pharmacare-plan-p-bc-palliative-care-benefits-registration/

Plan G (psychiatric medication coverage) has been upgraded and is also on a separate page:

https://oscargalaxy.org/download/pharmacare-plan-g-psychiatric-medication-coverage/

Attached Files

24 files
zip
SA_Generic_V37_Jan10_2023.zip moved
235.21 KB
zip
SA_3rd_Line_DM_Meds_V1_Jan8_2023.zip -moved
256.78 KB
zip
SA_Empagliflozin_Semaglutide_V1_Jan8_2023.zip moved
247.06 KB
zip
Empagliflozin/Semaglutide for Diabetes - same as V1_Jan8_2023, but no signature stamp.
114.81 KB
zip
SA_Generic_V35_Nov5_2022.zip - main General form with links to drug-specific SA eFORMS
vV35_Nov5_2022234.94 KB2022-11-05
zip
SA_Generic_V33_Apr21_2022.zip Fix broken link to Formulary Search
v33_Apr20_2022234.7 KB2022-05-21
zip
SA_DM_V9_Jan13_2022.zip - obsolete as of Dec2022.
330.49 KB
zip
SA_COPD_V7_Nov8_2022.zip: moved
473.89 KB
zip
SA_Dapagliflozin_HFrEF_V1_Aug23_2022.zip. moved
267.72 KB
zip
PlanG_V6_May24_2020.zip Fix signature function, such that discrete dot is added if signature field is left blank. Previously, none of the signatures saved unless ALL the fields were completed in some fashion.
461.61 KB
zip
SA_ARB_V1_Jul14_2020.zip moved
290.21 KB
zip
SA_Basal_Insulin_V3_Jul14_2020.zip moved
121.36 KB
zip
SA_Analogue_Insulin_Initiative_V1_Jan8_2022.zip
220.07 KB
zip
SA_PPI_V10_Jul14_2020.zip moved
272.15 KB
zip
SA_CI_V7_Jul14_2020.zip moved
417.57 KB
zip
SA_DOAC_V10_Jul14_2020.zip SA eFORM to access direct oral anticoagulant (DOAC) drugs for stroke prevention in AF. To access DOAC for treatment of DVT/PTE, use the SA Generic eFORM.
377.62 KB
zip
SA_Ticagrelor_V3_Jul14_2020.zip moved
264.68 KB
zip
SA_LMWH_V6_Jul14_2020.zip SA eFORM to access injectable heparins for treatment and prevention of VTE. See SA VTE Cancer Pt for use of LMWH in cancer thrombosis.
314.93 KB
zip
SA_VTE_Cancer_Pt_V3_Jul14_2020.zip SA eFORM to access injectable heparins (LMWH) for cancer patients with VTE, or requiring VTE prevention, if Warfarin is contra-indicated. Not for CVA protection in AF.
201.33 KB
zip
SA_Filgrastim_V3_Jul14_2020.zip SA eFORM to access Filgrastim/Grastofil - for neutropenia.
266.54 KB
zip
SA_ADHD_V7_Nov16_2021.zip moved
313.21 KB2021-11-16
zip
SA_Sovaldi_V3_Jul14_2020.zip moved
336.93 KB
zip
SA_Harvoni_V6_Aug30_2022.zip SA eFORM to access Harvoni for HCV treatment, genotype 1 only. Only available to gastroenterology and infectious disease.
372.43 KB
zip
SA_Harvoni_V3_Jul14_2020.zip is Obsolete - please use V6_Aug20_20233
368.68 KB

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