ClaimSecure – provides on-line claims service for the adjudication and reimbursement of eligible drug expenses.
Special Authorization
A broad range of prescription drugs are covered under the AFBS formulary, however, not all prescription drugs are covered. Also, certain drugs or categories of drugs may require a request for Special Authorization or coordination with your provincial drug plan. Typically, expensive new drugs providing minimal or no increased therapeutic value would not be added to the formulary.
Special Authorization may also be required in situations where the patient has not responded to first line therapies or where the drug may have potential for widespread use outside of approved use. From time to time new drugs are added to the Special Authorization Drug List.
Special Authorization Process
If you are prescribed a prescription drug which requires special authorization, or discover at the pharmacy that your prescription drug requires Special Authorization, please follow the Steps to Obtain Special Drug Authorization, as appropriate.
The Special Authorization process includes the completion of a brief questionnaire by your Medical Doctor outlining the medical justification for the prescribed medication. The questionnaire is reviewed by the clinical pharmacists at ClaimSecure who have been contracted by AFBS to provide this service and who follow accepted medical and pharmacological protocols. Their review is done on a completely confidential basis.
You will be responsible for any costs your Medical Doctor may charge for the completion of the Special Authorization form. A generic Special Authorization form is included in the "Forms" section of the Arts & Entertainment Plan™ website or by contacting the Arts & Entertainment Plan™ administrator at AFBS.
IMPORTANT: The Special Authorization Drug List is updated regularly, with new prescription drugs/medications added; criteria updated and, on occasion, drugs removed from special authorization. This list is current as at the date noted. Every attempt has been made to ensure the accuracy of the information provided, however, if there are discrepancies the medical and pharmacological protocols in place at ClaimSecure will apply. ClaimSecure has been contracted by AFBS to provide prescription drug Formulary management, including the Special Authorization process.
Program Handbook > Prescription Drug Care
