Drug Benefit List - Forms

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Forms

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The iDBL is a real time document that is updated daily.

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Printable Drug Benefit List and Related Publications

DBL Table of Contents

(Note: This contains the amended Price Policy as of February 13, 2019)

Special Authorization Forms

Note:These special authorization forms must be completed and signed by an authorized prescriber (e.g. physician, dentist or optometrist) who is requesting coverage on your behalf. In some instances, the patient may also be required to sign the forms.

They can be printed, then completed and signed by hand, or they can be filled in on-line, printed and then signed before sending to Alberta Blue Cross.

For more information on criteria for special authorization please click here (PDF).

Drug Special Authorization Request Form (PDF) (ABC 60015)

Forms for physicians

Your Comments are Important to Us

Please note: This is not a mechanism for appeal for a specific patient but pertains to drug product eligibility in general.

Online version Physician Feedback (PDF)

Notice:

The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.

Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.

Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL (iDBL), and any such changes to the Interactive DBL (iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.