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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HLTH5484
for the current year.
Form HLTH5484 Special Authority Request - Sacubitril-Valsartan Combination - British Columbia, Canada
Form HLTH5484 Special Authority Request - Sacubitril-Valsartan Combination in British Columbia, Canada is used to request special authorization for access to the medication combination of Sacubitril and Valsartan. This form is typically used when a patient's condition requires this specific medication and it may not be covered under their regular drug plan.
The form HLTH5484 Special Authority Request - Sacubitril-Valsartan Combination in British Columbia, Canada is typically filed by healthcare providers or physicians on behalf of their patients.
FAQ
Q: What is the HLTH5484 Special Authority Request?A: The HLTH5484 Special Authority Request is a form used in British Columbia, Canada to request coverage for the Sacubitril-Valsartan Combination medication.
Q: What is Sacubitril-Valsartan Combination?A: Sacubitril-Valsartan Combination is a medication used to treat heart failure.
Q: Who can use the HLTH5484 Special Authority Request form?A: The HLTH5484 Special Authority Request form is for healthcare providers in British Columbia.
Q: Why do healthcare providers need to use this form?A: Healthcare providers use this form to request coverage for the Sacubitril-Valsartan Combination medication for their patients.
Q: Is this form specific to British Columbia?A: Yes, the HLTH5484 Special Authority Request form is specific to British Columbia, Canada.
