Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form HLTH5490 for the current year.

Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada

Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada is used to request special authority for the use of Obeticholic Acid medication in the province of British Columbia, Canada. Obeticholic Acid is a specific medication used for certain medical conditions and requires approval from the healthcare authority for coverage and access.

The Form HLTH5490 Special Authority Request for Obeticholic Acid in British Columbia, Canada is filed by the patient's healthcare provider.

FAQ

Q: What is the HLTH5490 Special Authority Request?
A: The HLTH5490 Special Authority Request is a form used in British Columbia, Canada for requesting coverage for medications, including Obeticholic Acid.

Q: What is Obeticholic Acid?
A: Obeticholic Acid is a medication used to treat a certain liver condition called primary biliary cholangitis.

Q: What is a Special Authority Request?
A: A Special Authority Request is a formal application for coverage of a medication that is not automatically covered under the public healthcare system.

Q: Who uses the HLTH5490 Special Authority Request form?
A: Residents of British Columbia, Canada, who need coverage for medications, including Obeticholic Acid, use the HLTH5490 Special Authority Request form.

Q: How do I fill out the HLTH5490 Special Authority Request form?
A: You need to provide information about yourself, your medical condition, and the medication you are requesting coverage for. Specific instructions can be found on the form itself.

Q: What happens after I submit the HLTH5490 Special Authority Request?
A: The request will be reviewed by the Ministry of Health to determine if you meet the eligibility criteria for coverage. You will be notified of the decision.

Q: Can I be denied coverage for Obeticholic Acid through the Special Authority Request?
A: Yes, it is possible to be denied coverage if you do not meet the eligibility criteria set by the Ministry of Health.

Q: Is there an alternative to the HLTH5490 Special Authority Request in Canada?
A: Each province in Canada has its own process for requesting coverage for medications. In some provinces, a similar form may be used, while others may have different processes.

Q: Can I appeal a denied Special Authority Request?
A: Yes, if your request for coverage is denied, you have the right to appeal the decision. Follow the instructions provided in the denial letter for the appeal process.

ADVERTISEMENT

Download Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada

4.7 of 5 (17 votes)
  • Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada

    1

  • Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada, Page 2

    2

  • Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada, Page 1
  • Form HLTH5490 Special Authority Request - Obeticholic Acid - British Columbia, Canada, Page 2
Prev 1 2 Next
ADVERTISEMENT

Related Documents