Form HLTH5388 Special Authority Request - Adalimumab / Infliximab / Vedolizumab / Tofactinib for Ulcerative Colitis - Initial / Switch Coverage - British Columbia, Canada

Form HLTH5388 Special Authority Request - Adalimumab/Infliximab/Vedolizumab/Tofactinib for Ulcerative Colitis - Initial/Switch Coverage is used in British Columbia, Canada to request special coverage for the medications Adalimumab, Infliximab, Vedolizumab, or Tofacitinib for the treatment of ulcerative colitis.

The patient or their healthcare provider files the Form HLTH5388 Special Authority Request for Ulcerative Colitis - Initial/Switch Coverage in British Columbia, Canada.

FAQ

Q: What is the Special Authority Request form for?A: The Special Authority Request form is for requesting coverage of medications like Adalimumab, Infliximab, Vedolizumab, and Tofacitinib for Ulcerative Colitis in British Columbia, Canada.

Q: What medications are covered by this form?A: This form covers medications such as Adalimumab, Infliximab, Vedolizumab, and Tofacitinib for treating Ulcerative Colitis.

Q: Who can use this form?A: This form can be used by residents of British Columbia, Canada.

Q: What is the purpose of this form?A: The purpose of this form is to request initial or switch coverage for Adalimumab, Infliximab, Vedolizumab, or Tofacitinib for Ulcerative Colitis.

Q: How do I submit this form?A: The form can be submitted by your healthcare provider on your behalf.

Q: What should I include with the form?A: You should include any supporting documentation, medical records, or test results that are relevant to your request.

Q: Is there a fee for submitting this form?A: No, there is no fee for submitting this form.