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Enhanced Special Authorization Process

Certain prescription drugs require special authorization by ASEBP before we can approve coverage for them under your Extended Health Care benefits. These are high-cost specialty drugs used to treat potentially catastrophic conditions that can become more severe over time.

As a not-for-profit health and welfare trust, ASEBP has finite resources to draw upon to assist covered members in maintaining and improving their health. So, when we analyzed our claims activity and realized that five health conditions (chronic hepatitis C, Crohn’s disease/colitis, multiple sclerosis, psoriasis and rheumatoid arthritis) accounted for approximately 75% of our current annual spending on specialty drugs, we knew something would need to change to manage these rising costs.

To continue our commitment to providing health benefits and services that support the well-being of our covered members and their dependants, while ensuring the plan remains financially stable, on September 1, 2015, we introduced an enhanced special authorization process for drugs used to treat these five health conditions. This enhanced process will help us continue to offer the benefit coverage covered members need to remain healthy, now and in the future.

Use the links below to navigate to the topic you are interested in.

Covered health conditions
Who does the enhanced process affect?
Steps to follow for requesting specialty drug approval under the enhanced process
Enhanced special authorization request forms
Other information to know about enhanced special authorization
Special authorization requests for other conditions
Specialty drug approval renewals
Who to contact if you have questions


Which health conditions does the enhanced process cover?

  • Rheumatoid arthritis
  • Multiple sclerosis
  • Psoriasis
  • Crohn’s disease/colitis
  • Chronic hepatitis C

Who does the enhanced process affect?

Any covered member or dependant submitting a new or renewal request to ASEBP for a specialty drug used to treat of one of the listed health conditions.


Steps to follow to request approval

If you require a specialty drug treating one of these five health conditions: chronic hepatitis C, Crohn’s disease/colitis, multiple sclerosis, psoriasis or rheumatoid arthritis, please follow the steps below.


SA process

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT: At times, physicians and pharmaceutical support groups may provide doses of certain specialty drugs before benefit plans have processed special authorization requests. Be advised that should a course of treatment commence prior to receiving enhanced special authorization approval from ASEBP, there is a chance that coverage will not be approved and you will be responsible for the costs.

Enhanced special authorization request forms

The enhanced special authorization process is managed by its own set of ASEBP Enhanced Special Authorization Request forms. Each of the five health conditions covered by the enhanced process has a form tailored to its condition's unique diagnostic and treatment process. These forms need to be completed by both the covered member and their physician, then submitted by the physician to ASEBP for review. Access ASEBP Enhanced Special Authorization Request forms.


Other information to know about enhanced special authorization

  • Unlike special authorization requests, for enhanced special authorization requests you are required to provide consent on the form that corresponds to the health condition for which you’re seeking treatment.
  • At times, physicians and pharmaceutical support groups may provide doses of certain specialty drugs before benefit plans have processed special authorization requests. Be advised that should a course of treatment commence prior to receiving enhanced special authorization approval from ASEBP, there is a chance that coverage will not be approved and you will be responsible for the costs.
  • Enhanced special authorization was established by working with medical and other industry experts to review clinical data, medical and other research on the product and governmental guidelines.

Special Authorization requests for other conditions

If you require special authorization for a specialty drug used to treat a condition outside of the ones covered by the enhanced special authorization process (e.g. ankylosing spondylitis, psoriatic arthritis, cancer, hemophilia, blepharospasms, etc.), your physician will manage this process for you. There are no ASEBP forms to be completed. Simply discuss your condition and treatment options with your physician and they will request approval for you. Your physician will have access to all of the necessary paperwork in order to submit this request.


Renewals

If you are seeking renewal authorization, you must work with the prescribing physician to have the renewal portion of the ASEBP Enhanced Special Authorization form for your specific health condition (see below) completed and submitted to ASEBP at least 10 business days prior to the end date of your previous special authorization.

The only portion of the form you are required to complete (with the exception of chronic hepatitis C - see above) is Part 1 (Sections A and B). The remainder will be completed by the prescribing physician (Part 2, Sections A and F).

If there has been a period of more than 120 days where you were without supply for the medication (e.g. surgery or pregnancy prevented you from taking the medication or another health benefit plan paid the claim), your physician will be required to provide details explaining the reason for the lapse in Section F on the renewal application.

Register with My ASEBP using your personal email address to ensure you receive important renewal notifications by email. If you are not already registered, read this How to register for My ASEBP - online claims.pdf to help you get started.


Questions?

If you have any questions, please call 780-431-4780, toll-free 1-877-431-4786 (ext 4780) to speak with our Specialty Claims Coordinator or email specauthHS@asebp.ab.ca

Updated: August 25, 2016