Form
Plaque Psoriasis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
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Publication
Pharmacare Formulary
The Pharmacare Formulary is a list of prescription medications and medical supplies approved for coverage through PEI Pharmacare.
Information
PEI Pharmacare Forms
For Medical Professionals Special Authorization Forms Ankylosing Spondylitis Special Authorization Request Form [PDF | 113 KB] Crohn's Disease Special Authorization Request Form [PDF | 190 KB] DPP-4 / SGLT2 Inhibitors Special Authorization Request Form [PDF | 190 KB] Enfuvirtide...
Form
Out-of-Province Travel Declaration Form
PEI Pharmacare clients travelling outside of the province may be allowed to obtain up to 180 days of their eligible medication prior to leaving the province. If your medication is eligible, complete this form prior to leaving the province and take it to your pharmacy, so they can...
Form
Diabetes Referral Form
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug Program.
Form
DPP-4 / SGLT2 Inhibitors Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Rheumatoid Arthritis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Psoriatic Arthritis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Enfuvirtide Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Crohn's Disease Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.