Alzheimer's Drug Therapy Initiative - Special Authority Information

Now available - ADTI Special Authority forms including the Exelon® Patch!

Under the Alzheimer's Drug Therapy Initiative (ADTI), PharmaCare coverage of cholinesterase inhibitors is being made available through the Special Authority process. To receive PharmaCare coverage of these medications, individuals must be assessed by their physician to determine if they qualify for the initiative.

Eligibility for PharmaCare coverage is established once the Special Authority request is approved. Please note that coverage is not retroactive and is subject to the patient's plan rules, deductible and family maximum.

For patients who qualify, the prescriber submits the appropriate ADTI Special Authority request form, either for initial coverage or renewal/switching (see below). The SMMSE and GDS scale required for completing these forms are available at the link below.

Please note that individuals already approved for PharmaCare coverage of rivastigmine (Exelon®) do not require additional approval when switching to the Exelon® Patch.

For initial coverage, please allow for a two-week waiting period. Switching/renewal requests will be given priority.

Special Authority Forms:

5369 - Initial Coverage of Cholinesterase Inhibitors
5370 - Renewal/Switching Cholinesterase Inhibitors
5371 - Switching for Tolerability for Cholinesterase Inhibitors
SMMSE (Standardized Mini-mental State Examination)
GDS (Global Deterioration Scale)

For more information, return to ADTI main page.