Assumed Special Authorities

In most cases, medications prescribed by an exempted specialist automatically have an indefinite Special Authority (SA) approval created for the patient. An SA request from the general practitioner, or other prescriber, is not required to maintain coverage of the drug for the patient.

 What is a prescriber SA exemption?
A prescriber SA exemption provides coverage of a specific medication for all eligible patients of a practitioner or specific prescriber.

 What is a specialty SA exemption?
A specialty SA exemption provides coverage of a specific medication for all eligible patients of a group of specialists (for example, rheumatologists or oncologists).

Before issuing a prescription for such a medication, you may do one of the following:

  • Check the patient's chart to verify that the medication was initially prescribed by a specialist. If the medication was initially prescribed by a specialist and is not on the list of exclusions, you may choose not to submit a Special Authority request.

  • Submit an SA request. If an Assumed Special Authority is in place, coverage of a specific drug for a patient will be maintained indefinitely.

    Please note: Each criteria page indicates whether or not a practitioner or prescriber SA exemption exists for a specific medication.

Assumed SAs reduce the number of SA requests physicians are required to submit. The resulting decrease in workload improves processing times for other requests.

To view a list of the drugs not eligible for an Assumed SA, see drugs NOT included in the assumed SA process.

For a list of the drugs currently eligible for an Assumed SA, see drugs ELIGIBLE under specialty exemptions.