Under Green Shield, certain medications must be authorized before it will be covered. You will receive a error message when adjudicating stating “Drug mus be authorized”.
The physician must complete a form for the drug and fax it directly to Green Shield. To obtain the form, proceed to the Green Shield provider site:
https://www.providerconnect.ca/Default.aspx
Under “What You Need” click on “Pharmacy Provider”.
Under “Pharmacy Forms” click on “Drug Authorization Form”. Then select either “Brand name” or “Generic name” then click the first letter of your drug. Click on the name of the drug then print out the form.
Forms can then be either given to the patient for faxed directly to the physician. Please make sure to stress the forms must be faxed directly to Green Shield. Once the form is received by GS, it will take 2 business days to process. The patient will be notified by mail if the drug will or will not be covered. Patients may pay for the drug first and submit for reimbursement if coverage is subsequently approved. They will not be reimbursed if the drug is not covered. Patients may contact GS for more information after 2 business days.
GS will reimburse pharmacies for printing the form and providing it to the patient/physician. For pharmacies to claim reimbursement, process a new prescription in Nexxsys under the patient’s file using PIN 991252. GS will pay a $10 fee .