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Prior Authorization Drugs for Quebec
Under our group plans, certain drugs must be preauthorized. These drugs are known as "prior authorization drugs."
This allows Industrial Alliance to determine whether or not a drug will be eligible for reimbursement under the group plan, prior to an insured making a claim for the drug.
List of drugs – Province of Quebec
Condition or Type of Drug |
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Name |
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Actinic Keratosis |
|
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Levulan |
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Metvix |
|
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ADHD |
|
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Strattera |
|
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ALS |
|
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Rilutek |
|
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Alzheimer's |
|
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Aricept |
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Ebixa |
|
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Anemia Therapy |
|
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Aranesp |
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Eprex |
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Exjade |
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Revlimid |
|
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Anti-Obesity |
|
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Xenical
If your claim is for this drug, the F54-860A form needs to be completed by the attending physician. |
|
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Arthritis |
|
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Arava |
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Enbrel |
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Humira |
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Kineret |
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Leflunomide |
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Orencia |
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Remicade |
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Rituxan |
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Simponi |
|
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Aspergillosis |
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Asthma |
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Humira |
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Xolair |
|
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Cancer (Various) |
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Abraxane |
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Alimta |
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Avastin |
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Emend |
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Gleevec |
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Herceptin |
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Iressa |
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Kytril |
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Matulane |
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Neupogen |
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Nexavar |
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Sandostatin |
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Sprycel |
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Sutent |
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Tarceva |
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Tasigna |
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Temodal |
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Tykerb |
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Vectibix |
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Vesanoid |
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Xeloda |
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Zometa |
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Condylomas |
|
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Aldara |
|
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Crohn's Disease |
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Remicade |
|
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Cystic Fibrosis |
|
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Pulmozyme |
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Tobi |
|
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Enzyme Replacement Therapy |
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Cerezyme |
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Fabrazyme |
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Replagal |
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Zavesca |
|
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Eye Diseases |
|
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Lucentis |
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Macugen |
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Visudyne |
|
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Fertility |
|
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Bravelle |
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Cetrotide |
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Endometrin |
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Gonal-F |
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Lutrepulse |
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Menopur |
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Orgalutran |
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Ovidrel |
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Puregon |
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Repronex |
|
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Growth Hormones |
|
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Humatrope |
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Nutropin |
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Omnitrope |
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Saizen |
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Somatuline |
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Hepatitis C |
|
|
Baraclude |
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Hepsera |
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Pegasys |
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Pegetron |
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Unitron |
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HIV |
|
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Aptivus |
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Celsentri |
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Fuzeon |
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Prezista |
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Valcyte |
|
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Kidney Disease |
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Sensipar |
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Miscellaneous |
|
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Campral |
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Cymbalta |
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Mycamine |
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Regranex |
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Soliris |
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Suboxone |
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Tygacil |
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Xarelto |
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Zyvoxam |
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Multiple Sclerosis Drugs |
|
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Avonex |
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Betaseron |
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Cimzia |
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Copaxone |
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Rebif |
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Tysabri |
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Multivitamins |
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Adeks |
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Narcolepsy |
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Xyrem |
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Nutrition Formulas |
|
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Alimentum |
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Enfamil |
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Isosource |
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Jevity |
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Microlipid |
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Neocate |
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Nutramigen |
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Nutren |
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Nutrisource |
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Pediasure |
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Peptamen |
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Pregestimil |
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Resource |
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Similac |
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Twocal |
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Osteoporosis |
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|
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Psoriasis |
|
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Amevive |
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Enbrel |
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Humira |
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Raptiva |
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Stelara |
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Pulmonary Hypertension |
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Flolan |
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Remodulin |
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Revatio |
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Thelin |
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Tracleer |
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Volibris |
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Schizophrenic Disorder |
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Risperdal |
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Selected Muscle or Nerve Disorders |
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Azilect |
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Botox |
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Catena |
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Sativex |
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Xeomin |
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Urinary Incontinence |
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All strengths and generics of the listed drugs are subject to prior authorization.
The prior authorization list is subject to change and does not guarantee that a drug which is listed is covered under a specific group plan.
If you have any questions about this list of prior authorization drugs or the prior authorization process, please contact our Client Service Department at 1 877 422-6487.
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