• Acquisition Cost Request Pharmacy providers only should use this form to request "cost-to-operator " adjustments in the event that reimbursement on a given claim was less than your actual acquisition cost for the item claimed.
• Adjustment Pharmacy providers only should use this form to correct any incorrect or unknown information on the initially submitted claim (eg. to correct an incorrect DIN, correct a package size, quantity, or days supply,etc.).
• Claim Reversal Request
• Drug Authorization Forms A Drug Special Authorization form is required when a pharmacy receives a denial for an electronic drug claim that requires prior authorization.
• Fill Limits Exception Request Form Request for coverage of additional dispensing fees associated with exceptions to the maintenance medication dispensing frequency policy (3 months supply) and/or use of compliance packaging.
• Pharmacy Claim Submission Form Pharmacy providers may use this form to submit a manual claim in the event that the claim cannot be processed electronically. This form can be used for regular or compound claims.
• Request for Approval of Brand Name Drug

To verify the cognitive services that are a benefit of your patient’s drug plan, click here.

• Pharmacist Health Coaching - Cardiovascular Program
• Pharmacist Health Coaching - Smoking Cessation Program
• Pharmacist Deprescribing Program
• Pharmacogenetic Testing and Counselling Program

The goal of GSC’s Value-based Pharmacy initiative is to drive up the quality of care across Canada. By measuring pharmacy performance, providing feedback to facilitate improvement, and aligning reimbursement to the delivery of high-quality care, we help pharmacies gain insight into areas of patient care where they’re already doing well and areas where they can improve. For more information on quality-of-care measurement, our partners, and how the Pharmacy Quality Rating may impact pharmacy reimbursement, just select the links below.

Green Shield Canada's Update newsletters give you the latest information on trends in the industry and Green Shield Canada news. Please choose from the list below (available in PDF format):

Select a document below to view (in PDF) or print a copy:

For more detailed inquiries about drug eligibility, criteria, other Green Shield Canada policies, etc., please contact our Customer Service Centre at 1-888-711-1119.

• Acquisition Cost Request Form Pharmacy providers only should use this form to request "cost-to-operator " adjustments in the event that reimbursement on a given claim was less than your actual acquisition cost for the item claimed.
• Claim Reversal Request
• Pharmacy Adjustment Form Pharmacy providers only should use this form to correct any incorrect or unknown information on the initially submitted claim (eg. to correct an incorrect DIN, correct a package size, quantity, or days supply,etc.).
• Pharmacy Claim Submission Form Pharmacy providers may use this form to submit a manual claim in the event that the claim cannot be processed electronically. This form can be used for regular or compound claims.

SSQ Insurance’s Update newsletters give you the latest information on trends in the industry and SSQ Insurance news. Please choose from the list below (available in PDF format):

Select a document below to view (in PDF) or print a copy:

For more detailed inquiries about drug eligibility, criteria, other SSQ Insurance policies, etc., please contact our Customer Service Centre at 1(800) 463-6262

• Claim Reversal Request
• Drug Authorization Forms A Drug Special Authorization form is required when a pharmacy receives a denial for an electronic drug claim that requires prior authorization.

Select a document below to view (in PDF) or print a copy:

For more detailed inquiries about drug eligibility, criteria, other CCQ policies, etc., please contact our Customer Service Centre.

• Drug Authorization Forms A Drug Special Authorization form is required when a pharmacy receives a denial for an electronic drug claim that requires prior authorization.