Frequently asked questions

What is a prior authorization drug?

To be eligible for reimbursement, some very expensive drugs and those that have a risk of inappropriate use must have prior authorization from SSQ Insurance. To obtain such authorization, you must have a prior authorization form completed by your attending physician and submited to SSQ Insurance for analysis.

The drug will be covered if the medical condition and therapeutic indication meet the established criteria for use of the drug.

Get the prior authorization form for your drug.

What are the advantages of prior authorization?

In a group drug insurance plan, the premiums are proportional to the cost of the drugs consumed by the group. Prior authorization limits premium increases while it promotes appropriate use of the most expensive drugs.

How do you know if a drug must have prior authorization?

SSQ Insurance has put several tools at your disposal:

  • The website

    See the list of all the drugs that require prior authorization.

  • ACCESS | Plan Members

    When you login to your ACCESS | Plan Members account, click on Health Care/Access to Health Care Services on the main menu. The next page will give you access to the Is My Drug Covered section, where you can check the eligibility of your drug by entering its name or DIN number.

  • Telephone or email

    Contact SSQ Insurance Customer Services by calling 1-877-651-8080 or by sending an email to [email protected]. Our Call Centre's business hours are from 8:00 a.m. to 8:00 p.m.

  • When your claim is submitted online at the pharmacy

    When SSQ Insurance receives a claim for a drug requiring prior authorization for which authorization has not yet been given, the pharmacist is notified and a message appears on the insured's receipt.

Every month, SSQ Insurance's pharmaceutical staff reviews the list of drugs requiring prior authorization. They look at new guidelines for treatment, new treatments available and different pharmaco-economic studies.

How to submit a request for prior authorization?

If your drug requires SSQ Insurance's authorization, get the appropriate application form.

Have the form completed by your attending physician and send it to us by fax at: 1-855-453-3942 or by mail at the following address:

2525 Laurier Blvd
P.O. Box 10500
Quebec QC G1V 4H6

Physicians are generally familiar with the prior authorization process. During a visit to the doctor's office, your physician will fill out the form at the same time as he/she writes out the prescription.

Prior authorization drugs are generally prescribed by specialists who are well aware that these drugs require an authorization.

Insureds who are covered by their province's government prescription drug insurance plan must first submit their claim to the government, and then enclose their response with the form asking SSQ Insurance for prior authorization.

What is the processing time for a prior authorization request?

Requests for prior authorization are processed within 5 business days, provided that SSQ Insurance has all the information necessary for an analysis.

How to get a reimbursement?

Once authorization is given, you will receive your reimbursement the usual way.

Several ways to claim reimbursement are available based on your coverage:

With the SSQ Insurance card

Show your insurance card to the pharmacist. If your group insurance contract offers direct payment, you'll pay only the portion for which you are not covered. If your contract provides for a deferred reimbursement, your pharmacist will send your claim to SSQ Insurance, which will allow you to get your reimbursement.

Paper claims

All expenses can be claimed by mail. Claim forms are available on ACCESS | Plan Members.

How long will the authorization be valid for?

The time varies according to the drug and the indication covered by the request. Generally speaking, the first authorization may be valid from a few months to a year.

If the insured requests an extension of the authorization, the prescribing physician must provide the information on the last assessment in order to demonstrate effectiveness of treatment. Subsequent authorizations are usually given for a one to four-year period, where applicable.