Patient Exception and Exceptional Medications
Please find the form for the exceptional medication that you need by searching for the name of the medication by its first letter from the alphabetical links below, or use the “Search” tool above, typing in your medical condition.
Please note that all the forms are currently only available in French.
MÉDIC Construction is currently updating these forms. If you don’t find the one you need, contact Customer Service at 1 888 842-8282 and mention the medication that was prescribed to you and your medical diagnosis.
Demande d'autorisation de paiement
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A
ABRILADA (Adalimumab)
ACTEMRA (Tocilizumab)
ADTRALZA (Tralokinumab)
AIMOVIG (Erenumab)
AMGEVITA (Adalimumab)
AQUACEL FORM PRO
AUBAGIO (Tériflunomide)
AVSOLA (Infliximab)
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B
BRENZYS (Etanercept)
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C
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D
DEXCOM G6 (capteur et émetteur Dexcom G6)
DUPIXENT (Dupilumab)
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E
ENBREL (Étanercept)
ERELZI (Etanercept)
EYLEA (Aflibercept)
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F
FASENRA (Benralizumab)
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G
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H
HADLIMA (Adalimumab)
HULIO (Adalimumab)
HYRIMOZ (Adalimumab)
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I
IDACIO (Adalimumab)
INFLECTRA (Infliximab)
INQOVI (Cedazuridine/Decitabine)
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J
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K
KETOCAL, KETOVIE, KETOVIEMC PEPTIDE 4:1 (Formule nutritive - cétogène)
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L
LUCENTIS (Ranibizumab)
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M
MAR-TRIENTINE (Chlorhydrate de trientine)
MAVIRET (Glécaprévir/Pibrentasvir)
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N
NUCALA (Somatotrophine)
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O
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P
PAGASYS (Peginterféron alfa-2A)
POMALYST (Pomalidomide)
PREGNYL
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Q
QUINSAIR (Lévofloxacine)
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R
RASILEZ (Aliskirène/Hydrochlorothiazide)
REMICADE (Infliximab)
RENASTART (Formule nutritive – insuffisance rénale)
RENFLEXIS (Infliximab)
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S
SAIZEN (Somatotrophine)
SIMLANDI (Adalimumab)
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T
TRIKAFTA (Élexacaftor/tézacaftor/ivacaftor et ivacaftor)
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U
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V
VOSEVI (Sofosbuvir/Velpatasvir/Voxilaprévir)
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X
-
Y
YUFLYMA (Adalimumab)
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Z
ZELBORAF (Vémurafénib)