Abrilada (adalimumab) PfizerFlex Derm Formulaire d’inscription PSP
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Dermatology, eForms, Medication Coverage, QC
|
March 25, 2022
|
Download
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Abrilada (adalimumab) PfizerFlex Derm PSP Form
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BC, Dermatology, eForms, Medication Coverage, ON, QC
|
March 11, 2022
|
Download
|
Abrilada (adalimumab) PfizerFlex Rheum/Gastro PSP Form
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Arthritis, BC, eForms, Medication Coverage, ON, QC
|
March 11, 2022
|
Download
|
Abrilada (adalimumab) PfizerFlex Rhum/Gastro Formulaire d’inscription PSP
|
Arthritis, eForms, Medication Coverage, QC
|
March 11, 2022
|
Download
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Ajovy (fremanezumab) – PSP Form – Migraine – EN – 2022
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BC, eForms, Medication Coverage, Migraine, ON, QC
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April 19, 2022
|
Download
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Ajovy (fremanezumab) PSP Formulaire – Migraine – FR -2022
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eForms, Medication Coverage, Migraine, QC
|
April 19, 2022
|
Download
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Amgevita (adalimumab) Enliven Formulaire de PSP FR – Feb 2021
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eForms, Medication Coverage, Medication Exception, QC
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April 27, 2021
|
Download
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Amgevita (adalimumab) Enliven PSP Form EN – Feb 2021
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BC, eForms, Medication Coverage, Medication Exception, ON, QC
|
April 27, 2021
|
Download
|
Asthma Refer ID Tool
|
Asthma, BC, eForms, Medication Coverage, ON, QC
|
December 28, 2021
|
Download
|
Benlysta (belimumab) Formulaire d’Inscription PSP 10_21
|
eForms, Medication Coverage, QC
|
October 13, 2021
|
Download
|
Benlysta (belimumab) PSP Enrollment Form 10_21
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BC, eForms, Medication Coverage, ON, QC
|
October 13, 2021
|
Download
|
Botox (onabotulinumtoxina) Formulaire d’inscription Abbvie Care 2022 – FR
|
eForms, Medication Coverage, Migraine, QC
|
March 17, 2022
|
Download
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Botox (onabotulinumtoxina) PSP Form Abbvie Care 2022 – EN
|
BC, eForms, Medication Coverage, Migraine, ON, QC
|
March 17, 2022
|
Download
|
Brenzys (etanercept) Feuillet d’information
|
Arthritis, eForms, Medication Coverage, QC
|
June 9, 2022
|
Download
|
Brenzys (etanercept) Information Sheet
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
June 9, 2022
|
Download
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Brenzys (etanercept) Patient Support Program May 2021 – EN
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
February 1, 2022
|
Download
|
Brenzys (etanercept) Programme de soutien a lintention des patients mai 2021 – FR
|
Arthritis, eForms, Medication Coverage, QC
|
February 1, 2022
|
Download
|
Breo Ellipta Starter Kit Letter
|
Asthma, BC, eForms, Medication Coverage, ON, QC
|
November 22, 2021
|
Download
|
Breo Ellipta Trousse de depart pour patient
|
Asthma, eForms, Medication Coverage, QC
|
November 22, 2021
|
Download
|
Cimzia (certolizumab) & Bimzelx (bimekizumab) dermatologie PSP – FR
|
Dermatology, eForms, Medication Coverage, QC
|
April 19, 2022
|
Download
|
Cimzia (certolizumab) & Bimzelx (bimekizumab) Dermatology PSP Form – EN
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BC, Dermatology, eForms, Medication Coverage, ON, QC
|
April 19, 2022
|
Download
|
Cimzia (certolizumab) Rheumatology PSP Form – EN
|
BC, eForms, Medication Coverage, ON, QC, Rheumatology
|
April 19, 2022
|
Download
|
Dexcom G6 Formulaire de prescription
|
Diabetes, eForms, Medication Coverage, QC
|
September 22, 2021
|
Download
|
Dexcom G6 Prescription Rx Form
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
September 22, 2021
|
Download
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Dexcom G6 – RAMQ Demande d’autorisation de paiement
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Diabetes, eForms, Medication Coverage, QC, RAMQ
|
September 22, 2021
|
Download
|
Duobrii Fiche d’Information Patient – FR 2021
|
Dermatology, eForms, Medication Coverage, QC
|
September 9, 2021
|
Download
|
Duobrii Patient Information Sheet – EN 2021
|
BC, Dermatology, eForms, Medication Coverage, ON, QC
|
September 9, 2021
|
Download
|
Emgality (galcanezumab) LillyPlus Formulaire d’Inscription 2022
|
eForms, Medication Coverage, Migraine, QC
|
January 21, 2022
|
Download
|
Emgality (galcanezumab) LillyPlus PSP Form 2022
|
BC, eForms, Medication Coverage, Migraine, ON, QC
|
January 21, 2022
|
Download
|
Enerzair Breezhaler (indacaterol/ glycopyrronium/ mometasone furoate) RAMQ Demande d’autorisation de paiement
|
Asthma, eForms, Medication Coverage, QC, RAMQ
|
March 22, 2022
|
Download
|
Entyvio (vedolizumab) Formulaire d’inscription PSP 12_21
|
eForms, Gastroenterology, Medication Coverage, QC
|
March 9, 2022
|
Download
|
Entyvio (vedolizumab) PSP Enrolment Form 12_21
|
BC, eForms, Gastroenterology, Medication Coverage, ON, QC
|
March 9, 2022
|
Download
|
Epclusa (sofosbuvir and velpatasvir) Momentum HCV Support Form
|
BC, eForms, Hematology, Medication Coverage, ON, QC
|
February 1, 2022
|
Download
|
Epclusa (sofosbuvir et velpatasvir) Momentum VHC Formulaire Soutien
|
eForms, Hematology, Medication Coverage, QC
|
February 1, 2022
|
Download
|
Fiasp FlexTouch Pen Guide
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
February 25, 2022
|
Download
|
Guide pour le stylo FlexTouch de Fiasp (insulin_asparte)
|
Diabetes, eForms, Medication Coverage, QC
|
February 25, 2022
|
Download
|
Hadlima (adalimumab) Feuillet d’information
|
Arthritis, eForms, Medication Coverage, QC
|
May 30, 2022
|
Download
|
Hadlima (adalimumab) Information Sheet
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
May 30, 2022
|
Download
|
Hadlima (adalimumab) Patient Support Program 2022 – EN
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
March 9, 2022
|
Download
|
Hadlima (adalimumab) Programme de soutien a l’intention des patients 2022 – FR
|
Arthritis, eForms, Medication Coverage, QC
|
March 9, 2022
|
Download
|
Hulio (adalimumab) Formulaire de PSP FR – 2022
|
Arthritis, eForms, Medication Coverage, QC
|
March 1, 2022
|
Download
|
Hulio (adalimumab) PSP Form-EN 2022
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
March 1, 2022
|
Download
|
Humira (adalimumab) PSP Form AbbVie Care-EN 11-21
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
November 9, 2021
|
Download
|
Humira (adalimumab) PSP Formulaire d’inscription AbbVie Care-FR-11-21
|
Arthritis, eForms, Medication Exception, QC
|
November 9, 2021
|
Download
|
Ilumya (tildrakizumab) SUN PSP Form – 2022
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BC, Dermatology, eForms, Medication Coverage, ON, QC
|
February 17, 2022
|
Download
|
Ilumya (tildrakizumab) SUN PSP Inscription – 2022
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Dermatology, eForms, Medication Coverage, QC
|
February 17, 2022
|
Download
|
Inflectra (infliximab) PfizerFlex Formulaire d’inscription PSP 2021
|
Arthritis, eForms, Medication Coverage, QC
|
November 24, 2021
|
Download
|
Inflectra (infliximab) PfizerFlex PSP Form 2021
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
November 24, 2021
|
Download
|
Lupron (leuprolide acetate) Formulaire d’inscription Abbvie Care-FR
|
Cancer, eForms, Medication Coverage, QC
|
October 13, 2021
|
Download
|
Lupron (leuprolide acetate) PSP Form Abbvie Care-EN
|
BC, Cancer, eForms, Medication Coverage, ON, QC
|
October 13, 2021
|
Download
|
Maviret (glecaprevir pibrentasvir) Formulaire d_inscription Abbvie Care-FR
|
eForms, Hematology, Medication Coverage, QC
|
September 22, 2021
|
Download
|
Maviret (glecaprevir pibrentasvir) PSP Form Abbvie Care-EN
|
BC, eForms, Hematology, Medication Coverage, ON, QC
|
September 22, 2021
|
Download
|
Nubeqa (darolutamide) DART PSP Form – juillet 2021- FR
|
Cancer, eForms, Medication Coverage, QC
|
February 1, 2022
|
Download
|
Nubeqa (darolutamide) DART PSP Form – July 2021- EN
|
BC, Cancer, eForms, Medication Coverage, ON, QC
|
February 1, 2022
|
Download
|
Nucala_PSP_Enrollment_Form_Quebec_ENG_12-2021
|
Asthma, eForms, Medication Coverage, QC
|
December 20, 2021
|
Download
|
Nucala_PSP_Enrollment_Form_Quebec_FRE_12-2021
|
Asthma, eForms, Medication Coverage, QC
|
December 20, 2021
|
Download
|
Olumiant_(baricitinib)_LillyPlus_Formulaire_d_Inscription_2021
|
Arthritis, eForms, Medication Coverage, QC
|
December 20, 2021
|
Download
|
Olumiant_(baricitinib)_LillyPlus_PSP_Form_2021
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
December 20, 2021
|
Download
|
Orencia (abatacept) PSP Enrolment 12-21-EN
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
January 13, 2022
|
Download
|
Orencia (abatacept) PSP Inscription 12-21 -FR
|
Arthritis, eForms, Medication Coverage, QC
|
January 13, 2022
|
Download
|
Otezla (apremilast) PSP Form Active Psoriatic Arthritis 2020-08
|
eForms, Medication Coverage, Medication Exception, QC
|
December 3, 2020
|
Download
|
Otezla PSP Formulaire d_inscription arthrite psoriasique evolutive 2020-08
|
eForms, Medication Coverage, Medication Exception, QC
|
December 3, 2020
|
Download
|
Outil Refer ID en asthme
|
Asthma, eForms, Medication Coverage, QC
|
February 24, 2022
|
Download
|
Ozempic (semaglutide) Patient Starter Kit
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
February 1, 2022
|
Download
|
Ozempic (semaglutide) Trousse de depart pour patient
|
Diabetes, eForms, Medication Coverage, QC
|
February 1, 2022
|
Download
|
RAMQ Rx Payment Authorization – form 3996
|
eForms, Medication Coverage, QC, RAMQ
|
September 29, 2021
|
Download
|
Renflexis (infliximab) Feuillet d’information
|
Arthritis, eForms, Medication Coverage, QC
|
April 18, 2022
|
Download
|
Renflexis (infliximab) Information Sheet
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
April 18, 2022
|
Download
|
Renflexis (infliximab) Patient Support Program June 2022 – EN
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
June 29, 2022
|
Download
|
Renflexis (infliximab) Programme de soutien a l’intention des patients juin 2022 – FR
|
Arthritis, eForms, Medication Coverage, QC
|
June 29, 2022
|
Download
|
Repatha (evolocumab) Canada Life Insurance Form 03-22
|
BC, Cardiology, eForms, Medication Coverage, ON, QC
|
May 26, 2022
|
Download
|
Repatha (evolocumab) CanadaVie formulaire d’assurance 03-22
|
Cardiology, eForms, Medication Coverage, QC
|
May 26, 2022
|
Download
|
Repatha (evolocumab) Manulife Insurance Form
|
BC, Cardiology, eForms, Medication Coverage, ON, QC
|
February 7, 2022
|
Download
|
Repatha (evolocumab) Manuvie formulaire d’assurance
|
Cardiology, eForms, Medication Coverage, QC
|
February 17, 2022
|
Download
|
Repatha RepathaReady PSP Form 2020-11
|
BC, eForms, Medication Coverage, Medication Exception, ON, QC
|
December 3, 2020
|
Download
|
RepereRepatha PSP Formulaire 2020-11
|
eForms, Medication Coverage, Medication Exception, QC
|
December 3, 2020
|
Download
|
Rinvoq (upadacitinib) Atopic Dermatitis PSP Form Abbvie Care – EN
|
BC, Dermatology, eForms, Medication Coverage, ON, QC
|
March 9, 2022
|
Download
|
Rinvoq (upadacitinib) Dermatite Atopique Formulaire d’inscription Abbvie Care – FR
|
Dermatology, eForms, Medication Coverage, QC
|
March 9, 2022
|
Download
|
Rinvoq (upadacitinib) Formulaire d’inscription Abbvie Care-FR
|
Arthritis, eForms, Medication Coverage, QC
|
October 13, 2021
|
Download
|
Rinvoq (upadacitinib) PSP Form Abbvie Care-EN
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
October 13, 2021
|
Download
|
Ruxience (rituximab) GPA MPA Pfizerflex PSP Form-2021
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
November 24, 2021
|
Download
|
Ruxience (rituximab) GPA PAM Pfizerflex PSP Formulaire d inscription-2021
|
Arthritis, eForms, Medication Coverage, QC
|
November 24, 2021
|
Download
|
Ruxience (rituximab) PR Pfizerflex PSP Formulaire d’inscription-2021
|
Arthritis, eForms, Medication Coverage, QC
|
November 24, 2021
|
Download
|
Ruxience (rituximab) RA Pfizerflex PSP Form 2021
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
November 24, 2021
|
Download
|
Rybelsus (semaglutide) Patient Starter Kit
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
February 1, 2022
|
Download
|
Rybelsus (semaglutide) Trousse de depart pour patient
|
Diabetes, eForms, Medication Coverage, QC
|
February 1, 2022
|
Download
|
Saxenda (liraglutide) Patient Starter Kit
|
eForms, Medication Coverage, Medication Exception, QC
|
December 3, 2020
|
Download
|
Saxenda(liraglutide)Trousse de depart pour patient
|
eForms, Medication Coverage, Medication Exception, QC
|
December 3, 2020
|
Download
|
Selena – Sledai Assessment Tool
|
BC, eForms, Lupus, Medication Coverage, ON, QC
|
February 8, 2022
|
Download
|
Selena – Sledai échelle outil d’évaluation
|
eForms, Lupus, Medication Coverage, QC
|
February 8, 2022
|
Download
|
Simlandi (adalimumab) Formulaire d’inscription PSP
|
Arthritis, eForms, Medication Coverage, QC
|
April 19, 2022
|
Download
|
Skyrizi (risankizumab) PSP Form AbbVie Care 2022 – EN
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
April 19, 2022
|
Download
|
Skyrizi (risankizumab) PSP Formulaire d’inscription AbbVie Care 2022 – FR
|
Arthritis, eForms, Medication Coverage, QC
|
April 19, 2022
|
Download
|
Taltz (ixekizumab) LillyPlus Formulaire d’Inscription 2021
|
Arthritis, eForms, Medication Coverage, QC
|
November 24, 2021
|
Download
|
Taltz (ixekizumab) LillyPlus PSP Form 2021
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
November 24, 2021
|
Download
|
Tresiba (insulin degludec) Patient Dosing and Titration Tool – Cantonese-Mandarin -2022
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
May 2, 2022
|
Download
|
Tresiba (insulin degludec) Patient Dosing and Titration Tool – English -2022
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
May 2, 2022
|
Download
|
Tresiba (insulin degludec) Patient Dosing and Titration Tool – French -2022
|
Diabetes, eForms, Medication Coverage, QC
|
May 2, 2022
|
Download
|
Tresiba (insulin degludec) Patient Dosing and Titration Tool – Spanish-Portuguese -2022
|
Diabetes, eForms, Medication Coverage, ON, QC
|
May 2, 2022
|
Download
|
Tresiba (insulin degludec) Patient Dosing and Titration Tool – Tagalog -2022
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
May 2, 2022
|
Download
|
Tresiba (insulin degludec) Patient Starter Letter
|
BC, Diabetes, eForms, Medication Coverage, ON, QC
|
March 9, 2022
|
Download
|
Tresiba (insulin degludec) Trousse de depart pour patient
|
Diabetes, eForms, Medication Coverage, QC
|
March 9, 2022
|
Download
|
Trulicity (dulaglutide)RAMQ Demande d’autorisation de paiement
|
eForms, Medication Coverage, Medication Exception, QC, RAMQ
|
October 6, 2021
|
Download
|
VASCEPA Assistance Program Patient Enrolment Form
|
BC, Cardiology, eForms, Medication Coverage, ON, QC
|
May 3, 2022
|
Download
|
VASCEPA Programme d’Assistance – Formulaire d’inscription du patient
|
Cardiology, eForms, Medication Coverage, QC
|
May 3, 2022
|
Download
|
Venclexta_(venetoclax)_PSP_Formulaire_d_inscription_AbbVie_Care
|
Cancer, eForms, Medication Coverage, QC
|
February 17, 2022
|
Download
|
Venclexta_(venetoclax)_PSP_Form_AbbVie_Care
|
BC, Cancer, eForms, Medication Coverage, ON, QC
|
February 17, 2022
|
Download
|
Xeljanz (tofacitinib) Formulaire d’inscription PSP Pfizerflex-2021
|
Arthritis, eForms, Medication Coverage, QC
|
November 24, 2021
|
Download
|
Xeljanz (tofacitinib) Pfizerflex PSP Form 2021
|
Arthritis, BC, eForms, Medication Coverage, ON, QC
|
November 24, 2021
|
Download
|
XOLAIR (omalizumab) XHALE Formulaire d’inscription PSP – 2022
|
Asthma, eForms, Medication Coverage, QC
|
February 7, 2022
|
Download
|
XOLAIR (omalizumab) XHALE PSP Form 2022
|
Asthma, BC, eForms, Medication Coverage, ON, QC
|
February 7, 2022
|
Download
|
Xpose Patient Support Program 2020 English et Français
|
Cancer, Consent, eForms, Hematology, Internal Medicine, Oncology, QC
|
November 26, 2020
|
Download
|
Xtandi XPAP Formulaire d’inscription et de consentement du patient Feb 2019
|
eForms, Medication Coverage, Oncology, QC
|
July 8, 2019
|
Download
|