Understanding Prior Authorization Drug Coverage

What is it?
Some drugs must be pre-approved before your claim can be approved and reimbursed by Green Shield Canada. Drugs that  need pre-approval tend to be expensive, have the potential to be used inappropriately, used excessively or used for unapproved medical conditions.

How does it work?
Log in to your GreenShield+ account and use the drug coverage search tool to see if a drug requires prior authorization. If the result is “Exception Drug requires authorization,” you can submit an Authorization Form. If your submission is approved, your drug will be covered and you can submit the prescription as usual. If your submission is denied, you may pay out of pocket or discuss alternatives with your doctor. After your submission, the results of your Authorization Form will be available in GreenShield+. To view them, go to the top menu bar, select Coverage, and then click on Prior Authorization. While the fastest way to access your results is through GreenShield+, you will also receive a copy by mail.

How does the prior authorization program benefit you?
The program helps ensure medications are used safely, appropriately and according to clinical guidelines. It encourages the use of proven first-line treatments before approving more advanced options. This means you receive the most effective care while also helping to manage rising drug costs and protecting the value of your drug plan.

Upcoming Changes to Claim Submissions in GreenShield+

Starting January 21, 2026, Saskatchewan Teachers’ Federation health plan members will be required to upload a receipt for all claim submissions in GreenShield+. This change is aimed at improving the member experience by making claims more efficient, transparent and secure.