What the CLMS-1006 is for
Some drugs on a Saskatchewan Blue Cross plan are covered only after special authorization. The list includes drugs with Exception Drug Status on the Saskatchewan Drug Plan, high-cost and specialty therapies, drugs with a higher risk of off-label use, and drugs with cheaper alternatives. Blue Cross reviews each request against the same criteria the provincial Drug Plan uses for EDS, and it doesn’t publish those criteria by drug.
For a Saskatchewan resident taking an EDS drug, the usual route is an EDS request to the Drug Plan. Once the member has the approval letter, it replaces this form. The CLMS-1006 is for drugs that aren’t EDS-listed, and for members outside Saskatchewan whose province has no comparable special access program. Weight management drugs go on the CLMS-1007 instead.
Who completes it
The plan member completes page 1: member information with the policy and ID numbers, the patient’s details if the patient is a dependant, coordination of benefits, and the consent and authorization, which the member or patient signs. A coordinator section on the same page is for whoever is coordinating the request, such as a patient support program, the physician or a pharmacist. The prescribing physician completes page 2: patient support program enrolment, the specialty drug detail and the physician statement.
The two pages usually travel separately. The patient takes page 1 home to copy their benefit card numbers and sign the consent, and it comes back to the clinic days later, or gets faxed to Blue Cross apart from your page. In Medulla, you send page 1 to the patient over a secure link before or after the visit. They fill it in on the form from their phone, with their card in hand, and their answers land on the same PDF you complete the drug detail on. Blue Cross gets one form with both pages filled in.
How to fill in the physician’s part
Patient support program enrolment
Say whether the patient is enrolled in a manufacturer’s patient support program and, if so, give the program name, number and contact details. Specialty drugs often come with one, and Blue Cross uses it to coordinate coverage.
Specialty drug detail
Give the trade name, strength, dosage, frequency, diagnosis and expected duration of therapy. Use the trade name the pharmacy will dispense. A diagnosis that doesn’t match the drug’s approved use is the quickest way to a denial, so name the indication precisely.
Other treatments tried and results
This box carries most of the decision. List each previous drug with dose, duration and the reason it stopped: no response, a named adverse effect, or a contraindication. Add the lab values or disease activity scores that show severity. Blue Cross asks for both on the form.
Additional information
Use this for anything else the reviewer needs, such as a reason the usual first-line drug can’t be used, or whether the patient has applied to a provincial program. Attach clinic notes or specialist letters that support the request.
Physician statement
Print your name, specialty, address, phone and fax, then sign and date. Blue Cross uses the fax and phone to send questions, so check they’re current.
Common reasons it’s delayed
- Page 1 incomplete, or the consent not signed. The form warns that a partial form causes delays.
- No history of previous treatments, or treatments listed without doses, durations and outcomes.
- No lab data or scores to support the diagnosis and severity.
- A CLMS-1006 sent for a weight management drug, which needs the CLMS-1007.
- A Saskatchewan resident’s EDS drug sent on this form when the Drug Plan’s EDS approval letter was the document needed.
Submitting and who pays
The member, or the clinic on their behalf, sends the completed form and supporting documents to Saskatchewan Blue Cross by email to provider relations, by fax to 306-667-5860, by mail to the Claims Department in Saskatoon, or through the Member Portal’s document upload. Blue Cross’s guidance doesn’t mention paying the prescriber for the form, so any fee is between the clinic and the patient.