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Click ‘Get Form’ to open the sunlife drug exception form in the editor.
Begin by filling out the Plan Member information section. Enter your Contract number, Member ID number, and personal details such as your last name, first name, address, date of birth, and daytime telephone number.
In the Claimant information section, provide details about the claimant including their last name, first name, date of birth, and relationship to you. Select the reason for your request regarding drug eligibility.
Sign and date the authorization section to certify that all provided information is accurate. This step is crucial for processing your request.
If applicable, have your prescribing physician complete the reverse side of the form. They will need to provide diagnosis details and specify any requested drug exceptions.
Review all sections for completeness before submitting. Ensure that any required attachments are included.

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What is a drug exception for Sun Life?

If this is your situation, you can request that Sun Life Assurance Company of Canada make an exception. Exceptions will only be made for drugs which legally require a prescription. To be eligible for coverage, trials with two alternative drugs covered on your plan may be required.

How to get insurance to cover non-formulary drugs?

Your plan excludes certain types of medications or products from coverage. This is known as a plan (or benefit) exclusion. This means that your plan doesnt cover any prescription medications in the drug class or to treat the specific condition.

Is Wegovy covered by Sun Life?

Sun Life: Offers optional coverage for GLP-1 medications such as Ozempic, primarily for diabetes. Coverage for weight loss drugs like Wegovy may be available in customized group plans with prior authorization and plan sponsor approval.

What is the drug exception form?

Use this form to request coverage of a drug that is not automatically covered under your drug plan. Provide the requested information to ensure timely assessment of your claim.

How to get an excluded drug covered?

A formulary exception is a request to your insurance company to cover a non-formulary drug. This request is typically initiated by your provider, who will provide supporting documentation, accompanied by a letter of medical necessity (LMN), to explain why the requested medication is necessary for your treatment.

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