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Enhanced Special Authorization Request Forms

The enhanced special authorization process is managed by its own set of ASEBP Enhanced Special Authorization Request forms. Each of the five health conditions covered by the enhanced process has a form tailored to its condition's unique diagnostic and treatment process. These forms need to be completed by both the covered member and their physician, then submitted by the physician to ASEBP for review.

You can find the applicable form for your health condition in the menu to the left.

If you have questions about these forms or the enhanced special authorization process, please contact an ASEBP Senior Benefit Specialist at 780-431-4780 or

IMPORTANT: At times, physicians and pharmaceutical support groups may provide doses of certain specialty drugs before benefit plans have processed special authorization requests. Be advised that should a course of treatment commence prior to receiving enhanced special authorization approval from ASEBP, there is a chance that coverage will not be approved and you will be responsible for the costs.