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The Canada Life Assurance Company fax number

(833) 204-5809

Drug Claims Management

Used for: Drug Prior Authorization submission for PSHCP medications

Fax destination details

Department
Drug Claims Management
Purpose
Drug Prior Authorization submission for PSHCP medications
Form
GLP-1 Prior Authorization Form — GLP-1 Prior Authorization Form (M6453)
Address
PO Box 6000, Winnipeg, MB R3C 3A5, Canada
Voice phone
1-800-957-9777

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Form Completion Instructions: 1. Complete “Patient Information” sections. 2. Have the prescribing physician complete the “Physician Information” sections. 3. Send all pages of the completed form to us by mail, fax or email as noted below. Mail to: The Canada Life Assurance Company Drug Claims Management PO Box 6000 Winnipeg MB R3C 3A5; Fax to: The Canada Life Assurance Company Fax 1-833-204-5809 Attention: Drug Claims Management; Email to: CLPrior.Authorization@canadalife.com Attention: Drug Claims Management.

Official form instructions are published as a downloadable file on the organization's website.

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