Why drug strategy matters: Understanding Special Authorization and EDS

Prescription drugs continue to evolve at a rapid pace. New therapies are improving health outcomes but they often come with higher costs and more complex treatment considerations. This makes thoughtful drug program design and strong cost control measures more important than ever.

For employer-sponsored benefit plans, the challenge is finding the right balance. Plans must provide members with access to effective medications while ensuring the long-term sustainability of the plan. A well-structured drug program helps achieve both.

At Saskatchewan Blue Cross, Special Authorization and Exception Drug Status (EDS) programs are mandatory components of all Group Benefits plans. Together, these programs play an important role in supporting evidence-based drug use and managing access to high-cost and specialty medications.

What is Special Authorization?

Special Authorization helps ensure that certain medications are used appropriately and only when medically necessary. These drugs may be effective but they are not always the first or best option for every patient. Through the Special Authorization process, coverage is provided when specific medical criteria are met.

This approach supports better health outcomes by promoting the right therapy at the right time. It also helps avoid unnecessary drug costs which protects both plan sponsors and members over the long term.

Understanding Exception Drug Status (EDS)

Exception Drug Status applies to medications that fall outside standard coverage rules but may still be required in specific situations. EDS allows for flexibility when a member’s medical needs cannot be met through regular drug coverage options.

By carefully reviewing these requests, Saskatchewan Blue Cross helps ensure access to necessary treatments while maintaining consistent and fair coverage decisions across all plans.

Aligning with provincial programs

Both Special Authorization and EDS programs are aligned with provincial drug programs wherever possible. This alignment helps reduce duplication and supports coordinated coverage which can lead to lower overall costs.

For plan sponsors, this means greater predictability and improved cost management. For members, it means clearer pathways to coverage and fewer gaps in access to needed medications.

Learn more

Explore our Special Authorization and EDS guide for additional details and resources.