Request a drug through the Special Access Program
On this page
- Who can apply
- How to apply
- How we process requests
- How decisions are made
- Mandatory reporting requirements
- Information for manufacturers
- Contact us
Who can apply
If you're a health or dental practitioner, you can request a drug that is unavailable for sale in Canada through the Special Access Program (SAP). Your request must be for the treatment of a medical emergency, which Health Canada interprets as a serious or life-threatening condition where conventional treatments:
- have failed
- are unsuitable or
- are unavailable in Canada
A serious or life-threatening condition is defined as the need for hospitalization or inpatient care, risk of adverse pregnancy outcomes, risk of persistent or significant disability without treatment and the overall prognosis of the condition. Other important factors can also be taken into account.
For access to SAP, a practitioner is someone who:
- is entitled, under the laws of a province or territory, to treat patients with an unapproved prescription drug
- practises in that province or territory
- has prescribing privileges in the respective province
Most often, a licensed physician is the practitioner who uses SAP. If in doubt, you should consult your professional college for information on your scope of practice.
When requesting a drug through SAP on behalf of your patients, you must:
- ensure your patients are well informed of the possible risks and benefits of the drug being requested and its development status
- provide a report to Health Canada on the results of the use of the drug, including any adverse reactions
- maintain accurate and accessible records in the event that you are asked to account for quantities of the drug received
- ensure that the decision to prescribe the drug is supported by credible evidence available in relevant medical literature or provided by the manufacturer
In some cases, a foreign manufacturer may consider importing a drug into Canada for pre-positioning before receiving authorization to sell to a requesting practitioner.
How to apply
For a patient-specific request
To submit a request to access non-marketed drugs used to treat, diagnose or prevent serious or life-threatening conditions in a patient:
- Complete and sign the SAP request form (PDF Version, 379 KB).
In a critical emergency, please contact SAP by telephone at 613-941-2108.
- Fax your completed form, without a cover sheet, to 613-941-3194.
- Wait for a decision.
For a future use request
To access a non-marketed drug for a future medical emergency, you must give a valid reason for needing the drug in advance rather than for a specific patient. To submit a future use request:
- Complete and sign the future-use form (PDF version, 560 KB).
- Fax your completed form, without a cover sheet, to 613-941-3194.
- Wait for a decision.
Cost
The manufacturer determines the cost of the drug. In some cases, drugs released through SAP are free.
If there's a charge, hospitals, public or private insurers or, in some cases, patients or their families will cover the cost.
How we process requests
The SAP receives about 1000 requests each month. All requests are processed administratively and triaged to determine their priority with the highest priority given to most urgent matters.
Other factors that can affect triage include: proposed treatment dates that are weeks in advance, deficiencies in requests that require follow-up discussions with practitioners, and the need to clarify aspects of a patient’s medical history.
Timelines for decisions vary on a case-by-case basis and depend on factors such as the nature of the medical emergency, the completeness of the request and the availability of marketed alternatives. They also depend on the information provided to support the request regarding the use, safety and efficacy or effectiveness of the requested drug.
Time-sensitive requests, such as for immediate life-threatening conditions, receive the highest priority and are typically processed and resolved within hours of receipt.
Requests for drugs new to SAP or for those with limited evidence of safety and efficacy for a given condition may require additional time for a decision to be made, to allow for communication with manufacturers and practitioners.
The SAP assesses the information submitted to support the need for a drug for emergency use in one or more patients. If the data is insufficient, SAP may request additional information. A decision to authorize or deny the request will be made once all information is received.
Note: We will consider expediting our review for a drug:
- previously authorized through SAP for the same medical emergency
- authorized by the European Medicines Agency or the US Food and Drug Administration for the same medical emergency
How decisions are made
When reviewing a request, we consider factors such as the seriousness of the condition and the patient’s clinical status. We also look at previous therapies that were tried or excluded, the patient’s prior experience with the drug and any available data for the SAP. We also consider the availability of clinical trials. For more details on the SAP’s review criteria and decision-making process, refer to Review of Special Access Request (SAR) and supporting information.
After our review, we will make a decision as follows:
- Authorization: The information meets SAP criteria.
- We will fax a letter of authorization to the manufacturer and send a copy to the practitioner.
- Incomplete: The Special Access Request (SAR) form is incomplete or unclear.
- We will contact you if there is missing information or to clarify your request.
- Cancellation: We cancelled the request because the manufacturer is unable to provide access to the drug through SAP or the drug is marketed in Canada. We will fax the letter of cancellation to the practitioner along with the reason of cancellation.
- Withdrawn: The practitioner who made the request has withdrawn the application. We will fax the letter of withdrawal to the practitioner
- Denial: The information does not meet SAP criteria.
- If we are considering denying the request, we may contact the practitioner to discuss the reasons for this. After the phone call, it is possible we may reconsider our decision.
- We will send a letter, by fax, explaining our decision to the practitioner.
Mandatory reporting requirements
Follow-up form
To report outcomes, including adverse reactions, from using the drug:
- Complete, sign and date the follow-up form (PDF version, 351 KB).
- Fax your completed form, without a cover sheet, to 613-941-3194.
Information for manufacturers
Drugs accessed through SAP are supplied directly by manufacturers to practitioners.
Authorized drugs can only be sent to:
- the office of the practitioner who made the request
- pharmacies
- community pharmacies
- radiopharmacies
- blood banks
The manufacturer may impose restrictions or conditions on the release of the drug to ensure it is used correctly.
Manufacturers are also responsible for providing all drug information to practitioners who request it.
Pre-positioning
In some cases, a foreign manufacturer may want to import a drug into Canada for pre-positioning before a practitioner makes a request through SAP. To pre-position a drug, a manufacturer must:
- provide information about the medical emergency and how the new drug being imported will be used
- give a rationale as to why the product needs to be pre-positioned
- explain the urgency of having the product in Canada, including if the drug requires timely administration
- specify the quantity of drug to be pre-positioned
- identify the Canadian importer who will pre-position the drug in a Canadian facility (must hold an establishment licence in Canada)
To apply, follow these steps:
- Complete and sign the pre-positioning form (PDF version, 240 KB).
- Fax your completed form, without a cover sheet, to 613-941-3194.
- Wait for a decision from SAP.
Contact us
Access to SAP is available 24 hours a day, 365 days a year.
Regular business hours are from 8:30 am to 4:30 pm Eastern Standard Time, Monday to Friday.
On-call service is available for emergencies outside regular hours (evenings, nights, weekends and holidays) from 4:30 pm on Friday to 8:30 am on Monday. On a statutory holiday, on-call service continues until 8:30 am on the first business day following the holiday.
For questions about SAP, contact us:
Special Access Program
Pharmaceutical Drugs Directorate
Telephone: 613-941-2108
Fax: 613-941-3194
E-mail: sapd-pasm@hc-sc.gc.ca