Insured Health Services reimbursement request

Use this form to request reimbursement for an eligible medical supply, medical equipment or drug you paid for yourself.

Submit your request within 1 year of the purchase date. Include:

• an itemized statement;
• proof of payment; and
• an official prescription receipt if you are requesting reimbursement for a drug.

Follow the instructions on the form to submit your request. Do not send the completed form by regular email.

Learn more about the Yukon National Pharmacare Program.