Complete this form for claims incurred on or after January 1, 2022.

Want to submit your claims online and get your money back faster? Log in to RTIP’s secure member site.

If you need a printed copy of the form, please contact the RTIP Contact Centre at 1-833-318-2811.

Not yet registered on the RTIP plan member secure site? Learn how with these step-by-step instructions

If your doctor has prescribed a brand name drug instead of a generic brand, because of an adverse reaction or therapeutic failure, they will need to complete this form.

If you need a printed copy of the form, please contact the RTIP Contact Centre at 1-833-318-2811.