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We have something similar in Belgium, where some medications may be covered but ONLY when there is special need (i.e., an allergy to other, more "generic" medication to treat the same ailment.  In my case, I have an intolerance to statins, so a different type of cholesterol medication that is much more expensive and is not directly on the list of accepted medication for coverage is recommended for me.  And my insurances does therefore pay for it).   It is pretty simple to get that special allowance, and it can be in place for 3 months, or a year, and renewed if needed.