Non Steroidal Anti Inflammatory Drugs - Special Authority Criteria

Generic Name / Strength / Form
diflunisal

Criteria Approval Period
1. Diagnosis of rheumatoid or psoriatic arthritis or ankylosing spondylitis or gout or lupus.

OR

2. Treatment failure or intolerance to at least one of the following: ASA-enteric, naproxen, or ibuprofen.

 Indefinite

Practitioner Exemptions

  • Rheumatologists

Special Notes

  • Group 2 NSAID

Online Form (PDF)
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